Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.
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DOI：
10.1111/j.1526-4637.2009.00707.x
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Damush TM
中科院分区：
文献类型：
--
作者：
Bair MJ;Matthias MS;Nyland KA;Huffman MA;Stubbs DL;Kroenke K;Damush TM
确定慢性肌肉骨骼疼痛的自我管理的障碍和促进者。一项定性研究使用焦点小组方法退伍军人事务部(VA)和大学初级保健诊所在参与了一项临床试验-阶梯式情感障碍和肌肉骨骼疼痛(SCAMP)试验后招募，测试了针对患有慢性疼痛和抑郁的初级保健患者的优化抗抑郁治疗结合疼痛自我管理计划的干预与常规护理的干预。来自焦点小组数据的主题内容分析被用来确定患者对慢性肌肉骨骼疼痛自我管理的感知障碍和促进者。患者(N=18)年龄27-84岁(男性=54.8岁)，女性占61%，白人占72%，黑人占22%。疼痛自我管理的障碍包括：1)缺乏朋友和家人的支持；2)有限的资源(如交通、经济)；3)抑郁；4)止痛策略无效；5)时间限制和其他生活优先事项；6)由于担心疼痛加剧而避免活动；7)缺乏针对个人需求的量身定制的策略；8)完成学习后无法继续使用策略；9)身体限制；以及10)难以与医生进行互动。改善疼痛自我管理的促进者包括1)护士护理经理的鼓励；2)通过治疗改善抑郁；3)支持家人和朋友；4)提供不同的自我管理策略菜单供使用。需要未来的研究来证实这些发现，并设计干预措施，利用已确定的促进者，同时解决疼痛自我管理的障碍。
To identify barriers and facilitators to self-management of chronic musculoskeletal pain among patients with comorbid pain and depression. A qualitative study using focus group methodology Veteran Affairs (VA) and University primary care clinics Recruited after participation in a clinical trial The Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) trial tested an intervention of optimized anti-depressant therapy combined with a pain self-management program versus usual care for primary care patients with comorbid chronic pain and depression. Thematic content analysis from focus group data was used to identify patient-perceived barriers and facilitators to self-management of chronic musculoskeletal pain. 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. 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.
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影响因子：
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作者：
COULEHAN, JL;SCHULBERG, HC;ARENA, VC
通讯作者：
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DOI：
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影响因子：
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