A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies

Emery R. Eaves, Karen J. Sherman, Cheryl Ritenbaugh, Clarissa Hsu, Mark Nichter, Judith A. Turner, Daniel C. Cherkin

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. Methods: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. Results: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. Conclusions: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

Original languageEnglish (US)
Article number12
JournalBMC Complementary and Alternative Medicine
Volume15
Issue number1
DOIs
StatePublished - Feb 5 2015

Fingerprint

Complementary Therapies
Low Back Pain
Self Care
Therapeutics
Pain
Chronic Pain
Interviews
Yoga
Chiropractic
Massage
Immersion
Acupuncture
Pain Management
Crystallization
Life Style
Emotions
Maintenance
Quality of Life

Keywords

  • Acupuncture
  • CAM
  • Chiropractic
  • Chronic low back pain
  • Expectations
  • Massage
  • Pain management
  • Self-care
  • Yoga

ASJC Scopus subject areas

  • Complementary and alternative medicine

Cite this

A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies. / Eaves, Emery R.; Sherman, Karen J.; Ritenbaugh, Cheryl; Hsu, Clarissa; Nichter, Mark; Turner, Judith A.; Cherkin, Daniel C.

In: BMC Complementary and Alternative Medicine, Vol. 15, No. 1, 12, 05.02.2015.

Research output: Contribution to journalArticle

Eaves, Emery R. ; Sherman, Karen J. ; Ritenbaugh, Cheryl ; Hsu, Clarissa ; Nichter, Mark ; Turner, Judith A. ; Cherkin, Daniel C. / A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies. In: BMC Complementary and Alternative Medicine. 2015 ; Vol. 15, No. 1.
@article{b5f1af39972b46eebcd596139949bcbc,
title = "A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies",
abstract = "Background: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. Methods: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. Results: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a {"}positive outcome{"}. Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. Conclusions: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.",
keywords = "Acupuncture, CAM, Chiropractic, Chronic low back pain, Expectations, Massage, Pain management, Self-care, Yoga",
author = "Eaves, {Emery R.} and Sherman, {Karen J.} and Cheryl Ritenbaugh and Clarissa Hsu and Mark Nichter and Turner, {Judith A.} and Cherkin, {Daniel C.}",
year = "2015",
month = "2",
day = "5",
doi = "10.1186/s12906-015-0531-9",
language = "English (US)",
volume = "15",
journal = "BMC Complementary and Alternative Medicine",
issn = "1472-6882",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies

AU - Eaves, Emery R.

AU - Sherman, Karen J.

AU - Ritenbaugh, Cheryl

AU - Hsu, Clarissa

AU - Nichter, Mark

AU - Turner, Judith A.

AU - Cherkin, Daniel C.

PY - 2015/2/5

Y1 - 2015/2/5

N2 - Background: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. Methods: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. Results: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. Conclusions: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

AB - Background: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. Methods: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. Results: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. Conclusions: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

KW - Acupuncture

KW - CAM

KW - Chiropractic

KW - Chronic low back pain

KW - Expectations

KW - Massage

KW - Pain management

KW - Self-care

KW - Yoga

UR - http://www.scopus.com/inward/record.url?scp=84924289432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924289432&partnerID=8YFLogxK

U2 - 10.1186/s12906-015-0531-9

DO - 10.1186/s12906-015-0531-9

M3 - Article

C2 - 25652396

AN - SCOPUS:84924289432

VL - 15

JO - BMC Complementary and Alternative Medicine

JF - BMC Complementary and Alternative Medicine

SN - 1472-6882

IS - 1

M1 - 12

ER -