The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions

Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation

The Development and Response to Injury of Neonatal Rat Hindlimb Motoneurones and Their Afferent Connections: A Morphological Study

Development of motor function extends into the first three postnatal weeks in rats, and is correlated with maturation of spinal motoneurones and their afferent inputs. This study examined the normal development of somatodendritic morphology of identified ankle flexor motoneurones and the effect of nerve injury on the morphology and survival of cells. The effect of nerve injury upon motoneurone synaptic connectivity was also examined. Retrogradely labelled motoneurones were injected with fluorescent dyes. One to three days after birth, the soma and dendrites of these motoneurones were covered in filopodial and lamellipodial processes. After four postnatal days there was an elimination of these processes which proceeded from the soma to the distal dendrites. By nine days after birth, these structures were found only distally. There was no significant growth of the soma during the first postnatal week. After common peroneal (CP) nerve injury on postnatal day two, elimination of processes from the soma and proximal dendrites was halted some cells showed evidence of dendritic sprouting. Other motoneurones displayed features associated with neuronal degeneration. However, there was no significant difference in soma area of injured motoneurones compared with control motoneurones. Finally, two to three months later only 48-69% of the injured motoneurones survived. The effect of nerve injury on the distribution of parvalbumin immunoreactive primary afferent fibres and descending serotonergic fibres in the ventral horn was studied. Within five days after nerve injury, there was a decrease in the density of parvalbumin immunoreactivity around the injured CP motoneurone pool. In contrast, the density of serotonergic fibres was apparently unaltered. The somatodendritic surface of rat flexor motoneurones matures during the first week of postnatal life. Injury during the critical period arrests the maturation of the cell, and results in death of motoneurones