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Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review
Francine Toye1, Kate Seers2, Nick Allcock3
1Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
Background:
Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload.
Aim:
To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain.
Design And Setting:
Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC).
Method:
Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion.
Results:
Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain.
Conclusions:
This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.
Insights
Patients with chronic musculoskeletal pain often experience it as an adversarial struggle to affirm self and navigate healthcare. Understanding this struggle helps improve patient care and partnerships.
Area of Science:
- Qualitative research synthesis
- Patient experience research
- Pain management
Background:
- Musculoskeletal (MSK) pain is a prevalent condition contributing significantly to primary care demands.
- Understanding patient experiences is crucial for effective pain management.
Purpose of the Study:
- To systematically review and integrate qualitative research findings.
- To enhance understanding of patients' experiences with chronic non-malignant MSK pain.
Main Methods:
- Meta-ethnography synthesis of qualitative studies.
- Searched six electronic databases (Medline, Embase, Cinahl, Psychinfo, Amed, HMIC) up to February 2012.
- Included full reports of qualitative studies on adult chronic non-malignant MSK pain experiences.
Main Results:
- Seventy-seven papers from 60 studies were included.
- A concept of pain as an adversarial struggle emerged, involving self-affirmation, reconstruction, explanation, healthcare negotiation, and legitimacy.
- Some patients also reported a sense of moving forward alongside pain.
Conclusions:
- The review offers a theoretical foundation for enhancing patient experience in MSK pain care.
- A conceptual model is presented to improve patient-provider collaboration.
- This model aims to validate patients' pain and support them in moving forward.
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