A person centred approach to managing pain: bridging mental and physical health
Chronic musculoskeletal pain is common and is the cause of significant health and socio-economic burden. Current service provision is often suboptimal as it fails to adopt a holistic, person-centred approach to management.
The aim of this intervention was to address both the physical and psychological needs of patients with chronic musculoskeletal pain, improve patient related outcomes and facilitate the adoption of healthier lifestyles. The setting was inner city primary care (East London) serving a multi-ethnic community with high deprivation. Two innovative community services were systematically developed, piloted and evaluated: a Health Trainers` back pain course incorporating yoga and mindfulness delivered by local health trainers and a Psycho-educational course incorporating a combination of CBT, mindfulness and pain education delivered by the community psychology service.
There was a statistically significant improvement of WHO wellbeing scores of patients who attended the Health Trainers course (pre-course mean score 38 and post-course 55, paired t-test < 0.001). There was a statistically significant improvement of PHQ-9 scores (pre-course mean score 17, post-course 3, paired t-test<0.001), GAD scores (pre-course mean score 13, post-course 10, paired t-test <0.001) and 5D-5L VAS scores (pre-course mean score 43, post-course 53, paired t-test <0.001) for patients who attended the Psycho-education course. Half of the participants in the Health Trainers` course lost an average of 1.7 kg in weight during the 12 weeks` programme.Patient feedback was very positive and all participants (100%) reported that they would recommend the courses to their family and friends.
The success of the pilots demonstrates that a holistic approach when caring for people with chronic musculoskeletal pain, addressing both mental and physical needs, can result in major improvements across a range of patient related outcomes while empowering people to take control of their condition and improve their lives.