Spiritual Well-Being in People Living with Persistent Non-Cancer and Cancer-Related Pain.

CONTEXT: Existential and spiritual factors are known to play an important role in how people cope with disability and life-threatening illnesses such as cancer. However, comparatively little is known about the impact of pain on factors such as meaning and purpose in one's life and their potential roles in coping with pain. OBJECTIVES: The aim of this study was to determine spiritual well-being scores in people with persistent pain and to compare these with people with cancer and healthy controls. METHODS: We assessed 132 people with chronic pain, 74 people with cancer (49 with pain and 25 without pain) and 68 control participants using standardised measures of pain-related variables including pain intensity, physical function, mood and cognitions. Spiritual well-being was also assessed using a validated and widely used questionnaire, the Functional Assessment of Chronic Illness Therapy - Spirituality Scale (FACIT-Sp). RESULTS: Spiritual well-being scores were significantly lower in people with persistent pain when compared with controls and were no different when compared with people with cancer, including those who had cancer and pain. In addition, low levels of meaning and purpose were significant predictors of depression, anxiety, and stress across all groups. CONCLUSION: The findings demonstrate that persistent pain is associated with spiritual distress that is equal to those observed in people who have cancer. Furthermore, those who have higher levels of meaning and purpose are less likely to develop mood dysfunction when experiencing pain, indicating they may have a protective role.

Long-term outcomes from training in self-management of chronic pain in an elderly population: a randomized controlled trial.

This study compares the outcomes, from pretreatment to 1-year follow-up, of an outpatient, CBT-based pain self-management program (PSM) that included exercises, pain education, and pain coping strategies, with a control condition (exercise-attention control, EAC) that included exercises and a control for the attention of the treatment team. We previously reported short-term results (to 1-month follow-up) from the same study. This new paper considers the important issue of maintenance of treatment-related gains. The participants (n = 141) were a heterogeneous sample of ambulant, community-dwelling older adult patients with chronic pain (mean age: 73.90 [6.5] years [range: 65-87 years]). The long-term results indicate the pain self-management program group achieved and maintained significantly better results than the exercise-attention control group on the primary outcome, pain-related disability, as well as on usual pain, pain distress, depression, and fear-avoidance beliefs. The mean effect size for these gains by the pain self-management program group over the exercise-attention control group was 0.37 (range: 0.29-0.45), which is in the small effect size range. While statistically and clinically meaningful, these findings do indicate some weakening in effects over time but not to a significant degree. The study has implications for the provision of pain management interventions for community-dwelling older adults with chronic pain.

Self-management intervention for chronic pain in older adults: a randomised controlled trial.

This study compared an outpatient pain self-management (PSM) program, using cognitive-behavioural therapy and exercises, with 2 control conditions in 141 chronic pain patients aged > 65 years. Results immediately posttreatment indicated that relative to the Exercise-Attention Control (EAC) group, the PSM group was significantly improved on measures of pain distress, disability, mood, unhelpful pain beliefs, and functional reach. The mean effect size for these gains was 0.52 (range: 0.44-0.68). By 1-month follow-up, relative to the EAC group, the PSM group remained better on most measures. At the 1-month follow-up, relative to a Waiting List (usual care) (WL) group, the PSM group was significantly improved on measures of pain distress, disability, and unhelpful pain beliefs. The mean effect size for these variables was 0.69 (range: 0.56-0.83). Relative to the WL group, the EAC group made no significant gains on any of the measured variables. At 1-month follow-up, the mean proportion of reliably improved cases (across outcome variables) was 41% (range: 16-60%) for the PSM group, twice that of those who met this criterion in the 2 control conditions (and this difference was statistically significant). Similarly, significantly more (44%) of the PSM group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive-behavioural therapy-based PSM was more effective than exercises and usual care.

Patients' own accounts of sciatica: a qualitative study.

STUDY DESIGN.: Longitudinal qualitative interview study, nested within a back pain cohort study. OBJECTIVE.: Enhance the understanding of patients' own perspectives on living with sciatica to inform improvements in care and treatment outcomes. SUMMARY OF BACKGROUND DATA.: Reports of patients' own accounts of sciatica and its impact on daily life are still scarce. Research on back pain has shown that it is important to understand how people live with pain and how they perceive interactions with health care professionals and interpret interventions. These types of insights help to improve treatments and their acceptability to patients. METHODS.: In-depth qualitative interviews with 37 people at baseline and 6 and 12 months' follow-up. The interviews covered topics that were derived from the Illness Perceptions Questionnaire and allowed open-ended talk about people's experiences of pain. All interviews were tape-recorded, fully transcribed, and thematically analyzed. RESULTS.: People needed to make sense of sciatica through identifying a cause and having it clinically diagnosed. The impact of sciatic pain was seen to be constant, intense, and all-encompassing. Appreciation of this by clinicians was considered important, as well as the provision of clear information about treatment and prognosis. Expectations about treatment options varied between patients, and people balanced pain relief with adverse effects. CONCLUSION.: Our study highlights patients' own accounts of the distinctiveness, impact, and intrusiveness of their sciatic symptoms. Our findings emphasize the importance of leg pain in identifying a subgroup of back-pain patients more likely to have severe symptoms, be at risk of poor outcome, and who should be considered a priority for early diagnosis and management. Future management of sciatica needs to include listening to patients' stories, offering a credible physical assessment, explanation, and diagnosis of the condition. Explaining the limits to treatment is seen as positively contributing to the partnership between patients and clinicians.

GP attitudes and self-reported behaviour in primary care consultations for low back pain.

BACKGROUND: The implementation of guideline recommendations in primary care has become widespread. The treatment of low back pain (LBP) has followed suite. Research shows that the use of LBP guidelines is influenced by the believability of the underlying evidence, the GPs consultation style and uncertainties surrounding diagnosis and treatment. OBJECTIVE: To qualitatively examine the attitudes and self-reported behaviour of GPs in relation to guideline adherence for patients with LBP. METHOD: A mixed-method design combining a national UK-based survey of GPs and physiotherapists with an embedded qualitative study. This report focuses only on the GP interviews. We explored GPs' experience of managing LBP patients and the rationale for treatment offered to a patient described in a written vignette. All interviews were digitally recorded, fully transcribed and analysed using the constant comparative method. RESULTS: GPs encountered difficulties adhering to guideline recommendations for LBP patients. They experienced particular tensions between recommendations to stay active versus the expectation of being prescribed rest. GPs expressed that chronic LBP often poses an intractable problem requiring specialist advice. The perception that guideline recommendations are 'imposed' may create resistance, and the evidence base is not always considered believable. CONCLUSIONS: GPs acknowledge guideline recommendations but divergence occurs in implementation. This is due to GPs focussing on the whole person-not just one condition-and the importance of maintaining the doctor-patient relationship, which relies on effective negotiation of mutual perceptions and expectations. Further exploration on how consultation processes can be constructed to effectively combine evidence with patient-centred care is needed.

Living with low back pain-Stories of hope and despair.

Previous qualitative research has illustrated a range of issues about the daily life of people living with low back pain (LBP). In this paper, we consider the struggle between hope and despair through consideration of six people's narratives about their experiences of chronic LBP. The six cases were selected from a larger qualitative study of 37 patients in the UK, sampled from a prospective cohort of people consulting their general practitioner. These six cases were selected for particular focus as they exemplify the fluctuating emotions of hope and despair. A number of linked themes emerged which influenced the extent to which people oscillate between hope and despair, the most salient of which were 'uncertainty', 'impact on self', 'social context of living with pain', and 'worry and fear of the future'. It is clear from the narrative accounts that it is not only just physical pain that the back pain sufferer must endure, but also that the psychosocial implications pose an added and often complicated challenge. Health care practitioners should consider these fluctuating emotions of hope and despair in order to facilitate more patient-centred strategies for treatment.