Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

A qualitative study of professional stakeholders’ perceptions about the implementation of a stepped care pain platform for people experiencing chronic widespread pain

Authors: Judith Gellatly, Gosia Pelikan, Paul Wilson, Kate Woodward-Nutt, Michael Spence, Anthony Jones, Karina Lovell

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Chronic widespread pain (CWP) is a major public health problem. Many people experiencing CWP experience mental health problems such as anxiety or depression. Complete relief of skeletal and body pain symptoms is unlikely but with appropriate treatment the impact upon quality of life, functioning and mental health symptoms can be reduced. Cognitive behavioural therapy (CBT) is widely used for a range of health conditions and can have short and long-term improvements in patients with CWP. This research aimed to explore, from a professional stakeholder perspective, the implementation of a local Pain Platform offering a stepped care approach for interventions including telephone delivered CBT (T-CBT).

Methods

Fourteen professional stakeholders holding various roles across primary and secondary care services within the Pain Platform took part in semi-structured interviews. Their views and experiences of the implementation of the Pain Platform were explored. Interviews were recorded, transcribed verbatim and analysed according to Normalisation Process Theory (NPT).

Results

Professional stakeholders were positive about the Pain Platform and its potential to overcome previously identified existing access issues to psychological interventions for CWP patients. It was considered a valuable part of ensuring that patients’ preferences and needs are more readily addressed. In some circumstances, however, introducing psychological interventions to patients was considered challenging and the introduction of new referral processes was raised concerns. To ensure sustainability more work is required to reduce professional isolation and ensure efficient referral procedures between primary and secondary care services are established to reduce concerns over issues related to clinical governance and potential risk to patient.

Conclusions

The findings provide professional insight into the key challenges of introducing a Pain Platform incorporating psychological support across primary and secondary care services within a local service. These included development of sustainable procedures and closer working relationships. Areas requiring future development are identified.
Literature
1.
2.
Parsons S, Harding G, Breen A, Foster N, Pincus T, Vogel S, Underwood M. The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: a systematic review of qualitative studies. Clin J Pain. 2007;23(1):91–8.CrossRefPubMed
3.
Kato K, Sullivan PF, Evengård B, Pedersen NL. Chronic widespread pain and its comorbidities: a population-based study. Arch Intern Med. 2006;166(15):1649–54.CrossRefPubMed
4.
Morales-Espinoza EM, Kostov B, Salami DC, Perez ZH, Rosalen AP, Molina JO, LG-de P, JMS M, Àreu JB, Brito-Zerón P, Ramos-Casals M, Sisó-Almirall a. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care. Pain. 2016;157(4):818–26.CrossRefPubMed
5.
Toblin RL, Mack KA, Perveen G, Paulozzi LJ. A population-based survey of chronic pain and its treatment with prescription drugs. Pain. 2011;152(6):1249–55.CrossRefPubMed
6.
Nicholl BI, Macfarlane GJ, Davies KA, Morriss R, Dickens C, McBeth J. Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain – results from the EPIFUND study. Pain. 2009;141(1–2):119–26.CrossRefPubMedPubMedCentral
7.
Becker N, Bondegaard Thomsen A, Olsen AK, Sjøgren P, Bech P, Eriksen J. Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain. 1997;73(3):393–400.CrossRefPubMed
8.
White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample. J Rheumatol. 2002;29(3):588–94.PubMed
9.
Benjamin S, Morris S, McBeth J, Macfarlane GJ, Silman AJ. The association between chronic widespread pain and mental disorder: a population-based study. Arthritis and Rheum. 2000;43(3):561–7.CrossRef
10.
11.
Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67.CrossRefPubMedPubMedCentral
12.
Macfarlane GJ, Beasley M, Prescott G, McNamee P, Keeley P, Artus M, McBeth J, Hannaford P, Jones GT, Basu N, Norrie J, Lovell K. The maintaining musculoskeletal health (MAmMOTH) study: protocol for a randomised trial of cognitive behavioural therapy versus usual care for the prevention of chronic widespread pain. BMC Musculoskelet Di. 2016;17:179.CrossRef
13.
14.
Bergman S, Herrström P, Jacobsson LT, Petersson IF. Chronic widespread pain: a three year follow-up of pain distribution and risk. J Rheumatol. 2002;29(4):818–25.PubMed
15.
Lawson K. Treatment options and patient perspectives in the management of fibromyalgia: future trends. Neuropsych Dis Treat. 2008;4(6):1059–71.CrossRef
16.
Foster NE, Pincus T, Underwood MR, Vogel S, Breen A, Harding G. Understanding the process of care for musculoskeletal conditions—why a biomedical approach is inadequate. Rheumatology. 2003;42:401–3.PubMed
17.
Chew-Graham C, May C. Chronic low back pain in general practice: the challenge of the consultation. Fam Pract. 1999;16:46–9.CrossRefPubMed
18.
19.
20.
Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults. excluding headache Pain. 1999;80(1):1–13.PubMed
21.
McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, McNamee P, Symmons DPM, Woby S, Gkazinou C, Beasley M, Macfarlane GJ. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med. 2012;172(1):48–57.CrossRefPubMed
22.
Beasley M, Prescott GJ, Scotland G, McBeth J, Lovell K, Keeley P, Hannaford PC, Symmons DPM, MacDonald RIR, Woby S, Macfarlane GJ. Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial. RMD Open. 2015;1:e000026. https://​doi.​org/​10.​1136/​rmdopen-2014-000026.CrossRefPubMedPubMedCentral
23.
Romanelli M. New Technologies for Sustainable Health Care. In: Borangiu T, Dragoicea M, Nóvoa H, editors. Exploring Services Science. IESS 2016. Lecture Notes in Business Information Processing, vol. 247: Springer, Cham.
24.
Barnett J, Vasileiou K, Djemil F, Brooks L, Young T. Understanding innovators' experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: a qualitative study. BMC Health Serv Res. 2011;11(1):342.CrossRefPubMedPubMedCentral
25.
Nilsen P. Making sense of implementation theories, models and frameworks. Implelemt Sci. 2015;10:53.CrossRef
26.
May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, Murray E, Elwyn G, Légaré F, Gunn J, Montori V. Development of a theory of implementation and integration: normalization process theory. Implement Sci. 2009;4(29) https://​doi.​org/​10.​1186/​1748-5908-4-29.
27.
Teddlie C, Yu F. Mixed methods sampling: a typology with examples. J Mix Method Res. 2007;1(1):77–100.
28.
QSR International Pty Ltd NVivo qualitative data analysis Software: Version 11.4.1 [computer program]. 2017.
29.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
30.
Glaser BG. The constant comparative method of qualitative analysis. Soc Probl. 1965;12(4):436–45.CrossRef
31.
Royal College of Practitioners. The 2022 GP: a vision for general practice in the future NHS. London: Royal College of General Practitioners; 2013.
32.
Gupta A, Silman A, Ray D, McBeth J. The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study. Rheumatology. 2007;46:666–71.CrossRefPubMed
33.
McBeth J, Macfarlane GJ, Benjamin S, Silman AJ. Features of somatization predict the onset of chronic widespread pain: results of a large population-based study. Arthritis and Rheumatol. 2001;44:940–6.CrossRef
34.
Ojala T, Ha kkinen a, Karppinen J, Sipila K, Suutama T, Piirainen a. Chronic pain affects the whole person – a phenomenological study. Disability and rehabilitation article in Disabil Rehabil. 2014;37(4):1–9.
35.
Glennon P. Reports on the rheumatic diseases. In: Fibromyalgia syndrome: management in primary care, vol. 6. Chesterfield: Arthritis Research UK; 2010.
36.
Chaudhary N, Longworth S, Sell PJ. Management of mechanical low back pain: a survey of beliefs and attitudes from GPs in Leicester and Nottingham. Eur Gen Pract. 2004;110:71–2.CrossRef
37.
Upshur CC, Luckmann RS, Savageau JA. Primary care providerconcerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21:652–5.CrossRefPubMedPubMedCentral
38.
Stannard C, Johnson M. Chronic pain management--can we do better? An interview-based survey in primary care. Curr Med Res Opin. 2003;19:703–6.CrossRefPubMed
39.
Hadi MA, Alldred DP, Briggs M, Marczewski K, Closs SJ. 'Treated as a number, not treated as a person': a qualitative exploration of the perceived barriers to effective pain management of patients with chronic pain. BMJ Open. 2017;7(6):e016454.CrossRefPubMedPubMedCentral
40.
Lau R, Stevenson F, Ong BN, Dziedzic K, Treweek S, Eldridge S, Everitt H, Kennedy A, Qureshi N, Rogers A, Peacock R, Murray E. Achieving change in primary care--causes of the evidence to practice gap: systematic reviews of reviews. Implement Sci. 2016;11:40.CrossRefPubMedPubMedCentral
41.
Coalition for Collaborative Care. Personalised care and support planning handbook: The journey to person-centred care. England: NHS; 2015.
42.
Breen A, Austin H, Campion-Smith CE, Mann E. “You feel so hopeless”: a qualitative study of GP management of acute back pain. Eur J Pain. 2007;11:21–9.CrossRefPubMed
Metadata
Title
A qualitative study of professional stakeholders’ perceptions about the implementation of a stepped care pain platform for people experiencing chronic widespread pain
Authors
Judith Gellatly
Gosia Pelikan
Paul Wilson
Kate Woodward-Nutt
Michael Spence
Anthony Jones
Karina Lovell
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0838-y

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue

Research article

The effect of a new lifetime-cardiovascular-risk display on patients’ motivation to participate in shared decision-making

Research article

Health professional perceptions regarding screening tools for developmental surveillance for children in a multicultural part of Sydney, Australia

Research article

Initiation and cessation of mental healthcare after mental health screening in primary care: a prospective cohort study

Research article

Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis

Research article

Safety work and risk management as burdens of treatment in primary care: insights from a focused ethnographic study of patients with multimorbidity

Research article

Irish general practitioners' view of perinatal mental health in general practice: a qualitative study