What can we learn from the CLBP experiences of white-British and English-speaking Punjabi people?

Chronic low back pain (CLBP) is a leading cause of disability in the UK and worldwide. It has a huge burden on the individual, society, the economy and the healthcare system. CLBP is associated with negative beliefs and behaviours, which are influenced by culture, religion and interactions with healthcare practitioners (HCPs). In the UK, within culturally diverse settings such as Leicester, HCPs encounter people from different cultures and ethnic backgrounds, with South Asian Indians (including Punjabis) forming some of the largest ethnic minority groups.

However looking at the literature little is known about what these people believe, and their lived experience of back pain. We therefore conducted a series of one-one qualitative interviews with 10 CLBP participants (5 English-speaking Punjabi and 5 white British) we purposively recruited from physiotherapy waiting lists at a NHS physiotherapy department in Leicester, UK. We were interested to learn about their beliefs and experiences, to explore how these beliefs may have influenced their experience of living with CLBP, and to identify similarities and differences between the two ethnic groups.

Four participants were classified as ‘high risk’ on the Short Form Orebro Questionnaire and six were classified as moderate to highly disabled on the Oswestry Disability Index.

We found participants from both groups:

i) Held biomedical CLBP beliefs

ii) Experienced unfulfilling interactions with HCPs

iii) Endured negative psychosocial dimensions of CLBP


Specific findings to Punjabi participants included:

i) Disruption to cultural-religious well-being

ii) Perceived lack of understanding and empathy regarding their CLBP from the Punjabi community

iii) Punjabi participants reported initially using passive coping strategies; however, all participants reported a transition towards active coping strategies


Our findings offer new insights, which could help inform management of people with CLBP within these groups:

–           There may be specific training needs for HCPs to better understand the multi-factorial nature of CLBP, specifically the individual’s beliefs and experiences within their psychosocial and cultural-religious context.

–           HCPs may need to develop a flexible communication style that facilitates strong therapeutic alliance and a person-centred approach to management.

–          Other HCP priorities may include disseminating evidence-based information amongst patients and the public including ethnic minority populations.


Gurpreet is a physiotherapist working across an NHS musculoskeletal outpatient and pain management service in Leicester, UK. He conducted this research as part of his MRES at the University of Birmingham. He is currently involved in work around improving the management of persistent back pain disorders.

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