Upper limb pain in primary care: health beliefs, somatic distress, consulting and patient satisfaction

Palmer, K., Calnan, M., Wainwright, D., O'Neill, C., Winterbottom, A., Watkins, C., Poole, J. and Coggon, D. (2006) Upper limb pain in primary care: health beliefs, somatic distress, consulting and patient satisfaction. Family Practice, 23 (6), 609-617. (doi:10.1093/fampra/cm1047).

Abstract

Background: beliefs and mental well-being could influence decisions to consult about upper limb pain and satisfaction with care.

Objectives: to describe beliefs about upper limb pain in the community and explore associations of beliefs and mental health with consulting and dissatisfaction.

Methods: questionnaires were mailed to 4998 randomly chosen working-aged patients from general practices in Avon. We asked about upper limb pain, consulting, beliefs about symptoms, dissatisfaction with care, somatizing tendency (using elements of the Brief Symptom Inventory) and mental well-being (using the Short-Form 36). Associations were explored by logistic regression.

Results: among 2632 responders, 1271 reported arm pain during the past 12 months, including 389 consulters. A third or more of responders felt that arm pain sufferers should avoid physical activity, that problems would persist beyond 3 months, that a doctor should be seen straightaway and that neglect could lead to permanent harm. Consulters were significantly more likely to agree with these statements than other upper limb pain sufferers. The proportion of consultations attributable to such beliefs was substantial. Dissatisfaction with care was commoner in those with poor mental health: the OR for being dissatisfied (worst versus best third of the distribution) was 3.2 (95% CI 1.2–8.5) for somatizing tendency and 2.4 (95% CI 1.3–4.7) for SF-36 score. Both factors were associated with dissatisfaction about doctors' sympathy, communication and care in examining.

Conclusions: negative beliefs about upper limb pain are common and associated with consulting. Somatizers and those in poorer mental health tend, subsequently, to feel dissatisfied with care

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Contributors

Author: D. Coggon

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