Abstract
Background – Patients with unexplained chronic musculoskeletal pain (CMP) can be difficult to help, consulting a range of services before consulting specialist pain services. Conflicts between the explanatory models for illness used by patients and health professionals might contribute to this complex ‘career path’, increasing the likelihood of unsatisfactory outcomes for both practitioners and patients.
Purpose – To explore the understanding of the experiences of diagnosis and management amongst patients who attended a specialist musculoskeletal pain clinic.
Method – Potential participants were sent a postal questionnaire 6–20 months after their first clinic attendance. Data was collected on pain presence, severity and location, health related quality of life and care seeking behaviour. Questionnaire data was used to inform combined purposive and theoretical sampling. In-depth interviews were conducted which probed participants’ understanding of their CMP and its management. Data was analysed using FRAMEWORK.
Results – 15 patients were interviewed. Four main themes were identified; a) spoiled identity – were pain limited patients activities so much that this affected their sense of self; b)Diminishing faith in medicine – Patients were disappointed with aspects of their care seeking experience; c) Making sense of pain – Patients made sense of their pain by locating their pain within the context of their lives; d) Learning to live with the pain – An issue for all patients was whether or not their pain would go.
Conclusion – Developing, implementing and evaluating approaches to address patients’ spoiled identity might allow us to improve patient centred outcomes in CMP.
Correspondence should be addressed to SBPR c/o Royal college of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
