Funding The MUSICIAN trial was supported by an award from Arthritis Research UK, Chesterfield, UK. Grant number: 17292. The funding body approved the design of the study. They played no role in the collection, analysis, and interpretation of data or the writing of the manuscript.Peer reviewedPublisher PD

Bee, Penny

Lovell, Karina

MacFarlane, Gary J.

McBeth, John

BMC Musculoskeletal Disorders

English

PubMed

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.<br/

Mcbeth, John

Macfarlane, Gary

The University of Manchester - Institutional Repository

Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery.

Penny Bee

John McBeth

Gary J. MacFarlane

Karina Lovell

Springer - Publisher Connector

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

Southampton (e-Prints Soton)

Funding The MUSICIAN trial was supported by an award from Arthritis Research UK, Chesterfield, UK. Grant number: 17292. The funding body approved the design of the study. They played no role in the collection, analysis, and interpretation of data or the writing of the manuscript.Peer reviewe

The Open University

Managing chronic widespread pain in primary care : a qualitative study of patient perspectives and implications for treatment delivery

Crossref

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Managing chronic widespread pain in primary care : a qualitative study of patient perspectives and implications for treatment delivery

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The University of Manchester - Institutional Repository

Springer - Publisher Connector

Southampton (e-Prints Soton)

The Open University

Crossref

The University of Manchester - Institutional Repository

The University of Manchester - Institutional Repository