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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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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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“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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Metadata
- 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.
- 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
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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