A longitudinal study of an embodied-self-concept and its potential impact upon adjustment and acceptance in chronic non-specific lower back pain in female adults

Abstract

Aim: Analgesia and surgical interventions have little impact in reducing the unpleasantness and intensity of chronic non-specific low(er) back pain (CLBP) and access to Pain Management Programmes is limited with inconsistent results. Individuals need to learn to live with their pain and this study explores how one's self-concept (in relationship with/to their body i.e., an embodied-self-concept) and pain might influence an individual’s perceived ability to accept/adjust to their CLBP and if this changes over time. Receiving support may influence adjustment/acceptance of CLBP, and this study seeks understanding of what those with CLBP want/need when their pain is self-managed outside of specialist pain services as these are currently unknown. Acceptance of CLBP is associated with improved life quality and a new dynamic model of change in CP which can accommodate the changing embodied-self and allow for movement between CP-acceptance/adjustment, non-acceptance/non-adjustment and anti-acceptance/non-adjustment over time is required to inform psychological practice. Methodology: A longitudinal multiple-case-series over 19 months using mixed-methods triangulation convergence/corroboration of three female participants explored the (potentially) changing embodied-self, from the pre-pain self to the present. Each meeting at approximately 9-monthly intervals consisted of semi-structured interviews and two measures: one explored CP-acceptance (Chronic Pain Acceptance Questionnaire: CPAQ) the other, dissonance between self-aspects (Possible Selves Measure in Chronic Pain: PSM-CP). Findings: Changes in the embodied-self-concept and related behaviours (e.g., task-persistence) were motivated by participants’ self-concept goals in growthfull and not-for-growth directions, thus self-acceptance and CP-acceptance are inextricably linked. The participants’ painful body part was placed ‘outside’ of the self as a separate entity demanding care and attention. The participants were often fearful and experienced shame, blame and two experienced suicidal ideation. However, counselling was not advocated by GPs and was not a consideration by participants. Conclusion: Counsellors in private practice and primary care with the necessary skills and knowledge are well placed to work with CP. Cultural and societal shifts in a non-dualistic understanding of CP and its treatment/management may make counselling a more acceptable adjunct. A new model of change in CP has been developed highlighting the role of psychological agility, choice junctions and self-re-evaluation as key components to/in change in both growthfull and non-growthfull directions. The wholesale adoption of the Buddhist-informed definition of CP-acceptance has been challenged.