Dealing with doubt - How patients account for non-specific chronic low back pain

Objective: To explore the ways that persons with long standing chronic low back pain respond to the problem of medical doubt about the presence of organic pathology. Method: Qualitative analysis of accounts provided by 12 persons attending a back pain rehabilitation clinic in NW England. Results: Subjects rejected the notion that they were culpable for their pain. They were not culpable for the onset of their pain. They argued that despite their cooperation, no sensible explanation of their pain was forthcoming from health professionals. Finally, they asserted that medical scepticism had been damaging and dispiriting. Conclusion: Patients dealt with clinical doubt by stressing their own expertise. They constituted their beliefs about the cause and trajectory of their pain and disability as accurate accounts of their disability. They resisted the suggestion that there might be psychological factors involved in their ill-health by locating culpability among clinicians, who were confused or uncertain about diagnosis and treatment. (C) 2000 Elsevier Science Inc. All rights reserved.