An Expanded View of Self-Management: Patients' Perceptions of Education and Support in an Intervention for Chronic Musculoskeletal Pain

Marianne S. Matthias, Edward J. Miech, Laura J. Myers, Christy Sargent, Matthew J. Bair

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives. Chronic pain is prevalent, costly, and is associated with profound psychological effects. Although pain is prevalent in returning veterans of the recent military conflicts in Afghanistan and Iraq (Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn [OEF/OIF/OND] Veterans), little is known about chronic pain in these patients. This study's objective was to ascertain perceptions of a multicomponent intervention tested in a randomized controlled trial for OEF/OIF/OND veterans with chronic musculoskeletal pain (Evaluation of Stepped Care for Chronic Pain [ESCAPE]). Design. Qualitative interviews were conducted with 26 patients in the intervention arm of ESCAPE (21% of total intervention patients) to determine patients' experiences with and perceptions of the intervention. Patients were purposefully sampled to include treatment responders (defined as ≥30% reduction in pain-related disability or pain severity), nonresponders, and noncompleters (completed <50% of trial). Qualitative analysis was guided by grounded theory. Results. Both responders and nonresponders discussed the importance of the self-management education they received. Of particular significance, patients identified the nurse care manager who administered the intervention as being integral to patients' ability to self-manage their chronic pain. Patients described important ways in which the nurse facilitated their self-management, reported under three themes: 1) helping patients find what works for their pain; 2) holding patients accountable for their pain management; 3) motivating and providing emotional support to patients. Conclusions. Results corroborate previous work and suggest that current conceptualizations of self-management are incomplete. A model is proposed that not only depicts self-management as involving more than activities and strategies, but also acknowledges the central role of relationships and support in pain self-management.

Original languageEnglish (US)
Pages (from-to)1018-1028
Number of pages11
JournalPain Medicine (United States)
Volume13
Issue number8
DOIs
StatePublished - Aug 2012

Fingerprint

Musculoskeletal Pain
Patient Education
Self Care
Chronic Pain
2003-2011 Iraq War
Veterans
Afghan Campaign 2001-
Pain
Pain Management
Nurses
Afghanistan
Iraq
Aptitude
Randomized Controlled Trials
Interviews

Keywords

  • Chronic pain
  • Patient-provider communication
  • Qualitative research
  • Self-management
  • Veterans

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

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title = "An Expanded View of Self-Management: Patients' Perceptions of Education and Support in an Intervention for Chronic Musculoskeletal Pain",
abstract = "Objectives. Chronic pain is prevalent, costly, and is associated with profound psychological effects. Although pain is prevalent in returning veterans of the recent military conflicts in Afghanistan and Iraq (Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn [OEF/OIF/OND] Veterans), little is known about chronic pain in these patients. This study's objective was to ascertain perceptions of a multicomponent intervention tested in a randomized controlled trial for OEF/OIF/OND veterans with chronic musculoskeletal pain (Evaluation of Stepped Care for Chronic Pain [ESCAPE]). Design. Qualitative interviews were conducted with 26 patients in the intervention arm of ESCAPE (21{\%} of total intervention patients) to determine patients' experiences with and perceptions of the intervention. Patients were purposefully sampled to include treatment responders (defined as ≥30{\%} reduction in pain-related disability or pain severity), nonresponders, and noncompleters (completed <50{\%} of trial). Qualitative analysis was guided by grounded theory. Results. Both responders and nonresponders discussed the importance of the self-management education they received. Of particular significance, patients identified the nurse care manager who administered the intervention as being integral to patients' ability to self-manage their chronic pain. Patients described important ways in which the nurse facilitated their self-management, reported under three themes: 1) helping patients find what works for their pain; 2) holding patients accountable for their pain management; 3) motivating and providing emotional support to patients. Conclusions. Results corroborate previous work and suggest that current conceptualizations of self-management are incomplete. A model is proposed that not only depicts self-management as involving more than activities and strategies, but also acknowledges the central role of relationships and support in pain self-management.",
keywords = "Chronic pain, Patient-provider communication, Qualitative research, Self-management, Veterans",
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