‘I am afraid to make the damage worse’ – Fear of engaging in physical activity among patients with neck or back pain

Abstract

explore pain beliefs in relation to physical activity among neck and back pain patients consulting in primary health care in Sweden. The researchers’ secondary aim was to investigate how different pain beliefs are expressed in different ways among men and women. The researchers employed a qualitative study design using interviews with 11 participants (7 women, 5 men). Initial interviews explored their experiences of neck or back pain, feelings about and expectations for the upcoming appointment, understanding of the cause of the pain, pain management strategies, consequences of the pain and significant support from others. Subsequent interviews explored participants’ pain management strategies, strategies to get preferred treatments, treatment experiences and perceptions of the physiotherapist or the general medical practitioner. A thematic analysis of interview data resulted in the generation of a thematic matrix which helps provide an understanding of the nature of patients’ pain beliefs and the qualitative relationship of these beliefs to gender. There were several findings (themes) relevant to osteopathic practice. A key finding was that even though most patients were aware of the advantages of staying physically active with low back or neck pain, this did not lead to more activity. The authors propose that the fear of ‘doing more damage’ was stronger than knowledge to keep active. Related to this, patients expressed that they wanted more support to stay active, rather than just being told. Another interesting finding was related to how patients described their body and subsequent pain. For example, a theme that developed from analysis of interview data was termed ‘The mechanical body’, and referred to how patients tended to describe their body in a mechanical fashion and related their pain to ‘mechanical damage’. A closer look at the findings appear to suggest that unhelpful pain beliefs held by patients could be (and at times were) re-enforced by healthcare professionals when attempting to explain the meaning and origin of the patient’s pain. For example, some patients perceived that their pain was ‘due to an unstable vertebra that needed to be held in place’. Patients also expressed a ‘fear of hurting their fragile body’, which was related to their fear and subsequent avoidance of physical activity. Finally, gender influenced several themes and it appeared that healthcare personnel gave stereotyped messages. Notably, healthcare professionals provided female participants with ‘be careful messages’ suggesting that they perceived female patients as more physically vulnerable. In turn, these ‘be careful