Chronic Low Back Pain Model Maps Symptoms and Daily-Life Impacts

Key Takeaways

• US adults interviewed about clinician-confirmed chronic low back pain described varied back pain alongside spasms, numbness, and stiffness.
• Physical and emotional functioning were spontaneously described as affected by nearly all interview participants.
• Sleep, social participation, household responsibilities, and work or school were also affected.

Chronic low back pain can be difficult to represent through pain intensity alone. Patients may distinguish the quality of their pain from other symptoms and from the ways their condition affects daily life. For patient-reported outcome measures, the question is which experiences matter to patients and whether those experiences are captured. Patients’ open-ended accounts can reveal those experiences without restricting them to predefined categories.

Investigators paired a protocol-guided targeted review of 17 patient-perspective publications with subsequent observational, cross-sectional interviews. Interviewees were 30 US adults with clinician-confirmed chronic low back pain. Searches covered MEDLINE, EMBASE, APA PsycINFO, and reference lists; the search targeted publications from December 2013 through January 2023, although the included-publication list contains an earlier study. A healthcare research agency recruited interviewees with diversity targets for sex, race, ethnicity, and education. Online, semistructured interviews conducted from August through November 2023 began with open-ended symptom and daily-life questions; interviewers prompted for review-derived impacts if participants had not volunteered them. Researchers coded de-identified transcripts, assessed concept saturation, compared literature and interview concepts independently, and merged similar concepts.

The integrated conceptual model grouped 16 symptom concepts and 120 health-related quality-of-life impact concepts across 18 domains. Interviewees described pain as sharp, dull, aching, or stabbing, alongside spasms, numbness, stiffness, tingling, fatigue, headache, and weakness. The model combined interview and review concepts rather than counting affected people. Its impact areas included physical and emotional functioning, adaptive behaviors, sleep, social functioning, household chores and responsibilities, and work or school.

Physical functioning impacts were volunteered by 29/30 interviewees, and emotional functioning impacts by 28/30. Participants described difficulty walking, less social activity, frustration, and interrupted sleep, although spontaneous accounts were distinguished from responses elicited later by prompts. Nearly all symptom concepts and every impact domain emerged in the earlier interviews during the saturation assessment. These interview frequencies describe a recruited group, not prevalence among all people living with chronic low back pain.

The authors noted that the review was targeted rather than exhaustive and included populations different from the interview cohort. Interviews were limited to US adults, and some demographic groups were incompletely represented. Some concepts appeared in only one research input, leaving the integrated model non-exhaustive. The authors proposed using the model to explore whether future patient-reported outcome assessments cover relevant patient experiences. That proposed use does not establish treatment efficacy or validate a particular instrument.

Chronic low back pain encompasses patient-described symptoms and consequences that extend across daily activities. The authors concluded that the conceptual model could inform future examination of patient-reported outcome content validity.

Clinician Questions

Which chronic low back pain interview populations were not represented despite diversity recruitment targets?

Among US adults with clinician-confirmed chronic low back pain, investigators recruited for variation in sex, race, ethnicity, and education, but no Native American participants were interviewed. Applicability to Native American adults therefore remains uncertain.

Which chronic low back pain symptoms appeared only in patient interviews or only in the targeted review?

In the integrated chronic low back pain conceptual-model research, interview-only symptoms included tingling, frequent urination, and ringing in ears; review-only concepts included cramping, dry mouth, structural body changes, swelling, and tightness. “Only” distinguishes these research inputs; it does not mean those symptoms never occur elsewhere.

Recommended Reading

• For more on broader chronic-pain assessment: Rethinking Chronic Pain: A Biopsychosocial Approach to Management