Managing people with persistent musculoskeletal pain and distress in the primary care consultation

Conference:

2021 SAPC North (virtual)

Talk Code:

2B.4

Presenter:

Noureen Shivji

Co-authors:

Noureen Shivji1, Hollie Birkinshaw2 Adam Geraghty3, Helen Johnson1, Paul Little3, Michael Moore3, Beth Stuart3, Alexander Minshull4, Tamar Pincus2, Carolyn A. Chew-Graham1,5-6

Author institutions:

1School of Medicine, Keele University 2Department of Psychology, Royal Holloway, University of London 3Faculty of Medicine, University of Southampton 4School of Psychology, University of Birmingham 5 Midlands Partnership NHS Foundation Trust 6NIHR Applied Research Collaboration (ARC) West Midlands

Background:

Musculoskeletal pain impacts on a person’s quality of life and is commonly presented to primary care. Low mood and distress are commonly reported with persistent pain and may be labelled as ‘depression’. It is important to understand how pain-related distress is conceptualised and managed by people with pain and general practitioners (GPs). This will help GPs build on strategies that people have found useful.

The approach:

Qualitative methods with semi-structured interviews conducted via telephone or using virtual software (‘’Microsoft Teams’’), exploring how people with pain and GPs perceive pain-related distress, whether this is different to ‘depression’, and how it might be managed. Multiple methods of recruitment were utilised, interviews were digitally recorded, transcribed with consent, and analysed thematically using constant comparison techniques. A patient advisory group and a GP stakeholder group contributed to the study design and data analysis.

Findings:

Participants described challenges distinguishing distress and depression when the person also has pain. Some people described a sense of helplessness and despair when living with persistent pain; others reported how self-management involved acceptance of the situation, creating a new identity, and optimism about the future. GPs expressed uncertainty about how to manage people with pain and distress within the primary care consultation, with therapeutic nihilism expressed. GPs talked about the need to move away from reliance on medication, in accordance with NICE guidance, but acknowledged that interventions to replace drugs are key.

Implications:

The consultation is the cornerstone of general practice, ‘a meeting between experts’, which, in the case of persistent pain, challenges both patient and GP. Findings inform the strategies that people with persistent pain use to manage their pain and mood and offers suggestions to GPs about how to manage people with pain and distress within the primary care consultation.

Funding acknowledgement:

Versus Arthritis funds the ‘De-STRESS pain’ study