Health maintenance, meaning, and disrupted illness trajectories in people with low back pain: a qualitative study

Whilst ‘biographical disruption’ remains important for explaining how people rebuild biography following the onset of chronic illness, it does not self-evidently explain the problem of managing a fluctuating chronic condition such as non-specific low back pain. Chronic illness rarely leads to long-term improvement; the trajectory is not always linear, and sudden or gradual improvements alongside deterioration are commonly experienced. In the case of low back pain, self-management often involves utilisation of non-pharmaceutical approaches, personal resources for accommodating pain and disability, as well as managing symptoms with clinical treatments to relieve pain. Such a multifaceted approach – not only concerned with the reduction of symptoms – shifts focus beyond the ‘disease’ state and a single point of disruption, drawing attention to the use of ‘health maintenance actions’ to facilitate a proactive response to illness management. We propose this new approach as an alternative way of understanding the experience of patients with fluctuating health conditions such as low back pain.