Addressing distress in people with persistent musculoskeletal pain: A qualitative study to inform intervention development.
Problem
Musculoskeletal pain is one of the most common presentations in primary care. People with persistent musculoskeletal pain often experience low mood and distress, which is frequently labelled as depression. However, research has found that pain-related distress is qualitatively different to depression; distress is directly associated with the pain and its impact upon daily life. Previous qualitative analysis has identified that pain-related distress in people with musculoskeletal pain is primarily facilitated by uncertainty regarding the pain both currently and in the future, feeling stuck, and a lack of support. The De-STRESS pain study aims to develop an intervention to address pain-related distress in people with persistent musculoskeletal pain. In this qualitative study, key factors that should be included in an intervention were explored.
Approach
Semi-structured interviews were conducted either by telephone or over Microsoft Teams with both people living with persistent musculoskeletal pain and general practitioners (GPs.) The topic guide was developed iteratively as data collection progressed. The interviews explored participants’ views and recommendations of key components that should comprise an intervention to address distress in people with persistent musculoskeletal pain. Interviews were recorded, transcribed, and analysed using thematic analysis and constant comparison techniques. A Patient and Public Involvement and Engagement group contributed to the interpretation of the findings.
Findings
Twenty-one people with persistent musculoskeletal pain and 21 GPs were interviewed. The key components discussed by participants were 1) integration and collaboration with a healthcare professional, and 2) communication, support and interaction with other people experiencing pain and distress. Firstly, both GPs and people with musculoskeletal pain emphasised the need for the intervention to be supported by a clinician, although this could be with a specialist nurse or first contact physiotherapist, rather than a GP. For people with pain, this integration would facilitate a sense of trustworthiness and being looked after in primary care, whilst for GPs, this allowed them to be aware of and involved in the patients’ care despite having limited capacity. Secondly, people with pain emphasised the benefit that would come from being able to talk to others in a similar situation, and that the ability to share not only uncertainties and worries, but also positive strategies learnt through experience would assist in reducing distress associated with pain.
Consequences
The findings of this qualitative study emphasise the role of support both from clinicians and other people with pain in addressing pain-related distress. These will be a core basis on which the De-STRESS pain intervention will be developed.