Constructions of crisis: the social interactional functions of catastrophising in accounts of acute and persisting low back pain

Abstract

Background: Identifying psychosocial risk factors in patients with low back pain has become an important focus to help prevent persistent pain and disability. Catastrophising is seen as displays of magnification, rumination and helplessness which have become considered as obstacles to recovery and linked with poor outcomes. There has been increasing encouragement to adopt a more psychologically informed practice. This aims to improve the identification of psychological risk factors, such as catastrophising, to support more skilled assessment and achieve better outcomes by applying psychologically targeted interventions. Yet in both research and clinical contexts, preventing or reducing persistent problems through psychologically orientated interventions has proved less successful and more challenging than expected. Of interest, most literature proposing catastrophising as a risk for poor outcome comes from evidence collating responses to self-report scales, commonly the Pain Catastrophising Scale and the ‘Catastrophising’ component of the Coping Strategies Questionnaire. Little research has examined catastrophising in interaction contexts. Purpose: The study aimed to explore the personal accounts of patients experiencing acute and persisting low back pain problems to informunderstandings of psychosocial risk factors when expressed during clinical interactions. Methods: Nineteen participants experiencing acute low back pain (< 6weeks) were interviewed from close to onset until recovery, or throughout persisting problems. Repeated interviewswere undertaken generating 37 accounts of resolving, resolved and persisting problems followed up to three months to the timeframe considered the transition to chronicity. The accounts were analysed using discourse analysis strategies drawn from Discursive Psychology, Social Psychology and Sociolinguistics. Developing findings were considered against observations of accounts within clinical interactions. Results: Analysis found that catastrophising talk was performing several important interactional functions: Characterising personal circumstances to be appreciated as a problem; Indexing personal and moral significance into circumstances to be appreciated as unwanted, unjust and deserving of help; Managing issues concerning personal conduct and accountability; Enhancing listener engagement, compassion and emotional appeal; Creating emphasis and intensifying information to support persuasion and credibility. These interactional functions remained evident in accounts of persisting problems yet were hardly present in accounts conveying positive circumstances. Conclusion(s):Features in talk seen as catastrophising are ways to help to characterise and emphasise circumstances as bad, unwanted, undeserved and warranting care. The findings help explain the expression of catastrophising talk and its link with persisting problems.Catastrophising appears a common feature of ‘problem-talk’ and thus may remain a feature when reporting persisting problems or unwanted circumstances, and becomes interactionally unnecessary and absent in accounts of positive circumstances and recovery. Appreciating the social interactional function of the verbal expression of psychosocial factors is important in the interpretation of accounts. Implications: Undertaking sociologically-informed and psychologically informed research and practice seems an important step in advancing our interpretation or patient responses and approaches to patient care. Further research exploring interaction-based versus self-report strategies seems important for informing more effective clinical practice and patient management.