Pain management for chronic musculoskeletal conditions: the development of an evidence-based and theory-informed pain self-management course
Open accessAbstract
OBJECTIVE: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. DESIGN: We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. SETTING: Primary care in the inner city of London, UK. PARTICIPANTS: Adults (18 years or older) with chronic musculoskeletal pain. OUTCOMES: Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. RESULTS: The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. CONCLUSIONS: The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received.
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Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.
“Supportive self-management approaches are well established in the management of several chronic painful disorders, but this is not the case for chronic headache disorders.15–17”
From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [15]
The Introduction describes self-management courses as an approach used for chronic musculoskeletal pain and notes investment in such programmes. It also calls the evidence of effectiveness equivocal, so it does not establish their benefits; nor does the paper address whether supportive self-management is established for chronic headache disorders (searched: headache, migraine). (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrevious studies of this nature have reported that a usual care control arm was not an incentive to join the study.
“Previous studies of this nature have reported that a usual care control arm was not an incentive to join the study.15”
From Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: A randomised controlled trial protocol (CHESS) (2020) · cites this paper as [15]
The Results section reports difficult recruitment and suggests participation might be higher outside a research study, but does not link this to a usual-care control arm. The Phase III methods describe an uncontrolled pilot; the paper’s mention of usual care concerns treatment effectiveness, not an incentive to join. Searches for a usual-care control arm and recruitment incentives found no supporting passage. (LLM, conf=0.77)
Experimental — accuracy not yet measured17 of the 27 included studies used the MRC 2000 framework, the updated 2008 version, or a combination of the two.
“In particular, 17 of the 27 studies included in this review used the MRC 2000 framework, the updated 2008 version or a combination of the two [24–40].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [25]
A number of included studies adopted quantitative methods such as fractional factorial experiments, economic modelling, small uncontrolled pilot studies (with no control group), experimental 2×2 randomised controlled trials, probability models and evaluation questionnaires.
“A number of studies adopted quantitative methods such as fractional factorial experiments [10, 44], economic modelling [33], small uncontrolled pilot studies (with no control group) [25, 29, 38], experimental 2 × 2 randomised controlled trials [45, 46], probability models [49, 50] and evaluation questionnaires [43].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [25]
The majority of included studies (n = 16) subsequently refined the intervention to then test the optimised version within pilot studies or full-scale RCTs.
“The majority of studies (n = 16) subsequently refined the intervention to then test the optimised version of the intervention within pilot studies or full-scale RCTs [24–32, 34, 38–40, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [25]
Six included studies evaluated more than one element; they explored the acceptability to different stakeholders together with either the intervention's effectiveness or cost-effectiveness.
“Six studies evaluated more than one element; in particular, they explored the acceptability to different stakeholders together with either the intervention’s effectiveness [25, 26, 28, 35, 38] or cost-effectiveness [33].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [25]
Factorial experiments, uncontrolled pilot studies and probability models tended to be used to test specific components and to identify an intervention's potential effect.
“For example, factorial experiments, uncontrolled pilot studies and probability models tended to be used to test specific components and to identify an intervention’s potential effect [10, 25, 29, 38, 44, 49, 50].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [25]
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- Authors
- Carnes, D., Homer, K., Underwood, M., Pincus, T., Rahman, A., & Taylor, S. J. C.
- Affiliations
- Queen Mary University of London (GB)
- University of Warwick (GB)
- Royal Holloway University of London (GB)
- University College London (GB)
- Corresponding author
- Carnes, Dawn
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2013-11
- Volume
- 3
- Issue
- 11
- Pages
- e003534
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3831098
- OpenAlex
- W2155087785
- Cited by
- 26
- References
- 40
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 4 · 2017: 1 · 2016: 7 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 2.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0707-10189, NF-SI-0512-10103)
- Programme Grants for Applied Research
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic musculoskeletal pain, pain self-management, behaviour change theory, social learning theory, cognitive-behavioral approach, MRC framework for complex interventions, feasibility, group intervention, relaxation, social integration, coping, anxiety and depression, health care utilization, quality of life
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