Health care providers' experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study
Open accessAbstract
BACKGROUND: Chronic pain constitutes a significant burden for the individuals affected, and is a frequent reason why patients seek health care services. While in-person psychosocial interventions can be of support to people living with chronic pain, such interventions are not always accessible. eHealth interventions may provide greater accessibility, but the evidence and use of digital self-management solutions for chronic pain are still limited and the lack of health care provider input in the development process of such solutions a concern. Therefore, the aim of the current study was to investigate health care providers' experiences of treating patients with chronic pain, their attitudes towards, and use of, digital solutions in pain management, and their suggestions for content and design elements for a potential digital pain self-management intervention. METHODS: Twelve health care providers representing a variety of health care disciplines participated in semi-structured interviews. The interviews were analyzed using thematic analysis. RESULTS: The material was analyzed into three main themes: [1] Patients with chronic pain and their current use of the health care services, [2] Health care providers' own motivation and impression of patient prerequisites for use of digital self-management interventions, and [3] Suggestions for content and design elements in a digital self-management intervention for people living with chronic pain. The challenges faced by patients living with chronic pain were described as numerous. Despite interest and positive attitudes, few of the health care providers had used or recommended eHealth solutions to their patients. A range of potential content and functionality elements were identified, including aspects of motivation and engagement and providers also emphasized the importance of easy access and positive, personal content to support existing treatment. CONCLUSIONS: This study offers insights into health care providers' considerations for the potential of digital self-management interventions supporting patients living with chronic pain. Findings indicate the need for change and a more comprehensive treatment approach to pain management. eHealth solutions may contribute to such change, and providers pointed to a need for health care provider involvement, timely support and follow-up as important factors for integrating digital pain self-management interventions into clinical care. TRIAL REGISTRATION: ClinicalTrials.gov : NCT03705104.
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EPIO was designed and developed in close collaboration with researchers, eHealth experts, end users, and health care providers.
“The EPIO intervention was designed and developed in close collaboration with researchers, eHealth experts, end users, and health care providers [29-31].”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [31]
The Methods (Study design and participants) say that interviews with patients, spouses, and health care providers informed the intervention’s design and development, and that the research team had eHealth development expertise. The Discussion (Future implications) says these studies provided input toward the intervention cited as EPIO in reference 73. The paper supports stakeholder input, but does not establish the claimed close collaboration among all four groups throughout EPIO’s design and development. (LLM, conf=0.82)
Experimental — accuracy not yet measuredExisting digital pain management interventions have challenges including limited theoretical basis, limited user involvement, attrition/adherence problems, limited efficacy testing particularly beyond 3 months, and limited implementation planning.
“Challenges with existing digital pain management interventions nevertheless include limited or lack of theoretical basis19,75; limited or lack of user (ie, people with chronic pain and health care providers) involvement during the design and development processes60; challenges with program attrition/adherence2,41; limited efficacy testing/evidence of effect,38,61 particularly from trials longer”
From Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO (2024) · cites this paper as [60]
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Engaging with EPIO, a digital pain self-management program: a qualitative study
Bostrøm, K., Varsi, C., Eide, H., Børøsund, E., Kristjansdottir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Nordang, E. F., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07963-x · Cited by 18 · see citing works
Bostrøm, K., Børøsund, E., Eide, H., Varsi, C., Kristjansdottir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Stavenes Støle, H., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/47284 · Cited by 12 · see citing works
“More detailed information about the design and development of the EPIO intervention program has been presented elsewhere [29-31].”
Jang, S., Lee, B., Lee, E., Kim, J., Lee, J. I., Lim, J., Hwang, J. H., & Jang, S. (2023) · Journal of Pain Research · doi:10.2147/jpr.s388757 · Cited by 14 · see citing works
McDermott, K. A., Presciutti, A., Levey, N., Brewer, J. R., Rush, C. L., Giraldo‐Santiago, N., Pham, T. V., Pasinski, R., Yousif, N., Gholston, M., et al. (2024) · Journal of Pain Research · doi:10.2147/jpr.s471477 · Cited by 12 · see citing works
“17,23,24 Meanwhile, medical staff report understanding the difficulty of living with chronic pain 25 while experiencing frustration with patients’ lack of willingness to acknowledge psychosocial contributors to pain.”
Eiken, A.-G., Nordanger, D. Ø., Nes, L. S., & Varsi, C. (2022) · JMIR Formative Research · doi:10.2196/34458 · Cited by 11 · see citing works
“The design, development, and feasibility pilot-testing of EPIO have been published elsewhere [41-44], and a large-scale randomized controlled efficacy trial is currently ongoing.”
BackgroundMethodEngagement in Digital Self-management Interventions for Chronic Pain
MacLean, R. R., Shor, R., Reilly, E. D., Reuman, L., Solar, C. A., Halat, A. M., & Higgins, D. M. (2025) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001289 · Cited by 11 · see citing works
“17 As such, interventions requiring little to no clinician contact are of particular importance because these programs reach individuals with chronic pain with minimal impact on clinician time, staff training, treatment costs, and other patient-level logistical concerns.”
Bonotis, P., Angelidis, P., & Natsiavas, P. (2025) · JMIR Human Factors · doi:10.2196/57342 · Cited by 8 · see citing works
“Participants also raised concerns about HCPs’ ability to respond promptly to MyPal reports due to their busy schedules, which could affect the UX of patients, aligning with previous research on chronic pain monitoring [31].”
McCartney, H., Main, A., Weir, N., Kaur, H., Ibrar, M., & Maguire, R. (2025) · Journal of Medical Internet Research · doi:10.2196/66457 · Cited by 8 · see citing works
“Previous literature has highlighted DHT as a solution to mitigate some of the issues surrounding chronic pain management, such as limited resources for care [18,19,23].”
InfluentialSolberg Nes, L., Børøsund, E., Varsi, C., Eide, H., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Støle, H. S., Kristjansdottir, Ó. B., Bostrøm, K., et al. (2024) · Pain Reports · doi:10.1097/pr9.0000000000001174 · Cited by 7 · see citing works
de la Vega, R., Serrano‐Ibáñez, E. R., Ruiz-Párraga, G. T., Palermo, T. M., Wicksell, R. K., Fernández-Jiménez, E., Oliva, S., Roldán, S., Monfort, L., Peláez, M. J., et al. (2023) · Digital Health · doi:10.1177/20552076231219490 · Cited by 7 · see citing works
“Several problems exist; health-care providers may not hold a positive attitude toward digital interventions, 18 and there is little connection between scien-ti fi cally validated interventions and availability to patients (e.g., the ones they can download from App stores or access through websites).”
BackgroundPenlington, C., Palmer, J., Martinez‐Telchi, D., Durham, J., Valentine, T. L., Casals, M. J., & Oyarzo, J. F. (2023) · Journal of Oral Rehabilitation · doi:10.1111/joor.13587 · Cited by 5 · see citing works
manejo del dolor crónico –no oncológico–: un reto bioético emergente
Domínguez, D. C. (2022) · Medicina y Ética · doi:10.36105/mye.2022v33n2.06 · Cited by 5 · see citing works
“Today, chronic pain represents a social call for humanity to participate actively and concretely for the benefit of the dignity of the human being (69, 70).”
BackgroundRush, C. L., Brewer, J. R., Levey, N., Presciutti, A., McDermott, K. A., Pasinski, R., Yousif, N., Gholston, M., Raju, V., Greenberg, J., et al. (2024) · Family & Community Health · doi:10.1097/fch.0000000000000416 · Cited by 5 · see citing works
“…our findings are in keeping with previous studies, which have both highlighted the importance of patient engagement in the intervention process, while also reporting on low engagement and participation 11 as well as the impact of lack of access to resources as a potential barrier to engagement.”
Corline, A., Cole, F., Trewern, L., & Penlington, C. (2023) · British Journal of Pain · doi:10.1177/20494637231152979 · Cited by 5 · see citing works
Walton, D. M., Bobos, P., & MacDermid, J. C. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.03.013 · Cited by 4 · see citing works
Zhang, W., Chin, K., Zakaria, R., & Hassan, N. H. (2025) · Healthcare · doi:10.3390/healthcare13090994 · Cited by 4 · see citing works
“Stan-dardising study methods, including pain assessment and reporting, allows for relevant comparisons and high-quality evidence synthesis.”
Eather, C.-E., Sterling, M. M., Sullivan, C. M., & Elphinston, R. A. (2024) · Pain · doi:10.1097/j.pain.0000000000003441 · Cited by 3 · see citing works
Brewer, J. R., McDermott, K. A., Greenberg, J., Presciutti, A., Camera, D. L., Ritchie, C. S., & Vranceanu, A. (2024) · Pain Management · doi:10.1080/17581869.2024.2432852 · Cited by 3 · see citing works
Bilgin, A., Öcalan, S., & Kovancı, M. S. (2025) · Journal of Religion and Health · doi:10.1007/s10943-025-02251-4 · Cited by 3 · see citing works
Strand, E. B., Varsi, C., Børøsund, E., Eide, H., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Støle, H. S., Kristjánsdóttir, Ó. B., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1540852 · Cited by 2 · see citing works
“…attrition (Amagai et al., 2022; Ludden et al., 2015), limited evidence of intervention efficacy both in the short and particularly long-term (Lee et al., 2018; Moman et al., 2019; Thurnheer et al., 2018), and limited intervention implementation into actual practice post study (Varsi et al., 2019).”
Cruz, M., Pinho, S., Castro‐Lopes, J. M., & Sampaio, R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0273213 · Cited by 2 · see citing works
McCartney, H., Main, A., Ibrar, M., Kaur, H., Weir, N., & Maguire, R. (2024) · JMIR Research Protocols · doi:10.2196/51311 · Cited by 3 · see citing works
“It may also help in reducing waiting lists for care [23].”
BackgroundInfluentialStochkendahl, M. J., Nicholl, B. I., Wood, K., Mair, F. S., Mork, P. J., Søgaard, K., & Rasmussen, C. D. N. (2025) · Digital Health · doi:10.1177/20552076241313159 · Cited by 1 · see citing works
“7,8 The implementation of DHIs for LBP has been studied from patients ’ perspectives.”
Harding, R. P., Passaportis, M. J. R., Miles, E., & Matcham, F. (2026) · Journal of Health Psychology · doi:10.1177/13591053251406436 · Cited by 1 · see citing works
“We did not incorporate the perspective of HCPs who play an influential role in informing and encouraging self-management among this population (Varsi et al., 2021).”
PENGARUH TERAPI MUSIK PADA PASIEN KANKER PARU DENGAN NYERI KRONIK
Komalawati, D. (2021) · Afiat · doi:10.34005/afiat.v7i2.2135 · Cited by 1 · see citing works
Oraison, H. M., Loton, D. J., & Kennedy, G. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20196844 · Cited by 1 · see citing works
“Depression may act as a demotivator for attending treatments [38], as it is related to fearful cognitions [6] and associated with reduced physical activity and increased fear avoidance [27] and catastro-phizing [39], all contributing to lower levels of attendance for treatments.”
BackgroundUpdating Ways and Enhancing Pain Management Efficiencies among Healthcare
Alsubaie, M., AlDossary, N., Yaaquop, N., Arishi, O., Alshahrani, S., & Almutairi, F. (2022) · International Journal for Scientific Research · doi:10.59992/ijsr.2022.v1n2p11 · Cited by 1 · see citing works
Engaging with EPIO, a digital pain self-management program: A qualitative studyPreprint
Bostrøm, K., Varsi, C., Eide, H., Børøsund, E., Kristjánsdóttir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Nordang, E. F., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-952389/v1 · Cited by 1 · see citing works
Mohd-Zuki, A.-H., Isa, M., & Suddin, L. S. (2022) · Journal of Public Health Issues and Practices · doi:10.33790/jphip1100202
Kim, H. H., Lee, J., Kim, J. H., Beck, S. S., & Park, Y. R. (2023) · doi:10.2196/preprints.47485
Bendelin, N. (2023) · Linköping University medical dissertations · doi:10.3384/9789180750288
Zarska, A., Slat, S., Kehne, A., Macleod, C., Rye, H., Dehmlow, C., Hilliard, P., Jaffe, K., & Lagisetty, P. (2023) · Journal of Pain Research · doi:10.2147/jpr.s402354
Samonte, M. J. (2023) · International Conference on Industrial Engineering and Operations Management (IEOM) · doi:10.46254/na07.20220111
“…al. 2021; Koumpouros 2021; Shah and Chiew 2019; Slepian et al. 2020) while there are some that focused on web applications (Oldenmenger et al. 2017; Richardson et al. 2021; Tipprom et al. 2018) because it allowed users to access the system on multiple devices or platforms (Oldenmenger et al. 2017;…”
UPDATING WAYS AND ENHANCING PAIN MANAGEMENT EFFICIENCIES AMONG HEALTHCARE
Almohammadi, A. H., Althalabi, A. J. K., Alyami, S. S. H., Musawa, A. A. Y., akkam, N. M. Y., Adawi, A. M. H., Marwani, M. A. H., Balol, A. T., garwi, A. M. H., Alqahtani, M., et al. (2022) · doi:10.53555/jptcp.v29i04.5685
Cruz, M., Durães, M. I., Azevedo, P., Carvalhal, C., Pinho, S., & Sampaio, R. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175207
“This idea has emerged in a previous study [16].”
BackgroundResultInfluentialNisa, Z. U., Munir, H., & Hussain, S. (2025) · medtigo Journal of Medicine · doi:10.63096/medtigo30623127
Pain Education and Preparation Across Health Care Professions: A Scoping Review
Baloy, R. (2025) · Journal of Innovation in Health Sciences Education · doi:10.46409/003.ktwc7116
Ma, J., Chen, H., Ma, J., Fan, L., Liang, J., Tan, J., Yan, Y., Huang, L., Yang, H., & Yin, L. (2025) · British Journal of Hospital Medicine · doi:10.12968/hmed.2024.1042
Velvin, G., Johansen, H., & Bostrøm, K. (2025) · Scientific Reports · doi:10.1038/s41598-025-16184-1 · Cited by 1 · see citing works
“Communicating barriers, combined with a limited expertise among healthcare professionals in supporting symptoms management 35,69,70,79 , may contribute to the underrecognition and undertreatment of pain and fatigue.”
Sørensen, M. M., Jäger, M., & Stochkendahl, M. J. (2025) · Chiropractic & Manual Therapies · doi:10.1186/s12998-025-00604-0
“When the apps are validated and backed by evidence [7, 10, 12, 15–17], are easy to use [10, 11, 13, 14, 16, 17, 22], and personalised to the patient’s condition [10, 14, 16] HCPs perceive them as useful and beneficial, and a mean to improve patient compliance with treatment [16, 20].”
InfluentialAdditional file 1 of Engaging with EPIO, a digital pain self-management program: a qualitative study
Bostrøm, K., Varsi, C., Eide, H., Børøsund, E., Kristjánsdóttir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Nordang, E. F., et al. (2022) · Figshare · doi:10.6084/m9.figshare.19687094
Malichewe, C. V., Yoram, F., Lyamai, J. T. J., Mkusa, V., Kiwango, G., Nyongole, O. V., & Sirili, N. S. (2026) · PLoS ONE · doi:10.1371/journal.pone.0342485
Elsabbagh, L., & Woo, K. (2026) · Journal of Primary Care & Community Health · doi:10.1177/21501319251415124
Ramirez, C., Torres, E., Ortega, P., & Mendes, S. (2025) · International Journal of Social and Psychological Aspects of Healthcare · doi:10.51847/iexzitn688
Sadia, H., & Rafique, F. (2026) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.1080/15360288.2026.2676628
Delivery Model Matters for Digital Interventions in Pain Self-Management: Mixed Methods Study
Nes, L. S., Børøsund, E., Nordang, E. F., Asbjørnsen, R. A., Eide, H., Varsi, C., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Støle, H. S., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/89780
“The design and development of the EPIO program was consequently informed by evidence, with pervasive end user and health care provider input throughout and the inclusion of personalization aspects to support engagement and adherence [16,25,26].”
Taccardi, D., Suárez, N. R. E., Shah, S., Daly-Cyr, J., LeBlanc, A., Ghasemlou, N., Cooper, L., Bosma, R., & Roy, R. (2026) · Canadian Journal of Pain · doi:10.1080/24740527.2026.2696249
The use of eHealth in primary physiotherapy care: a mixed-method study
Agger, N., Nørregaard, M. B., & Christiansen, D. H. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2719949
Yamin, J. B., Grahl, A., Anzolin, A., Doan, T. D. N., Ellis, S., Gardiner, L., Hewardt, I., Lee, S. A., Lee, J., Kelley, J. M., et al. (2026) · Pain Management · doi:10.1080/17581869.2026.2740677
Pursley, M., Maguire, R., Mavroeidi, A., Main, A., McCartney, H., & Mitchell, F. (2026) · doi:10.2196/preprints.112588
- Authors
- Varsi, C., Ledel Solem, I. K., Eide, H., Børøsund, E., Kristjansdottir, O. B., Heldal, K., Waxenberg, L. B., Weiss, K. E., Schreurs, K. M. G., Morrison, E. J., Stubhaug, A., & Solberg Nes, L.
- Affiliations
- Oslo University Hospital (NO)
- Sunnaas sykehus (NO)
- University of Florida (US)
- University of Washington (US)
- University of Twente (NL)
- Mayo Clinic (US)
- Corresponding author
- Varsi, Cecilie
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2021-03-25
- Volume
- 21
- Issue
- 1
- Pages
- 275-275
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC7992849
- OpenAlex
- W3137947372
- Cited by
- 53
- References
- 91
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 9 · 2023: 11 · 2022: 9 · 2021: 2
- FWCI
- 8.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Twente Research Information (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Duo Research Archive (University of Oslo) (submittedVersion, cc-by)
- University of Twente Research Information (submittedVersion, other-oa)
- Funders
- Norges Forskningsråd (256574)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- chronic pain, digital self-management intervention, e-health, pain management, health care access, patient engagement, psychosocial interventions
- MeSH terms
- Self-Management, Attitude, Health Personnel, Humans, Qualitative Research, Chronic Pain, Pain Management
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