Managing chronic widespread pain in primary care

a qualitative study of patient perspectives and implications for treatment delivery

Penny Bee, John McBeth, Gary J. MacFarlane, Karina Lovell

Research output: Contribution to journalArticle

6 Citations (Scopus)
3 Downloads (Pure)

Abstract

BACKGROUND: Clinical guidelines recommend a combination of physical, pharmacological and psychological treatments for chronic widespread pain, but published accounts of treatment acceptability are lacking.

METHODS: Semi-structured interviews (n = 44) nested within a randomised controlled trial comparing the clinical and cost effectiveness of prescribed exercise, cognitive behavioural therapy (CBT), and combined exercise and CBT to treatment as usual for adults with chronic widespread pain.

RESULTS: Three main themes emerged from the data: i) the illness context (how people experience chronic pain and associated health services); ii) the identity context (how people react to their symptoms and accommodate these within themselves) and iii) the intervention context (the extent and manner by which the trial interventions models aligned with these responses). Referral to a prescribed exercise programme resonated most closely with participants' tendency to attribute pain to a structural or mechanical defect. Psychological therapy brought with it connotations of social judgement, deviance and stigma. Experience of psychological therapy often exceeded expectation. Participants who engaged in cognitive reflection and behavioural adaptation reported an upward identity shift independent of increased physical exercise behaviour.

CONCLUSIONS: A logical rationale for a health intervention is in itself insufficient to ensure uptake and participation. Potential differences in treatment meaning emphasise the importance of acknowledging different phases of illness acceptance and of providing the most appropriate treatment option for the stage of reconciliation. Health service providers must not only understand people's own perceptions of chronic widespread pain but also the broader spheres of influence in which this pain is experienced.

Original languageEnglish
Article number354
Pages (from-to)1-11
Number of pages11
JournalBMC Musculoskeletal Disorders
Volume17
DOIs
Publication statusPublished - 22 Aug 2016

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Chronic Pain
Primary Health Care
Exercise
Cognitive Therapy
Psychology
Therapeutics
Health Services
Pain
Cost-Benefit Analysis
Referral and Consultation
Randomized Controlled Trials
Pharmacology
Guidelines
Interviews
Health

Keywords

  • Chronic widespread pain
  • Treatment acceptability
  • Patient perspectives
  • Qualitative

Cite this

Managing chronic widespread pain in primary care : a qualitative study of patient perspectives and implications for treatment delivery. / Bee, Penny; McBeth, John; MacFarlane, Gary J.; Lovell, Karina.

In: BMC Musculoskeletal Disorders, Vol. 17, 354, 22.08.2016, p. 1-11.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Clinical guidelines recommend a combination of physical, pharmacological and psychological treatments for chronic widespread pain, but published accounts of treatment acceptability are lacking.METHODS: Semi-structured interviews (n = 44) nested within a randomised controlled trial comparing the clinical and cost effectiveness of prescribed exercise, cognitive behavioural therapy (CBT), and combined exercise and CBT to treatment as usual for adults with chronic widespread pain.RESULTS: Three main themes emerged from the data: i) the illness context (how people experience chronic pain and associated health services); ii) the identity context (how people react to their symptoms and accommodate these within themselves) and iii) the intervention context (the extent and manner by which the trial interventions models aligned with these responses). Referral to a prescribed exercise programme resonated most closely with participants' tendency to attribute pain to a structural or mechanical defect. Psychological therapy brought with it connotations of social judgement, deviance and stigma. Experience of psychological therapy often exceeded expectation. Participants who engaged in cognitive reflection and behavioural adaptation reported an upward identity shift independent of increased physical exercise behaviour.CONCLUSIONS: A logical rationale for a health intervention is in itself insufficient to ensure uptake and participation. Potential differences in treatment meaning emphasise the importance of acknowledging different phases of illness acceptance and of providing the most appropriate treatment option for the stage of reconciliation. Health service providers must not only understand people's own perceptions of chronic widespread pain but also the broader spheres of influence in which this pain is experienced.",
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