Negotiating the Social Self in Chronic Spinal Pain: A Qualitative Study

Purpose: This study examined how people living with chronic spinal pain experience, interpret and navigate social representations of their condition and the interactions these generate across clinical, occupational, and personal settings. Materials and Methods: Thirty semi-structured interviews were analysed using an approach informed by constructivist grounded theory, through initial, focused and theoretical coding. Results: Five categories emerged, capturing how social representations and relational dynamics threatened the social self and prompted deliberate strategies for restoring agency. Theoretical coding identified a central process (maintaining and rebuilding the social self), describing how participants navigated these threats across social contexts. Notably, approximately half the participants reproduced, without revision, representations of chronic pain typical of the general population, directing judgements of simulation or inadequate effort at others with the condition. These strategies primarily aimed to restore agency and maintain a viable social self, rather than to reduce pain. Conclusions: These findings describe one process through which social environments shape the experience of chronic spinal pain by influencing how the social self is continually negotiated. Recognising these processes may help rehabilitation professionals attend to the social dimensions of chronic pain.