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BMJ Open 3:e002654 doi:10.1136/bmjopen-2013-002654
  • Rheumatology
    • Research

Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians

  1. Leon M Straker2
  1. 1Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
  2. 2School of Physiotherapy, Curtin University, Perth, Australia
  3. 3Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia and Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
  4. 4School of Medicine, The University of Notre Dame Australia, Perth, Australia
  5. 5Anthropology and Sociology, The University of Western Australia, Perth, Australia
  1. Correspondence to Ivan B Lin; ivan.lin{at}cucrh.uwa.edu.au
  • Received 30 January 2013
  • Revised 7 March 2013
  • Accepted 7 March 2013
  • Published 9 April 2013

Abstract

Objectives To determine the low back pain beliefs of Aboriginal Australians; a population previously identified as protected against the disabling effects of low back pain due to cultural beliefs.

Design Qualitative study employing culturally appropriate methods within a clinical ethnographic framework.

Setting One rural and two remote towns in Western Australia.

Participants Thirty-two Aboriginal people with chronic low-back pain (CLBP; 21 men, 11 women). Participants included those who were highly, moderately and mildly disabled.

Results Most participants held biomedical beliefs about the cause of CLBP, attributing pain to structural/anatomical vulnerability of their spine. This belief was attributed to the advice from healthcare practitioners and the results of spinal radiological imaging. Negative causal beliefs and a pessimistic future outlook were more common among those who were more disabled. Conversely, those who were less disabled held more positive beliefs that did not originate from interactions with healthcare practitioners.

Conclusions Findings are consistent with research in other populations and support that disabling CLBP may be at least partly iatrogenic. This raises concerns for all populations exposed to Western biomedical approaches to examination and management of low back pain. The challenge for healthcare practitioners dealing with people with low back pain from any culture is to communicate in a way that builds positive beliefs about low back pain and its future consequences, enhancing resilience to disability.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

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