Barriers and facilitators to chronic pain self-management: A qualitative study of primary care patients with comorbid musculoskeletal pain and depression

Matthew Bair, Marianne Matthias, Kathryn A. Nyland, Monica A. Huffman, DaWana L. Stubbs, Kurt Kroenke, Teresa Damush

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Objective: To identify barriers and facilitators to self-management of chronic musculoskeletal pain among patients with comorbid pain and depression. Design: A qualitative study using focus group methodology. Setting: Veteran Affairs (VA) and University primary care clinics. Patients: Recruited after participation in a clinical trial. Intervention: The Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) trial tested an intervention of optimized antidepressant therapy combined with a pain self-management program versus usual care for primary care patients with comorbid chronic pain and depression. Outcome Measures: Thematic content analysis from focus group data was used to identify patient-perceived barriers and facilitators to self-management of chronic musculoskeletal pain. Results: Patients (N = 18) were 27 to 84 years old (M = 54.8), 61% women, 72% white, and 22% black. Barriers to pain self-management included: 1) lack of support from friends and family; 2) limited resources (e.g., transportation, financial); 3) depression; 4) ineffectiveness of pain-relief strategies; 5) time constraints and other life priorities; 6) avoiding activity because of fear of pain exacerbation; 7) lack of tailoring strategies to meet personal needs; 8) not being able to maintain the use of strategies after study completion; 9) physical limitations; and 10) difficult patient-physician interactions. Facilitators to improve pain self-management included 1) encouragement from nurse care managers; 2) improving depression with treatment; 3) supportive family and friends; and 4) providing a menu of different self-management strategies to use. Conclusions: Future research is needed to confirm these findings and to design interventions that capitalize on the facilitators identified while at the same time addressing the barriers to pain self-management.

Original languageEnglish
Pages (from-to)1280-1290
Number of pages11
JournalPain Medicine
Volume10
Issue number7
DOIs
StatePublished - Oct 2009

Fingerprint

Musculoskeletal Pain
Pain Management
Self Care
Chronic Pain
Primary Health Care
Depression
Focus Groups
Pain
Veterans
Mood Disorders
Antidepressive Agents
Fear
Nurses
Outcome Assessment (Health Care)
Clinical Trials
Physicians
Therapeutics

Keywords

  • Chronic Pain
  • Depression
  • Primary Care
  • Self-Management

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Barriers and facilitators to chronic pain self-management : A qualitative study of primary care patients with comorbid musculoskeletal pain and depression. / Bair, Matthew; Matthias, Marianne; Nyland, Kathryn A.; Huffman, Monica A.; Stubbs, DaWana L.; Kroenke, Kurt; Damush, Teresa.

In: Pain Medicine, Vol. 10, No. 7, 10.2009, p. 1280-1290.

Research output: Contribution to journalArticle

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