Table 4.
Direct quotations representing identified themes and subthemes from centrally sensitised participants with non-specific chronic low back pain.
| Theme 1: Developmental Learning Experiences |
|---|
| Sub-theme: Developmental Learning Difficulties and Weaknesses |
| “Academically I failed 5th form. I worked out I don’t quite learn that way … I learn more by being shown how to do it, and then doing it, rather than being lectured about it”. (P5) |
| “I did struggle to learn just off the... off the board, I needed someone to actually show me it. (P3)” |
| “P: I hated school. I didn’t learn that way. I don’t learn now that way. |
| I: So what was ‘that way’? |
| P: Ok - see I’m a big picture person … You see I think I learn pictorially … books and magazines, but pictures … I pick them up, and then I translate them”. (P4) |
| “Yeah, and homework was just such a battle. I struggled. I’ve always struggled with maths – that was my worst subject … I was in mathematics with applications which meant maths for dummies”. (P5) |
| “I used to be distracted, like I couldn’t sit in a class and there might be something going on out... out the window like a caretaker or something, and I always... I was always tempted to leave just like that, straight away”. (P3) |
| “A lot of my behaviour was based on sheer frustration, but sometimes teachers thought it was just me misbehaving”. (P3) |
| “I had really good balance but the most crappiest co-ordination you’ve ever seen. If I threw a stone it would come down and hit me on the head. I couldn’t catch a ball and I couldn’t kick a ball”. (P2) |
| Sub-theme: Developmental Learning Strengths |
| “Yeah and I can pull things apart once and remember how they go together … Yeah I’ve got a very good memory for that”. (P2) |
| “But at intermediate and at college I was usually put in the accelerant for things like maths. I was always sort of like really, really good at spelling, and English and grammar, they were my sort of strong suits at school”. (P8) |
| “I wasn’t fast – I just had the stamina to keep going … I couldn’t swim very well. You’re either a runner or a swimmer – you’re not both - and I was a runner … I … did not want to go to school swimming sports, because … because everyone else could swim, and I couldn’t swim in the pool”. (P1) |
| Theme 2: Personal Characteristics: |
|---|
| Sub-theme: Confidence |
| “(The convent was) really where I wanted to go... And if I’m really truthful today, that's where I’d like to be. That is me, that is who I am … that is who I am. I’m a woman of prayer and a lover of God … that is me”. (P6) |
| “I really struggle with low energy because I’m a person of high energy and motivation. So... I really struggle with it”. (P3) |
| “I do believe that what you go through as a child it shapes your core beliefs. It shapes your core beliefs, and in my family you just get on with it, you don’t complain”. (P5) |
| “I think.. a lot of how I grew up was feeling subdued, feeling like I had to be different. I had to be like them, and I wasn’t”. (P4) |
| “And … if I’m thinking I’m stupid, well they’re going to think I’m stupid … so there was two people at the table I didn’t know, and because I didn’t know them, I was tense and stressed for at least the first hour or so. Yeah because it was just out of my comfort zone cause I didn’t know them. Yeah which is silly – it does seem silly”. (P5) |
| “I’ve learnt to relax in terms of you can only do what you can do, you can only influence what you put your hand to so don’t stress out. And I’ve learnt to... even though I may not be able to spell, but I can read it, learnt to write lists or write things down…” (P3) |
| “I just had the stamina to keep going. Mm. Just keep going in life. I don’t know, I just put up with it, I just put up with life really”. (P1) |
| Sub-theme: Sense of Control |
| “It should be like this. … I think ‘this’ was like harmony, like everyone … everyone is in harmony, and there's understanding, and it's happy and it's joyful. Yeah it's harmonious. It's not disjointed and fragmented … it's not fragmented. I felt my life was very fragmented, and I felt very much alone”. (P6) |
| “In my mind if I didn’t get something done, if there was a deadline or there was going to be some kind of negative problem from it, I would push myself, I would just carry on and do it even though I knew that I wasn’t really being very kind to myself”. (P7) |
| “I have to learn to say no, so I’m learning to say no to things … Never (said) no. … I think it was the fear. It was a fear of upsetting someone”. (P7) |
| “Yeah, I just couldn’t handle that. I used to have to go away and crawl under the house... So you lived this life of, “wait a minute, if this is how it is then I’m the only one, I have to take control of me. I have to really make sure that I know what I’m doing and no-one, and I repeat no-one, is going to shake that.” (P6) |
| Theme 3 Sensitivity: |
|---|
| Sub-theme: Emotional Sensitivity |
| “So I’ve always obviously been a bit anxious. My mum is a ‘panicker’ … … Yeah, and she’d install her fear into me I guess without knowing it, and that would make me anxious, you know. Yeah. … It was like ‘oh my goodness’, and that would just instantly put anxiety into me”. (P2) |
| “I absolutely panicked over exams, just panicked in exams and go completely blank just because of the stress of not doing well, more than anything. … My mum always used to say before exams, ‘now we know you’ve worked really hard so don’t worry,’ and then if I didn’t get anything there or what they thought I should get I was in terrible problems – trouble”. (P7) |
| “It's so weird [chuckles]. It's all very, very odd, but yeah I … yeah I worry about what people think too much”. (P5) |
| “… if I have made a mistake I beat myself up... to quite some considerable amount…. And I’ve got a big thing about being normal and not showing anyone any type of weakness. And if people do find that weakness and sort of make a joke about it, it hits home pretty hard”. (P3) |
| “I’ve always thought, and I don’t know if it's exact anxiety as such, but I’ve always thought if I haven’t got something to worry about I’ll make something up … yeah my dad's a worrier, his mother was a worrier, you know, it's a bit of a family trait” (P8). |
| “I think again, seeing my kids is very interesting because I think there's definitely a natural genetic in it that they’re sensitive to people. Particularly (son) and (daughter) are both similar to me in that they’re very sensitive … well they’re all sensitive to other people's feelings, but they are very sensitive to people and what they think and getting things wrong. Yeah so I think for me there's a combination of already being like that naturally…” (P7) |
| Sub-theme: Physical Sensitivities |
| “Yeah, well I know I’ve got sensitivity to light. I don’t recall how long that's been going on, but... needing sunglasses on even if it wasn’t bright sunlight”. (P8) |
| “I’m massively sensitive to sound. I get very irritated with sound, any kind of repetitive sound. And there's one particular kind of music which … is it house music where it's just like the same beat all the time, I literally feel like I want to hit my head against a wall. Yeah sound is one thing, but then the sound of water or something I really like, but there are certain sounds that can very quickly get me highly irritated”. (P7) |
| “I know I’ve always been startled easily by loud noises, like somebody popping a balloon or oooh!” (P8) |
| “…but too strong - if it's a bad smell, like turps or kerosene - and I can smell burning a mile off - I became afraid of smell … The smell I was actually nauseous”. (P1) |
| “Oh I bounced – oh yeah I bounced. Mum would say to me too much cheese would affect me, but yeah different foods … But I had to be a bit careful”. (P2) |
| “It's the texture and the thought of biting down. I mean I’ve tried a few new foods but I can’t even tell you what they taste like because the anxiety level was so high and the thought of chewing down on them is just … (screws up face) … Like even now when I roast the chicken I use tongs to pull the meat off, … there's no way I’d touch them”. (P5) |
| “Often in the evenings I will do my fitness, then come home and that's when I tend to just sort of almost like blob out, just watch something and just try and block all things out. And there's often... if I get too over-stimulated I can’t get to sleep at night”. (P3) |
| “So yes, and I also get quite – not panicky exactly, but agitated if I’ve got too much going on in the week”. (P8) |
| “It doesn’t bother me – strong smells [chuckles]. I’ve worked with sewerage pumps [laughs] … I don’t smell things that other people say they smell, frequently”. (P2) |
| Theme 4 Trauma: |
|---|
| Sub-theme: Physical trauma |
| Some described physical abuse: |
| “…And he just grabbed me and smacked me, like kept on punching me and punching me and punching me and punching me and punching me. And he grabbed a knife and held it to my throat, and that was it, my life was over. … He used to smash all my stuff - … He used to, you name the abuse, he just didn’t care”. (P1) |
| “I mean I used to get smacked, I suppose in those days you’d call it. Well the nuns used to strap me. Oh, they would strap me for being naughty, and I would just go, “I was just having fun”. (P4) |
| Others described physical trauma related to an accident: |
| “It was massive disappointment because I loved it so much and it was really, really fulfilling in every way, sort of emotionally, physically, everything. So yeah it's sort of very hard to then think well what can I do, because you’re so fulfilled with what you do…” (P7) |
| “And then (daughter) was in a car accident when she was... she was 17. So that actually's when all of this started”. (P8) |
| Sub-theme: Emotional trauma |
| “I had a husband before [husband 2] – [husband 1] … he also was abusive … He used to threaten to burn me in my bed, standing with petrol cans and a lighter, and go “shall I do it now, shall I burn you now?” (P1) |
| “I mean I wasn’t (physically) abused as a child or anything like that, but I think there's different ways of damaging children… But I mean mum used to try to get me to eat things, and (step-father) used to really try to the point where the house would just be a tense, stressful, shouting, horrible place to be at the dinner table, every single night”. (P5) |
| “’Cos then my cousin was killed when she was just 18, and her parents I... you know, spent my holidays with so I was really close with her. And then (daughter) was in a car accident. So that is actually when all of this started … I still feel like the worst of everything started up at that accident, the last accident”. (P8) |
| “Growing up with only one parent I think is going to be stressful for a start … So my first stress – obviously my mother (dying). And this is what I think all of this stems from is post-traumatic stress”. (P8) |