Pain Medicine. Volume 10 Issue 7, Pages 1280 - 1290

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

Matthew J. Bair, MD, MS,*†‡§ Marianne S. Matthias, PhD,* Kathryn A. Nyland, BS,* Monica A. Huffman, BS, ‡ DaWana L. Stubbs, MD, § Kurt Kroenke, MD,*†‡§ and Teresa M. Damush, PhD*†‡§
*VA Health Services Research & Development Center of Excellence on Implementation of Evidence-Based Practices; † Roudebush VA Medical Center, Indiana University Center for Health Services and Outcomes Research; ‡ Regenstrief Inc.; § Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA © 2009 American Academy of Pain Medicine

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.

Self-Management • Chronic Pain • Depression • Primary Care