Locus of Control in Health and the Perspectives of Individuals with Chronic Low Back Pain - A Qualitative Study

Abstract

Introduction: Chronic low back pain is considered the main musculoskeletal disorder requiring rehabilitation and is becoming an increasingly significant health problem. In this sense, a biopsychosocial approach is accepted as an important strategy in the treatment of chronic pain. Furthermore, physical exercise has been shown to be clinically relevant compared with other interventions for chronic low back pain. Locus of control, a psychosocial construct associated with how an individual perceives their health condition, can act as a protective factor, reducing the impact of living with chronic pain when understood holistically. Therefore, the objective of this study was to understand and deepen knowledge of nonspecific chronic low back pain by examining patients' experiences and beliefs about their condition. Methods: Descriptive qualitative study with inductive thematic analysis. Data were collected through semi-structured interviews and the creation of a drawing, both analyzed using the principles of reflective thematic analysis. Adult individuals of both sexes with nonspecific chronic low back pain were included. The health locus of control scale was applied to characterize the individuals' profile in terms of sociodemographic components (sex, age, ethnicity, occupation, education, marital status, smoking, and alcohol consumption). Results: The final sample consisted of 11 individuals, mostly women (72.3%), with a mean age of 43.8 years (±14.3), and a mean pain duration of 108.3 months (±96.7). The vast majority presented an internal locus of control (81.8%). The following themes were identified: 1- Causes of pain; 2- Coping strategies/Intervention; 3- Perceptions of control over pain: Self-responsibility and outsourcing; and 4- Impact of pain on the patient's life. Discussion: Locus of control is believed to be a mutable variable, although considered by many to be a stable characteristic. Considering this hypothesis, since this is an interview conducted at a single point in time, there is a possibility that the perspectives of these individuals with chronic low back pain and their perception of their own health may have changed over time. Therefore, it becomes necessary to test this hypothesis through new longitudinal or experimental studies. Conclusion: The results demonstrate that, in individuals with chronic low back pain, having a tendency towards an internal locus of control for health does not prevent them from exhibiting externalized behaviours, such as dependence on others for pain relief, reaffirming the individual as multidimensional and chronic pain as multifactorial.