Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery
Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery
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.
Bee, Penny
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McBeth, John
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MacFarlane, Gary J.
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Lovell, Karina
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22 August 2016
Bee, Penny
2ffe571a-595c-4624-a4d6-2b5816cc70ce
McBeth, John
98012716-66ba-480b-9e43-ac53b51dce61
MacFarlane, Gary J.
332acabb-a9cf-4434-b375-c8dd3a659e9f
Lovell, Karina
ee43e9ef-061e-450e-854d-12cad3e8ccd4
Bee, Penny, McBeth, John, MacFarlane, Gary J. and Lovell, Karina
(2016)
Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery.
BMC Musculoskeletal Disorders, 17, [354].
(doi:10.1186/s12891-016-1194-5).
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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s12891-016-1194-5
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Accepted/In Press date: 29 July 2016
Published date: 22 August 2016
Identifiers
Local EPrints ID: 491447
URI: http://eprints.soton.ac.uk/id/eprint/491447
ISSN: 1471-2474
PURE UUID: 2346b729-8afe-4a25-841d-83a3565add9b
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Date deposited: 24 Jun 2024 16:49
Last modified: 25 Jun 2024 02:10
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Author:
Penny Bee
Author:
John McBeth
Author:
Gary J. MacFarlane
Author:
Karina Lovell
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