Communicating and diagnosing non-specific low back pain: A qualitative study of the healthcare practitioners' perspectives using a social diagnosis framework

Abstract

Background: There is general agreement that nonspecific low back pain is best understood within a biopsychosocial understanding of health. However, clinicians and patients seemingly adhere to a biomedical model, which may introduce misperceptions of pain and does not inform treatment or prognosis. Objective: To explore, from the perspective of healthcare practitioners, how persistent nonspecific low back pain may be communicated in a way that moves beyond a biomedical diagnosis. Design: An explorative qualitative investigation using a constructivist diagnostic framework. Methods: Focus group and individual interviews of 10 purposefully selected chiropractors, physiotherapists and general practitioners were codified and thematically analysed. Results: Four themes emerged: "Clinicians' nuanced understanding of back pain"; "The challenges of shared decision-making"; "Cultural barriers to moving beyond biomedicine"; and "More than a label - individual explanations for pain". Pain and disability were perceived as products of multiple bio-psychosocial factors. Clinicians identified the impact of multiple social actors, an unhealthy work culture, and the organization of the medical system on the notion of pain and suffering. Conclusion: Clinicians perceived a need to communicate the complexity of non-specific low back pain in order to help patients make sense of their condition, rather than applying diagnostic labelling. There are multiple barriers to integrating a constructivistic diagnostic framework into clinical practice that need to be overcome.