Subjective pain experience of people with chronic back pain.
OBJECTIVE
Studies into the effect of pain experience on those who have it have largely focused on the views and interpretations of researchers gained by the use of assessment tools aimed at measuring pain. The purpose of this study was to explore and describe pain, as experienced by those with chronic back pain, and to document 'insider' accounts of how pain is perceived and understood by those who have it.


METHODS
Unstructured interviews using the framework approach. Subjects were sampled for age, sex, ethnicity and occupation, from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 M; 6 F) agreed to be interviewed. Interviews were unstructured, but followed a topic guide. Subjects were interviewed in English (nine) or their preferred language (two). Tape-recordings of interviews were transcribed verbatim and read in depth twice to identify the topics or concepts. Data were extracted in the form of words and phrases by use of thematic content analysis. The themes were pain description and amount of pain. An independent researcher reviewed the data and confirmed or contended the analysis.


RESULTS
All subjects, except one, provided descriptors of the quality of their pain. The use of simile was common to emphasize both what the pain was, and what it was not. Five subjects expressed a loss of words in trying to describe their pain. Only 13 of 29 different pain descriptors used were commensurate with those in the McGill Pain Questionnaire (Melzack, 1983). Subjects had great difficulty quantifying their pain intensity. Several explained how the pain fluctuated, thus, quantifying pain at one point in time was problematic. Only one subject offered a numerical description of pain intensity.


CONCLUSIONS
Subjects provided graphic and in-depth descriptions of their pain experience, but these bore little resemblance to commonly used assessment tools. The findings challenge the appropriateness of such formal instruments.
De Souza
L H
LH
Centre for Research in Rehabilitation, Brunel University, UK. lorraine.desouza@brunel.ac.uk
Frank
A O
AO
D000222:Adaptation, Physiological; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010358:Patient Participation; D011788:Quality of Life; D012494:Sampling Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires