Barriers and Facilitators to Chronic Pain Self-Management: A Qualitative Study of Primary Care Patients with Comorbid Musculoskeletal Pain and Depression

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

doi:10.1111/j.1526-4637.2009.00707.x

Cited by 259Musculoskeletal pain and rehabilitationPain Management and Opioid UsePediatric Pain Management Techniques

Barriers and Facilitators to Chronic Pain Self-Management: A Qualitative Study of Primary Care Patients with Comorbid Musculoskeletal Pain and Depression

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Bair, Matthew J., Matthias, Marianne S., Nyland, Kathryn A., Huffman, Monica A., Stubbs, DaWana L., Kroenke, Kurt, Damush, Teresa M.·2009·Pain Medicine

DOI 10.1111/j.1526-4637.2009.00707.xPMC PMC2884223

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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.

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Undesirable physical and emotional symptoms and impaired physical functioning can directly prevent patients from carrying out normal daily activities, including tasks required to appropriately and successfully self-manage.
“As such, undesirable physical and emotional symptoms and impaired physical functioning can directly prevent patients from carrying out normal daily activities, including tasks required to appropriately and successfully self-manage [139–141].”
From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [139]

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Authors: Bair, M. J., Matthias, M. S., Nyland, K. A., Huffman, M. A., Stubbs, D. L., Kroenke, K., & Damush, T. M.
Affiliations: Richard L. Roudebush VA Medical Center (US)
Health Services Research & Development (US)
Indiana University Indianapolis (US)
Corresponding author: Bair, Matthew J.
ORCID: Bair, Matthew J.
Matthias, Marianne S.
Kroenke, Kurt
Damush, Teresa M.
Venue: Pain Medicine
Publisher: Oxford University Press (OUP)
Published: 2009-10
Volume: 10
Issue: 7
Pages: 1280-1290
ISSN: 1526-2375 (ISSN-L)
1526-4637
DOI: 10.1111/j.1526-4637.2009.00707.x
PMC: PMC2884223
OpenAlex: W1986073191
Cited by: 259
References: 42
Citations by year: 2026: 14 · 2025: 12 · 2024: 12 · 2023: 17 · 2022: 20 · 2021: 26 · 2020: 18 · 2019: 30 · 2018: 16 · 2017: 10 · 2016: 19 · 2015: 18 · 2014: 14 · 2013: 15 · 2012: 10
FWCI: 4.09
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: doi.wiley.com/10.1002/tdm_license_1 (tdm, 2161 d)
Locations: Pain Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
IUScholarWorks (Indiana University) (submittedVersion)
Funders: National Institute of Mental Health (MH 071268, R01MH071268)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: musculoskeletal pain, depression, comorbidities, barriers and facilitators, primary care patients, patient support, family support, nurse care managers, patient-physician interaction, fear-avoidance beliefs, antidepressant treatment
MeSH terms: Adult, Aged, Aged, 80 and over, Attitude to Health, Chronic Disease, Depression, Female, Humans, Indiana, Male, Middle Aged, Musculoskeletal Diseases, Primary Health Care, Self Care, Comorbidity, Arthralgia

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Barriers and Facilitators to Chronic Pain Self-Management: A Qualitative Study of Primary Care Patients with Comorbid Musculoskeletal Pain and Depression

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