We included 49 papers describing 42 studies. Patients are concerned with engagement in
meaningful activities; but they also want to be believed and have their experiences and
identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment,
and cure, but also reassurance of the absence of pathology. Some struggle to meet social
expectations and obligations. When these are achieved, the credibility of their pain/disability
claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to
accommodate social demands. Patients generally seek to regain their pre-pain levels of
health, and physical and emotional stability. After time, this can be perceived to become
unrealistic and some adjust their expectations accordingly.
Conclusions
The social component of the biopsychosocial model is not well represented in current coresets
of outcome measures. Clinicians should appreciate that the broader impact of low back
pain includes social factors; this may be crucial to improving patients’ experiences of health
care. Researchers should consider social factors to help develop a portfolio of more relevant
outcome measures