What are patients' and healthcare professionals’ experiences of living with multiple long-term conditions alongside arthritis or persistent musculoskeletal pain?

Problem

Painful arthritis-related conditions are long-term in nature and often experienced alongside other long-term conditions (LTCs). Multimorbidity, the presence of ≥2 LTCs, is an urgent healthcare challenge; and leads to increased levels of “work” or treatment burden for patients and healthcare providers (HCPs). We know relatively little about the impact of multimorbidity on the healthcare experiences of people living with persistent musculoskeletal (MSK) pain or rheumatoid arthritis (RA), and their ability to manage their conditions. Furthermore, it is unclear how the presence of multimorbidity in those with persistent MSK pain or RA influences HCP management approaches. Our study uses qualitative methods to answer:• How does multimorbidity affect self-management and the capacity to cope in those living with persistent musculoskeletal pain or RA?• What are HCPs experiences of treating and managing patients with persistent MSK pain or RA and multimorbidity?

Approach

This study, conducted in Scotland, is ongoing. We are interviewing 80 patients living with persistent MSK pain or RA with and without multimorbidity, and 40 HCPs. This abstract reports preliminary findings from interviews with 20 patients and 17 HCPs. Analysis draws on two inter-related theoretical frameworks - Burden of Treatment Theory and Normalisation Process Theory which focus on the ‘work’ done by patients and HCPs.

Findings

Key points in patient interviews (5 MSK pain, 15 RA), which describe the onerous work that patients do to manage their conditions, include: (1) planning work needed to manage medical appointments and medication routinely and during exacerbations; (2) challenges faced by patients with work and family commitments; (3) monitoring work required to balance multiple conditions.Key points from the HCP interviews (seven GPs, a practice nurse, a rheumatology consultant, three pain medicine consultants, a pain specialist nurse, a psychologist, a pharmacist, and two physiotherapists) include: (1) poor and limited treatment options for MSK pain; (2) challenge of managing pain relief and avoiding analgesic addiction; (3) crucial importance of improving patient understanding, managing expectations, and encouraging ownership; (4) added complexity from multimorbidity and associated polypharmacy; (5) patients’ ability to adhere to treatment is affected by a multitude of factors that may be personal, lifestyle related, social or organisational.

Consequences

These preliminary findings highlight the challenges faced by patients with MSK pain or RA and their HCPs, including the demanding work involved in monitoring and managing treatment, made more difficult by polypharmacy, work or family commitments, and limited treatment options available.Our findings will be used to inform policy and the development of interventions to help patients and HCPs manage persistent MSK pain or RA in the context of multimorbidity.