title: A systematic review and meta-synthesis of the impact of low back pain on people's lives.
abstract: BACKGROUND
  Low back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people's lives.
  
  
  METHODS
  Two reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people's experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach.
  
  
  RESULTS
  We included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone 'doing battle' with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly.
  
  
  CONCLUSIONS
  The social component of the biopsychosocial model is not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients' experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.
authors.affiliation: Warwick Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK. r.froud@warwick.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: Froud
authors.forename: Sue
authors.initials: S
authors.lastname: Patterson
authors.forename: Sandra
authors.initials: S
authors.lastname: Eldridge
authors.forename: Clive
authors.initials: C
authors.lastname: Seale
authors.forename: Tamar
authors.initials: T
authors.lastname: Pincus
authors.forename: Dévan
authors.initials: D
authors.lastname: Rajendran
authors.forename: Christian
authors.initials: C
authors.lastname: Fossum
authors.forename: Martin
authors.initials: M
authors.lastname: Underwood
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D017281:Cost of Illness; D004644:Emotions; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011788:Quality of Life; D012720:Severity of Illness Index; D012919:Social Behavior; D011795:Surveys and Questionnaires