"My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain

Rodrigo R N Rizzo; Benedict M Wand; Hayley B Leake; Edel T O'Hagan; Matthew K Bagg; Samantha Bunzli; Adrian C Traeger; Sylvia M Gustin; G Lorimer Moseley; Saurab Sharma; Aidan G Cashin; James H McAuley

doi:10.1016/j.jpain.2022.12.009

"My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain

J Pain. 2023 May;24(5):824-839. doi: 10.1016/j.jpain.2022.12.009. Epub 2022 Dec 26.

Authors

Affiliations

¹ School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia. Electronic address: r.rizzo@neura.edu.au.
² School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.
³ Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia.
⁴ Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
⁵ Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia.
⁶ School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia.
⁷ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁸ Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia.
⁹ IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia.
¹⁰ School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia.

PMID: 36577460
DOI: 10.1016/j.jpain.2022.12.009

Abstract

A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. PERSPECTIVE: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.

Keywords: Chronic pain; Low back pain; Pain management; Process evaluation; Qualitative research.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Behavior Therapy
Chronic Pain* / therapy
Exercise Therapy
Humans
Low Back Pain* / psychology
Low Back Pain* / therapy
Pain Management / methods
Qualitative Research
Self-Management*