Enduring versus curable: mixed-methods perspectives about pain among chiropractic patients

Qualitative methods are fundamental for studying patient preferences, particularly to understand how people perceive and manage pain that is unresponsive to standard treatment. Yet there is limited literature describing how formative qualitative research can inform quantitative studies on chronic pain. Integrating patient perspectives from qualitative research helps ensure that quantitative protocols and pain measures are grounded in patients' lived experiences.This paper details how our team, as part of a center focused on appropriate care for spinal pain, collected qualitative data about how chiropractic patients perceived pain chronicity, and how we used these findings to inform a national quantitative study.

In this exploratory sequential mixed methods study, we conducted 40 semi-structured interviews and deployed a mixed methods survey to 108 chiropractic patients with spinal pain. We conducted thematic analysis of the qualitative data, and we summarized those findings in a visual framework. The visual framework, in turn, informed the inclusion criteria and survey items for a quantitative, observational survey of 2,025 chronic pain patients from 125 chiropractic clinics in the United States.

Qualitative research revealed that many patients viewed chronic pain as permanent. Patients who defined chronicity this way shifted from seeking a cure to utilizing longer-term pain management and coping strategies; in this way, patients' understandings about chronicity influenced their care-seeking and satisfaction. This set of findings challenged our team's initial assumption that chronicity was primarily understood in terms of pain duration or intensity, and that all patients expected a cure.

Qualitative findings shaped the methods and interpretation of our quantitative observational research. This process led to a conceptual framework of chronic pain, more informative surveys and a shared understanding of the diverse beliefs that drive care-seeking behaviors among chronic pain patients.