The value of focusing, a psychological self-help strategy, when living with chronic low back pain: a mixed methods study.

Abstract

Chronic low back pain (CLBP) is a widespread and disabling condition affecting many thousands of people in the UK, causing distress in many areas of their lives. Most people with CLBP do not have access to specialist advice and resort to managing it themselves. The government drive to encourage people to manage their own long-term conditions has led to some work on the use of self-help techniques with CLBP. However little research has been done with CLBP populations who are not seeking specialist advice. This study actively sought people from this population group. Focusing - a self-help technique based on the client-centred psychological approach - was introduced to two people who had long-term CLBP. In addition two people who had been using Focusing in their lives for some time and have long-term CLBP (but have not applied Focusing to that problem) were also recruited. Focusing was taught either face-to-face or by telephone for six weekly hour-long sessions; the experienced Focusers spent an hour each week for six weeks Focusing with their pain. Using a mixed methods approach the four participants were interviewed a number of times, namely before, immediately after and three to six months following the Focusing sessions. They also completed the WHOQOL-PainUK questionnaire, the short-form McGill Pain Questionnaire and a global QOL measure at these three times. During the Focusing sessions they completed the SF-MPQ and the global QOL weekly. Within the concurrent nested design the qualitative aspect formed the theoretical driver for the study; the quantitative element providing a smaller amount of data. This enabled the findings to be framed in a way which makes them accessible to the wide range of healthcare professionals involved in the management of CLBP; an approach described as one of 'utility'. The management of potential incongruencies in using a mixed method approach was a continuous theme throughout the study and a model - the context of stability model - was devised to enable a harmonisation of these in the study design.During the study three of the four participants reported a change in the meaning of their pain, and improvement in the perception of their pain and its impact. After using Focusing with their CLBP participants reported that the pain no longer controlled what they did, they were able to feel more 'themselves' and value themselves and Focusing had given them a supported place to talk about their pain. Focusing appears to have an impact for these people in enabling the acceptance of CLBP and an improvement in overall quality of life was found. The physical, psychological and independence quality of life domains in particular showed sustained improvement. No negative side effects were noted by any of the participants. Further study is needed to demonstrate whether the use of Focusing with CLBP confers longer term benefits and is suitable for a wider range of people.