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© 2014, © The Author(s) 2014. Chronic back pain affects a significant proportion of older women, often with severe implications for their social lives, relationships and families. It is often characterized by intractability and causative ambiguity, challenging a range of medical and moral boundaries around sickness and wellness. In this study, we utilize solicited diaries with women to capture the day-to-day undulations of living with chronic back pain. These diaries provide rich insight into issues around: disrupted roles and social lives; experiences of perpetuality and isolation; acts of pretense and withdrawal; and, its perceived illegitimacy as an illness experience. Situated within gendered and life-stage cultural scripts, these women’s diaries illustrate how ideas about legitimacy and worthiness circulate within and around the social milieu of chronic back pain. We posit that individualized shame and dynamics of recognition are central to women’s suffering, reflecting persistent and disruptive social hierarchies of illness.

Background: Back pain is an increasingly prevalent health concern amongst Australian women for which a wide range of treatment options are available, offered by biomedical, allied health and complementary and alternative medicine (CAM) providers. Although there is an emerging literature on patterns of provider utilisation, less is known about the reasons why women with back pain select their chosen practitioner. In this paper we explore the influences on back pain sufferers' decision-making about treatment seeking with practitioners for their most recent episode of back pain. Methods. Drawing on 50 semi-structured interviews with women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH) who have chronic back pain, we focus on the factors which influence their choice of practitioner. Analysis followed a framework approach to qualitative content analysis, augmented by NVivo 9 qualitative data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison. Results: The women identified four predominant influences on their choice of practitioner for back pain: familiarity with treatment or experiences with individual practitioners; recommendations from social networks; geographical proximity of practitioners; and, qualifications and credentials of practitioners. The therapeutic approach or evidence-base of the practices being utilised was not reported by the women as central to their back pain treatment decision making. Conclusions: Choice of practitioner appears to be unrelated to the therapeutic approaches, treatment practices or the scientific basis of therapeutic practices. Moreover, anecdotal lay reports of effectiveness and the 'treatment experience' may be more influential than formal qualifications in guiding women's choice of practitioner for their back pain. Further work is needed on the interpersonal, collective and subjective underpinnings of practitioner choice, particularly over time, in order to better understand why women utilise certain practitioners for back pain. © 2014 Kirby et al.; licensee BioMed Central Ltd.

Aim of the study: To analyse the use of complementary and alternative medicine (CAM), allied health and biomedicine for back pain amongst Australian women aged 60-65. Methodology: Self-completion postal survey in 2011/2012 of 1310 women who reported seeking help for back pain from the mid-age cohort of the Australian Longitudinal Study on Women's Health (ALSWH). Questions asked about their use of, and attitudes towards, CAM, allied health and biomedicine for the treatment of back pain. Results: Intensity of back pain was greater for those who consulted biomedical and allied health practitioners. Women reported seeking help from biomedical and allied health practitioners more quickly after onset of pain than CAM practitioners but the longer their pain persisted the more likely they were to consult CAM practitioners. Use of CAM reflected less perceived benefit of biomedicine and allied health. The perceived differences in approach of CAM practitioners (e.g. more time in consultation, more equal relationship, more holistic approach) may be influential in their use and perceived benefit. Ease of access/availability may also influence use of CAM in particular. Some communication limitations were reported regarding discussing the use of other practitioner groups with biomedical and CAM practitioners. Conclusions: Help for back pain occurs within highly differentiated contexts of care with patients juggling multiple and often ideologically distinct provider groups in order to improve their health and well-being. Further detailed research is required to examine patient motivations and pathways across biomedical, allied health and CAM providers in order to facilitate continuity of clinical care. © 2012 Elsevier GmbH.

Objectives: To analyse use of conventional and complementary and alternative (CAM) practitioners and self-prescribed CAM amongst mid-age Australian women with back pain. Design: Self-completion postal surveys completed in 2004 and 2007, of the mid-age cohort of the Australian Longitudinal Study on Women's health. Questions asked for written responses about the use of conventional practitioners, CAM practitioners and self-prescribed CAM for treatment of back pain. Setting: Analysis of cross-sectional and longitudinal survey data (n=9820), conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), which was designed to investigate multiple factors affecting the health and well being of women over a 20-year period. Main outcome measure: Women were asked if they had sought help for back pain in the previous twelve months. Results: The prevalence of back pain was 54.8% (n=5383). The percentage of women who sought help for their back pain was 17.3% (n=1700). Of the women who sought help for back pain, 2% consulted with a CAM practitioner only, 35% consulted a conventional practitioner only and 63% with both a conventional and CAM practitioner. Conclusions: Back pain is prevalent amongst mid-age Australian women, although only one third sought help. Women who sought help for their back pack were high users of CAM (practitioners and self-prescribed) and conventional care providers, consulting a CAM practitioner in complement with conventional biomedical consultations rather than as an alternative. Further research is needed to explore the complex contemporary landscapes of back pain negotiation and management. © 2012 Elsevier Ltd.