Barriers to self-management of chronic pain in primary care: A qualitative focus group study

Abstract

Background Supported self-management is a recommended intervention for chronic pain. Effective self-management should enable an individual to reduce the impact of pain on their everyday life. Clinical guidelines suggest primary care services have a role to play in supporting self-management of chronic pain. Aim To examine the opinions of primary care healthcare professionals (HCPs) and people with chronic pain and their carers, in order to identify possible barriers to the facilitation and adoption of self-management. Design and setting A qualitative study using focus groups in locations throughout Scotland. Method Eighteen focus groups were held with patients and HCPs. Fifty-four patients, nine carers, and 38 HCPs attended the groups. Results Four categories of barriers were found. 1) Patient-HCP consultation: Some patients felt a discussion about self-management came too late or not at all. Communication and building positive relations were sometimes challenging. 2) Patient experience: The emotional impact of pain was difficult and patients often felt unsupported by HCPs. 3) Limited treatment options: Some participants felt there was a tendency for overmedicalisation. 4) Organisational constraints: Short appointment times, long waiting lists, and a compartmentalised NHS created challenges. Conclusion This study illustrates some of the barriers faced by HCPs and patients in the facilitation and adoption of self-management of chronic pain. If self-management is to be an important approach to chronic pain, primary care services need to be designed to address the barriers identified.