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Patients’ experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review
Open accessAbstract
BACKGROUND: Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload. AIM: To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain. DESIGN AND SETTING: Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC). METHOD: Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion. RESULTS: Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain. CONCLUSIONS: This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.
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“The way pain patients feel is often dismissed in health care [8,9].”
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“In spite of a number of recent studies in this area, however, in their meta-analysis, Bawa et al. demonstrated only limited evidence in support of mindfulness-based interventions for patients with chronic pain and called for more and better studies in this area [70, 71].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [71]
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Torrijos‐Zarcero, M., Mediavilla, R., Rodríguez‐Vega, B., Del Río‐Diéguez, M., López‐Álvarez, I., Rocamora‐González, C., & Palao‐Tarrero, Á. (2021) · European Journal of Pain · doi:10.1002/ejp.1734 · Cited by 71
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“While these experiences have similarities with adult populations with persistent musculoskeletal pain,33–37 what is striking is that young people are frequently the least likely to seek help or to access professional help for their pain,38 39 especially when they have comorbid mental health conditions.14 40 In this co…”
BackgroundQuality-of-Life in Achilles Tendinopathy: An Exploratory Study
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Meanings of "acceptance" for patients with long-term pain when starting rehabilitation
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“…“not real,” inexplicable and mental in nature and move away from the search for an elusive biomedical explanation/“fix” toward multimodal treatments 73 and clinical practices that are more patient-centered, efficient, and firmly grounded in contemporary (ie, bio-psychosocial) understanding of…”
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BackgroundOpioid deprescribing: Qualitative perspectives from those with chronic non-cancer pain
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Qualitative Evidence Synthesis
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“…of the lived experience of persistent pain reveal that patients feel that their report of pain is not believed by health care professionals (Toye et al., 2013; Toye et al., 2014) and that practitioners sometimes feel scepticism about the presence of chronic pain in patients revealing…”
Lyle, S., Williamson, E. M., Darton, F., Griffiths, F. E., & Lamb, S. E. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1177611 · Cited by 24
“[42,43] Despite persistent similarities with Toye et al’s [41] meta-ethnography, this paper illustrates the need for studies on chronic MSK conditions not to assume that older and younger people’s experiences can be conflated.”
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“[37]: participants felt let down by the health system, yet compelled to continue engaging with said system.”
BackgroundExploring the value of qualitative research films in clinical education
Toyé, F., Jenkins, S., Seers, K., & Barker, K. L. (2015) · BMC Medical Education · doi:10.1186/s12909-015-0491-2 · Cited by 20
“The themes from this review [28, 29] are summarised in Fig.”
BackgroundSelf-citationPragmatic but flawed: the NICE guideline on chronic pain
Eccleston, C., Aldington, D. J., Moore, A., & Williams, A. C. D. C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01058-8 · Cited by 19
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“Thus, patients are urged to fi nd the appropriate balance between expressing their pain to defend their right to treatment while concealing their pain to seem “normal” ( Toye et al., 2013 ).”
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“[ 20 – 23 , 39 – 42 , 44 , 48 , 49 , 51 , 52 ] ( L o n g - t e r m ) s y m p t o m s t h a t fl u c t u a t e , fl a r e u p , a n d a r e i n v i s i b l e o r un p r e d i c t a b l e i n t e r m s o f f r e q u e n c y a n d i n t e n s i t y a r e d e s c r i b e d a s t h e m o s t c h a ll e…”
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Lidocaine for postoperative pain after cardiac surgery: a systematic review
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Nitel Araştırmaların Analizi: Meta-Sentez
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“Some studies revealed that the patient’s perspective is linked to symptom relief and the healing process in general.(44,45,50) Along similar lines, it has been suggested that pediatricians’ beliefs about chronic pain are important for the course of treatment, including how they educate patients and families about pain.”
BackgroundNøst, T. H., Steinsbekk, A., Riseth, L., Bratås, O., & Grønning, K. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2668-3 · Cited by 13
“The informants’ descriptions of living with chronic pain were similar to findings in other studies [7, 16, 17, 38], and therefore not elaborated on here.”
Result“Power of Storytelling”: A Content Analysis of Chronic Pain Narratives on YouTube
Devan, H., Elphick-laveta, T., Lynch, M., MacDonell, K., Marshall, D. C., Tuhi, L., & Grainger, R. (2021) · Canadian Journal of Pain · doi:10.1080/24740527.2021.1929117 · Cited by 13
“The causes of chronic pain are multifactorial and are frequently misunderstood by both health practitioners and the public.(4) Furthermore, due to the often invisible nature of the condition, people living with chronic pain can be marginalized by society and clinicians and their realities minimized.”
BackgroundGoldman, R. E., Broderick, J. E., Junghaenel, D. U., Bolton, A., May, M., Schneider, S., & Stone, A. A. (2021) · Frontiers in Pain Research · doi:10.3389/fpain.2021.692567 · Cited by 13
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Beyond the binaries: reshaping pain communication through arts workshops
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Narratives of life with long-term low back pain: A follow up interview study
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“struggling to prove legitimacy of pain, struggling to maintain sense of self in spite of pain) was present (Toye et al. 2013).”
BackgroundYu, L., Scott, W., Goodman, R., Driscoll, L., & McCracken, L. (2021) · British Journal of Pain · doi:10.1177/2049463721994863 · Cited by 10
“17 The specific objectives were (1) to examine previously supported two-factor structures for the SEQ and reduce items using CFA, (2) to examine the reliability and validity of the newly validated, shorter SEQ, (3) to examine whether scores from the shorter SEQ appear sensitive to change after the treatment, and wheth…”
Long, J., Briggs, M., Long, A., & Astin, F. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.12998 · Cited by 11
“Health professionals have an important role in helping people come to terms with diagnosis of a LTC (Toye et al. 2013) and the study provides qualitative evidence of the potential benefits of MMIs in equipping patients to accept and manage LTCs more effectively.”
BackgroundSelf-citationPatients' experiences of living with persistent back pain
van Griensven, H. (2015) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2015.03.003 · Cited by 10
Incorporating personal narratives in positive psychology interventions to manage chronic pain
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Casey, M., Smart, K. M., Hearty, C., Lowry, D., & Doody, C. (2019) · Physiotherapy Practice and Research · doi:10.3233/ppr-180120 · Cited by 9
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Rolin-Gilman, C., Fournier, B., & Cleverley, K. (2017) · Pain Management Nursing · doi:10.1016/j.pmn.2017.03.002 · Cited by 9
Nizza, I. E., Smith, J. A., & Kirkham, J. A. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.901271 · Cited by 11
Mohrsen, A., Sørensen, T., Lund, H., Rasmussen, S. Z., Jensen, A., Skov, K. B., & Rathleff, M. (2024) · International Journal of Sports Physical Therapy · doi:10.26603/001c.92908 · Cited by 8
“Play!”: Combatting Pathocentric Epistemic Injustice in Chronic Pain Care
Charette, M. (2024) · Qualitative Health Research · doi:10.1177/10497323241300437 · Cited by 8
“These economies are pervasive in the case of chronic pain (Buchman et al., 2017; Della Croce, 2023; Toye et al., 2013).”
Okuhara, T., Okada, H., Yokota, R., & Kagawa, Y. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.109402 · Cited by 10
A Qualitative Examination of Pain Centrality Among Veterans of Iraq and Afghanistan Conflicts
Outcalt, S. D., Nicolaidis, C., Bair, M. J., Myers, L. J., Miech, E. J., & Matthias, M. S. (2016) · Pain Medicine · doi:10.1093/pm/pnw137 · Cited by 8
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Should Physicians Disclose Their Own Health Challenges? Perspectives of Patients With Chronic Pain
Chang, H. A., Iuliano, K. R., Tackett, S. A., Treisman, G. J., Erdek, M. A., & Chisolm, M. S. (2022) · Journal of Patient Experience · doi:10.1177/23743735221128675 · Cited by 7
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Healthcare priorities in patients with chronic facial pain of temporomandibular disorders
Taimeh, D., Ríordáin, R. N., Fedele, S., & Leeson, R. (2022) · Oral Diseases · doi:10.1111/odi.14483 · Cited by 7
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Parents’ and Teachers’ Perceptions of Physical Activity in Schools: A Meta-Ethnography
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“Despite the controversy surrounding the quality appraisal of qualitative studies (Eakin & Mykhalovskiy, 2003), studies must provide an adequate description of the concepts and be methodologically sound (Campbell et al., 2011; Toye et al., 2013).”
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“First-person research suggests that individuals living with persistent (chronic) pain bene fi t from approaches that validate their pain through meaningful explanations so that they feel their personal stories are heard and acknowledged (49, 82).”
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“Qualitative studies support the complexity of the condition and describe living with chronic musculoskeletal pain as an “adversarial struggle on multiple levels” including sense of body and self, “time, relationships and health care” (Toye et al., 2013).”
The suffering of chronic pain patients on a wait list: Are they amenable to narrative therapy?
Carr, E., McCaffrey, G., & Ortiz, M. (2017) · Canadian Journal of Pain · doi:10.1080/24740527.2017.1316173 · Cited by 5
“835).(43) There continues to be emphasis on initiatives to improve patient–physician communication, because”
BackgroundSelf-citationRönne-Petersén, L., Niemi, M., Walach, H., Lavebratt, C., Yang, L. L., Gerdle, B., Ghafouri, B., & Falkenberg, T. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308924 · Cited by 4
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Naeem, H. (2025) · Philosophy & Technology · doi:10.1007/s13347-025-00988-0 · Cited by 5
“As a result, patients often feel disbelieved and misunderstood (Tosas, 2021; Toye et al., 2013 ), compounding their suffering and hindering treatment.”
Liddiard, K. J., Brown, C. A., & Raynor, A. J. (2024) · Healthcare · doi:10.3390/healthcare12161655 · Cited by 4
“A reasonable hypothesis was that the experience of rehabilitation as personally meaningful may be reflected in the circumstances of how therapy was resolved [72].”
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“Patients frequently feel their pain is not taken seriously and that unique cultural, social, and individual experiences that place pain in a broader existential context are overlooked (Nichols et al., 2020; Srikesavan et al., 2023; Toye et al., 2013, 2014, 2017a, 2017b, 2022).”
Exploring the experiences of individuals living with persistent pain using a visual art diary
Lou, J. C., Pourkazemi, F., & Mackenzie, L. A. (2022) · British Journal of Occupational Therapy · doi:10.1177/03080226221079239 · Cited by 4
“Pain signals can wholly capture an individual’s attention, often leading to repeated internalisation of the perceived threat of pain and potentially damaging their personal identity (Toye et al., 2013).”
BackgroundDudley, M., Olson, R. E., Mescouto, K. A., & Setchell, J. (2024) · Health Sociology Review · doi:10.1080/14461242.2024.2350501 · Cited by 4
“In the confessional context of doctor-patient interactions (Mayes, 2009), patients professed to clinicians their status as a ‘ good person ’ (Toye et al., 2013) and active member of society by discussing their work, or aspirations to be physically active and independent.”
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Gormsen, L. K. (2025) · Journal of Pain Research · doi:10.2147/jpr.s508125 · Cited by 3
“Furthermore, they describe their pain in broken sentences, taking a little break to gain time to express her-/himself more accurately, the pain patient Carl said: Yes… it is many things.”
Kealy, E., & Hebron, C. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2300400 · Cited by 3
“This fear may represent the journey of uncertainty that they have been on, while trying to gain answers for their pain, which has often left them feeling invalidated (Toye et al., 2013, 2021; Toye, Seers, Hannink, and Barker, 2017).”
Hedén, L., Berglund, M., & Gillsjö, C. (2020) · Journal of Aging Research · doi:10.1155/2020/7597524 · Cited by 3
Metadata
- Authors
- Toye, F., Seers, K., Allcock, N., Briggs, M., Carr, E., Andrews, J., & Barker, K.
- Affiliations
- University of Warwick (GB)
- Glasgow Caledonian University (GB)
- Leeds Beckett University (GB)
- University of Calgary (CA)
- Nuffield Orthopaedic Centre (GB)
- Venue
- British Journal of General Practice
- Published
- 2013-12
- Volume
- 63
- Issue
- 617
- Pages
- e829-e841
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3839392
- OpenAlex
- W2091768352
- Cited by
- 156
- References
- 119
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 14 · 2023: 18 · 2022: 18 · 2021: 18 · 2020: 10 · 2019: 6 · 2018: 6 · 2017: 12 · 2016: 13 · 2015: 4 · 2014: 5
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- ResearchOnline (submittedVersion)
- Funders
- National Institute for Health and Care Research (09/2001/09, PDA/01/05/010)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Social Sciences › Arts and Humanities › History and Philosophy of Science › Medicine, History, and Philosophy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- patient experience, self-affirmation, pain coping, legitimacy, patient-provider partnership, conceptual model, primary care
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Aged, Aged, 80 and over, Humans, Interpersonal Relations, Middle Aged, Patient Acceptance of Health Care, Self Concept, Stress, Psychological, Qualitative Research, Young Adult, Chronic Pain, Musculoskeletal Pain
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