Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Back Pain | Research article

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

Authors: YiJun Li, Michel W. Coppieters, Jenny Setchell, Paul W. Hodges, Gwendolyne G. M. Scholten-Peeters

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Low back pain (LBP) is the second highest cause of health burden in China. Delayed recovery, poor clinical outcomes and persistence of LBP are associated with negative pain beliefs about LBP. Chinese philosophies are nested into the daily life of people in China, which is likely to influence pain beliefs. However, there is lack of knowledge about people’s discourses regarding their LBP in China. The primary aim of this study was to explore the discourses underlying the beliefs of people in China about what causes their persistent or recurrent LBP. The secondary aim was to investigate the sources of these pain beliefs.

Methods

People (n = 152) from South Central, East and North Mainland China with LBP completed an online survey about what they believed caused their persistent or recurrent LBP and where these understandings came from. Potential causes of persistent or recurrent LBP were explored qualitatively using discourse analysis. The sources of these discourses were assessed by descriptive statistics with conventional content analysis.

Results

Five discourses were identified to underpin participants’ beliefs about what caused their persistent or recurrent LBP, namely: (1) biomedical problems (66.4%), (2) unbalanced lifestyle (48.7%), (3) menstruation and ‘kidney’ status (9.2%), (4) the ‘Five Elements’ imbalance (7.9%), and (5) energy status (5.9%). Most participants responded that their pain beliefs were based on information derived from healthcare professionals (59.2%), followed by the internet (24.3%) and family (23.0%).

Conclusions

People from moderately and well-developed parts of Mainland China think predominantly in line with a Western biomedical viewpoint about their LBP. Traditional Chinese medicine related pain beliefs mainly to the concept of ‘balance’ were evident on contemporary Chinese society’s understandings of LBP. These cultural beliefs could be relevant to consider in LBP management and involve healthcare professionals, family and patient in this process.
Appendix
Available only for authorised users
Literature
1.
James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–858.CrossRef
2.
Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the global burden of disease study 2017. Ann Transl Med. 2020;8(6):299.PubMedPubMedCentralCrossRef
3.
4.
Wu A, Dong W, Liu S, Cheung JPY, Kwan KYH, Zeng X, et al. The prevalence and years lived with disability caused by low back pain in China, 1990 to 2016: findings from the global burden of disease study 2016. Pain. 2019;160(1):237–45.PubMedCrossRef
5.
Jin K, Sorock GS, Courtney TK. Prevalence of low back pain in three occupational groups in Shanghai, People’s Republic of China. J Saf Res. 2004;35(1):23–8.CrossRef
6.
Wang M, Yu J, Liu N, Liu Z, Wei X, Yan F, et al. Low back pain among taxi drivers: a cross-sectional study. Occup Med. 2017;67(4):290–5.CrossRef
7.
Yue P, Liu F, Li L. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health. 2012;12(1):789.PubMedPubMedCentralCrossRef
8.
金莉雅, 贾曼, 许飞珠. 国内护理人员腰背痛患病率的 Meta 分析. 中国实用护理杂志. 2013;29(020):45–7.
9.
Jackson T, Thomas S, Stabile V, Shotwell M, Han X, McQueen K. A systematic review and Meta-analysis of the global burden of chronic pain without clear etiology in low- and middle-income countries: trends in heterogeneous data and a proposal for new assessment methods. Anesth Analg. 2016;123(3):739–48.PubMedCrossRef
10.
11.
World Health Organization. Regional Office for the Western P. People’s Republic of China health system review. Manila: WHO Regional Office for the Western Pacific; 2015.
12.
Zhou L, Nunes MB. Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model. Glob Health Action. 2016;9:29964.PubMedCrossRef
13.
Yu L, Wang X, Lin X, Wang Y. The use of lumbar spine magnetic resonance imaging in eastern China: appropriateness and related factors. PLoS One. 2016;11(1):e0146369.PubMedCrossRef
14.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–67.PubMedCrossRef
15.
Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394–9.PubMedCrossRef
16.
Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J. 2007;16(10):1539–50.PubMedCrossRef
17.
18.
Sloan TJ, Gupta R, Zhang W, Walsh DA. Beliefs about the causes and consequences of pain in patients with chronic inflammatory or noninflammatory low back pain and in pain-free individuals. Spine (Phila Pa 1976). 2008;33(9):966–72.CrossRef
19.
Henschke N, Lorenz E, Pokora R, Michaleff ZA, Quartey JNA, Oliveira VC. Understanding cultural influences on back pain and back pain research. Best Pract Res Clin Rheumatol. 2016;30(6):1037–49.PubMedCrossRef
20.
Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Smeets RJ. Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. Eur J Pain. 2011;15(2):213–9.PubMedCrossRef
21.
Foster NE, Bishop A, Thomas E, Main C, Horne R, Weinman J, et al. Illness perceptions of low back pain patients in primary care: what are they, do they change and are they associated with outcome? Pain. 2008;136(1–2):177–87.PubMedCrossRef
22.
Wertli MM, Eugster R, Held U, Steurer J, Kofmehl R, Weiser S. Catastrophizing - a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J. 2014;14(11):2639–57.PubMedCrossRef
23.
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–78.PubMedCrossRef
24.
Walsh DA, Radcliffe JC. Pain beliefs and perceived physical disability of patients with chronic low back pain. Pain. 2002;97(1–2):23–31.PubMedCrossRef
25.
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83.PubMedCrossRef
26.
Main CJ, Foster N, Buchbinder R. How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Pract Res Clin Rheumatol. 2010;24(2):205–17.PubMedCrossRef
27.
Pincus T, Kent P, Bronfort G, Loisel P, Pransky G, Hartvigsen J. Twenty-five years with the biopsychosocial model of low back pain-is it time to celebrate? A report from the twelfth international forum for primary care research on low back pain. Spine (Phila Pa 1976). 2013;38(24):2118–23.CrossRef
28.
Bunzli S, Watkins R, Smith A, Schütze R, O’Sullivan P. Lives on hold: a qualitative synthesis exploring the experience of chronic low-back pain. Clin J Pain. 2013;29(10):907–16.PubMedCrossRef
29.
Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, et al. A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord. 2014;15:50.PubMedPubMedCentralCrossRef
30.
Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskelet Disord. 2017;18(1):466.PubMedPubMedCentralCrossRef
31.
32.
33.
Orhan C, Van Looveren E, Cagnie B, Mukhtar NB, Lenoir D, Meeus M. Are pain beliefs, cognitions, and behaviors influenced by race, ethnicity, and culture in patients with chronic musculoskeletal pain: a systematic review. Pain Physician. 2018;21(6):541–58.PubMed
34.
Sharma S, Ferreira-Valente A, de C William AC, Abbott JH, Pais-Ribeiro J, Jensen MP. Group differences between countries and between languages in pain-related beliefs, coping, and catastrophizing in chronic pain: a systematic review. Pain Med. 2020. https://​doi.​org/​10.​1093/​pm/​pnz373.
35.
Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013;3(4):e002654.PubMedPubMedCentralCrossRef
36.
Thong ISK, Tan G, Lee TYC, Jensen MP. A comparison of pain beliefs and coping strategies and their association with chronic pain adjustment between Singapore and United States. Pain Med. 2017;18(9):1668–78.PubMed
37.
38.
Chan HY, Chui YY, Chan CW, Cheng KK, Shiu AT, So WK, et al. Exploring the influence of traditional Chinese medicine on self-care among Chinese cancer patients. Eur J Oncol Nurs. 2014;18(5):445–51.PubMedCrossRef
39.
Leung L. Traditional Chinese medicine—a beginner’s guide. InnovAiT. 2010;4(1):49–54.CrossRef
40.
41.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.PubMedCrossRef
42.
Willig C. Discourse analysis. In: Qualitative psychology: a practical guide to research methods. 3rd ed. Los Angeles/London/New Delhi/Singapore/Washington DC/Boston: SAGE; 2015. Cited 08-03-2019.
43.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
44.
45.
Hornby AS. Oxford Advanced Learner’s English-Chinese Dictionary 6th ed. Mainland China: The Commercial Press, Oxford University Press; 2004.
46.
Wong J, Fisher J. The role of traditional confinement practices in determining postpartum depression in women in Chinese cultures: a systematic review of the English language evidence. J Affect Disord. 2009;116(3):161–9.PubMedCrossRef
47.
Jiang WY. Therapeutic wisdom in traditional Chinese medicine: a perspective from modern science. Trends Pharmacol Sci. 2005;26(11):558–63.PubMedCrossRef
48.
Ninnemann K. Shenkui. In: Loue S, Sajatovic M, editors. Encyclopedia of immigrant health. New York: Springer New York; 2012. p. 1350.
49.
Wong WC, Li MK, Chan WY, Choi YY, Fong CH, Lam KW, et al. A cross-sectional study of the beliefs and attitudes towards menstruation of Chinese undergraduate males and females in Hong Kong. J Clin Nurs. 2013;22(23–24):3320–7.PubMedCrossRef
50.
Wang L, Suo S, Li J, Hu Y, Li P, Wang Y, et al. An investigation into traditional Chinese medicine hospitals in China: development trend and medical service innovation. Int J Health Policy Manag. 2016;6(1):19–25.PubMedCentralCrossRef
51.
Shen JJ, Wang Y, Lin F, Lu J, Moseley CB, Sun M, et al. Trends of increase in western medical services in traditional medicine hospitals in China. BMC Health Serv Res. 2011;11:212.PubMedPubMedCentralCrossRef
52.
53.
Needham J, Gwei-Djen L, Sivin N. Science and civilization in China. Volume 6, biology and biological technology. Part VI: medicine. Cambridge: Cambridge University Press; 2000.
54.
Moseley GL, Butler DS. Explain pain supercharged : the clinician’s manual; 2017.
55.
Tung W-C, Li Z. Pain beliefs and behaviors among Chinese. Home Health Care Manag Pract. 2014;27(2):95–7.CrossRef
56.
Li L, Deng X, Zhang H, Yang H, Chen J, Hou X, et al. A cross-sectional survey of low back pain in nurses working in orthopedic departments. Workplace Health Saf. 2019;67(5):218–30.PubMedCrossRef
57.
Tan BK, Smith AJ, O'Sullivan PB, Chen G, Burnett AF, Briggs AM. Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey. BMC Musculoskelet Disord. 2014;15:255.PubMedCrossRef
58.
Coudeyre E, Rannou F, Tubach F, Baron G, Coriat F, Brin S, et al. General practitioners’ fear-avoidance beliefs influence their management of patients with low back pain. Pain. 2006;124(3):330–7.PubMedCrossRef
59.
Poiraudeau S, Rannou F, Baron G, Le Henanff A, Coudeyre E, Rozenberg S, et al. Fear-avoidance beliefs about back pain in patients with subacute low back pain. Pain. 2006;124(3):305–11.PubMedCrossRef
60.
61.
de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine: a practical guide. Cambridge: Cambridge University Press; 2011.CrossRef
62.
Hondras M, Hartvigsen J, Myburgh C, Johannessen H. Everyday burden of musculoskeletal conditions among villagers in rural Botswana: a focused ethnography. J Rehabil Med. 2016;48(5):449–55.PubMedCrossRef
Metadata
Title
How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey
Authors
YiJun Li
Michel W. Coppieters
Jenny Setchell
Paul W. Hodges
Gwendolyne G. M. Scholten-Peeters
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03500-1

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Research article

High self-efficacy – a predictor of reduced pain and higher levels of physical activity among patients with osteoarthritis: an observational study

Research article

Investigating the biomechanical function of the plate-type external fixator in the treatment of tibial fractures: a biomechanical study

Research article

Stretching and relaxing the plantar fascia may change plantar fascia thickness but not pressure pain thresholds: a cross-sectional study of patients with plantar fasciopathy

Research article

The incidence and characteristics of accelerated knee osteoarthritis among women: the Chingford cohort

Research article

Does the IOFix implant improve union rates?

Research article

Prenatal diagnosis of fetal skeletal dysplasia using 3-dimensional computed tomography: a prospective study