Background & Aims
Chronic low back pain is one of the leading causes of disability with millions of years lost to disability each year [1]. Therapeutic outcomes for chronic low back pain patients are generally poor, with many individuals lacking adequate treatment options to manage their pain [2]. Due to this, there is an increasing emphasis placed upon novel and optimised pain relief therapies, including a growing interest in pain self-management though exposure to natural environments [3]. However, it is important to understand how some patients with chronic low back pain may be able to cope better than others and whether they see any added value in experiencing time in nature. The aim of this mixed-methods study was to explore the symptom profiles alongside the lived experience of people living with chronic low back pain and how nature plays a role in their coping strategies.
Methods
An online questionnaire gathered the symptom profiles of 37 individuals with chronic low back pain (mean age = 45.6, SD = 13.2, range = 53; 23 females). The questionnaire consisted of 8 scales, of which the McGill Pain Questionnaire (SF-MPQ-2), the Tampa Scale for Kinesiophobia (TSK-9), and the Coping Strategies Questionnaire (CSQ-R) emerged as the most salient later during the interviews. From these participants, 4 semi-structured interviews (mean age = 55, SD = 12.62; 75% female; expected final sample N = 10) from individuals across the UK were conducted to understand their lived experiences of chronic low back pain, and their coping styles in greater depth. An inductive constructivist approach toward Thematic Analysis was employed to analyse interview data.
Results
The sample’s pain was reported through the scales of the MPQ: (continuous mean = 4.69, SD = 1.81; intermittent mean = 3.61, SD = 2.32; neuropathic mean = 2.69, SD = 2.16; affective mean = 4.39, SD = 2.76). TSK was higher in Activity Avoidance (mean = 12.63, SD = 3.89) than Somatic Focus (mean = 8.29, SD = 2.91). The CSQ detailed higher coping self-statements (mean = 4.15, SD = 1.06) and distraction (mean = 3.74, SD = 1.14) than other coping strategies. Two primary themes emerged from the preliminary Thematic Analysis; Limited Treatment Options Prompt Greater Pain Self-Management (subthemes: Self-Management is an Investment, The Necessity of Routine), and The Accessibility to Natural Spaces for Helping Control Pain is Important, but Insufficient (subthemes: Walking Struggles on Terrain, Affordances for Rest, and Mindfulness of Outdoor Activities).
Conclusions
The findings from the questionnaire suggest that chronic pain is most impactful for the sample in its continuous descriptors, but also affectual. Respondents may be more wary of performing certain movements than alert to physical symptoms. The most adopted coping strategies are ones that are primarily self-driven (“I just keep going despite…”) or offer distraction; this is also supported through both primary themes. Thematically, emphasis was given to the importance of the outdoors for many reasons, all of which amounted to assisting in the self-management of pain. In flare-up episodes where access to the outdoors was difficult, participants either forced themselves outside regardless, or sought visual access through windows. The outdoors provided space for activities (exercise, maneuverability), socialising, and distraction through escapism. Pain self-management was seen as an investment, with some participants struggling with the initial costs of time and effort.
References
1.Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand?homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., … Wang, S.-J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19-27. https://doi.org/10.1097/j.pain.0000000000001384
2.Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287. https://doi.org/10.1016/j.ejpain.2005.06.009
3.Stanhope J, Breed MF, Weinstein P. Exposure to greenspaces could reduce the high global burden of pain. Environmental Research 2020;187: 109641.https://doi.org/10.1016/j.envres.2020.109641
Presenting Author
Alexander Smith
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial