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 org anic pathology. Method: Qualitative analysis of accounts provided by 12 per sons attending a back pain rehabilitation clinic in NW England. Results: Su bjects rejected the notion that they were culpable for their pain. They wer e not culpable for the onset of their pain. They argued that despite their cooperation, no sensible explanation of their pain was forthcoming from hea lth 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 ca use and trajectory of their pain and disability as accurate accounts of the ir disability. They resisted the suggestion that there might be psychologic al factors involved in their ill-health by locating culpability among clini cians, who were confused or uncertain about diagnosis and treatment. (C) 20 00 Elsevier Science Inc. All rights reserved.