Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Chronic pain: good management of practical pain control strategies is associated with being older, more health activated and having better mental health

Claire Budge 1 4 , Melanie Taylor 1 , Materoa Mar 2 , Chiquita Hansen 1 , Folole Fai 3
+ Author Affiliations
- Author Affiliations

1 THINK Hauora, 200 Broadway Avenue, Palmerston North 4410, New Zealand

2 Te Tihi o Ruahine Whānau Ora Alliance, 200 Broadway Avenue, Palmerston North 4410, New Zealand

3 MidCentral DHB, PO Box 2075, Palmerston North 4410, New Zealand

4 Corresponding author. Email: clairebudge@gmail.com

Journal of Primary Health Care 12(3) 225-234 https://doi.org/10.1071/HC19066
Published: 29 September 2020

Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Abstract

INTRODUCTION: Chronic pain affects a large proportion of the adult population and people in pain need to learn how to manage it in order to maintain quality of life.

AIM: This study aimed to examine how well people with long-term conditions make use of self-management strategies to control their pain, and to identify personal attributes associated with a higher degree of success.

METHODS: People with chronic pain who participated in the first phase of a longitudinal long-term conditions study in the MidCentral region made up the study sample (N = 326, response rate 21%). They completed a questionnaire by mail or online, which included items on pain management, general health, patient activation, experiences with general practice and demographics.

RESULTS: Pain control strategies were managed fairly well overall. Taking pain medication and avoiding caffeine, alcohol, heavy meals and exercise before bed were managed best, whereas sleep, relaxation breathing and remaining socially active were managed least well. A multiple regression analysis found higher scores on patient activation, self-rated overall pain management at home, mental health and older age (≥75 years) to be associated with better management.

DISCUSSION: This study identified pain control strategies that are managed well, and less well, outside of a specific intervention. Results highlight topics for discussion in consultations and identify areas where general practice could provide better self-management support, such as sleep and exercise. Better overall pain control strategy management was most strongly associated with patient activation; that is, a combination of knowledge, skills and confidence to manage health and health care that is amenable to intervention. Improving the level of activation in people with long-term conditions may enhance their use of pain control strategies.

KEYwords: Chronic pain; self-management; primary health care


References

[1]  NHC. Meeting the needs of people with chronic conditions. Wellington: National Health Committee; 2007. [cited 2020 June 24]. Available from: https://www.health.govt.nz/system/files/documents/publications/meeting-needs-chronic-conditions-feb07.pdf

[2]  Watkins E, Wollan PC, Melton LJ, et al. Silent pain sufferers. Mayo Clin Proc. 2006; 81 167–71.
Silent pain sufferers.Crossref | GoogleScholarGoogle Scholar | 16471069PubMed |

[3]  Health Navigator. Chronic pain. 2018. [cited 2019 June 12]. Available from: https://www.healthnavigator.org.nz/health-a-z/c/chronic-pain/

[4]  Dominick C, Blyth F, Nicholas M. Patterns of chronic pain in the New Zealand population. N Z Med J. 2011; 124 63–76.
| 21946879PubMed |

[5]  Ministry of Health. Annual data explorer 2016/17: New Zealand Health Survey [data file]. [cited 2019 June 30]. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2016-17-new-zealand-health-survey

[6]  Hariharan J, Lamb GC, Neuner JM. Long-term opioid contract use for chronic pain management in primary care practice: a five year experience. J Gen Intern Med. 2007; 22 485–90.
Long-term opioid contract use for chronic pain management in primary care practice: a five year experience.Crossref | GoogleScholarGoogle Scholar | 17372797PubMed |

[7]  McGhie J, Grady K. Where now for UK chronic pain management services? Br J Anaesth. 2016; 116 159–62.
Where now for UK chronic pain management services?Crossref | GoogleScholarGoogle Scholar | 26787786PubMed |

[8]  Davis JA, Robinson RL, Le TK, et al. Incidence and impact of pain conditions and comorbid illnesses. J Pain Res. 2011; 4 331–45.
Incidence and impact of pain conditions and comorbid illnesses.Crossref | GoogleScholarGoogle Scholar | 22090802PubMed |

[9]  Shipton EA. Recognition of the vocational practice of the scope of Pain Medicine in New Zealand. N Z Med J. 2012; 126 5–8.
| 23385829PubMed |

[10]  Swain N, Parr-Brownlie LC, Thompson BL, et al. Six things you need to know about pain. N Z Med J. 2018; 131 5–8.
| 30496161PubMed |

[11]  Smith BH, Torrance N. Management of chronic pain in primary care. Curr Opin Support Palliat Care. 2011; 5 137–42.
Management of chronic pain in primary care.Crossref | GoogleScholarGoogle Scholar | 21415754PubMed |

[12]  MacKichan F, Paterson C, Britten N. GP support for self-care: the views of people experiencing long-term back pain. Fam Pract. 2013; 30 212–8.
GP support for self-care: the views of people experiencing long-term back pain.Crossref | GoogleScholarGoogle Scholar | 23042439PubMed |

[13]  Lukewich J, Mann E, WanDenKerkhof E, et al. Self-management support for chronic pain in primary care: a cross-sectional study of patient experiences and nursing roles. J Adv Nurs. 2015; 71 2551–62.
Self-management support for chronic pain in primary care: a cross-sectional study of patient experiences and nursing roles.Crossref | GoogleScholarGoogle Scholar | 26118587PubMed |

[14]  Cramm JM, Nieboer AP. Disease management: the need for a focus on broader self-management abilities and quality of life. Popul Health Manag. 2015; 18 246–55.
Disease management: the need for a focus on broader self-management abilities and quality of life.Crossref | GoogleScholarGoogle Scholar | 25607246PubMed |

[15]  Grady PA, Gough LL. Self-management: a comprehensive approach to management of chronic conditions. Am J Public Health. 2014; 104 e25–31.
Self-management: a comprehensive approach to management of chronic conditions.Crossref | GoogleScholarGoogle Scholar | 24922170PubMed |

[16]  Devan H, Hale L, Hempel D, et al. What works and does not work in a self-management intervention for people with chronic pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2018; 98 381–97.
What works and does not work in a self-management intervention for people with chronic pain? Qualitative Systematic Review and Meta-Synthesis.Crossref | GoogleScholarGoogle Scholar | 29669089PubMed |

[17]  Turner BJ, Ogbeide S. Self-management of chronic pain: a plan for primary care. Pract Pain Manag. 2018; 18 45–50.

[18]  Lorig KR, Holman HR. Self-management education: history, definition, outcomes and mechanisms. Ann Behav Med. 2003; 26 1–7.
Self-management education: history, definition, outcomes and mechanisms.Crossref | GoogleScholarGoogle Scholar | 12867348PubMed |

[19]  Bemis L, Harper B, Molla-Hosseini S. Self-management strategies for chronic pain reported in population-based surveys: a systematic review. Final Report. The University of Arizona; 2017. [cited 2019 July 31]. Available from: https://repository.arizona.edu/handle/10150/624027

[20]  Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med. 2018; 52 1543–4.
Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?Crossref | GoogleScholarGoogle Scholar | 29941618PubMed |

[21]  Wanlass R, Fishman D. Strategy wheel. [cited 2019 July 20]. Available from: http://www.ucdmc.ucdavis.edu/nursing/Research/INQRI_Grant/strategy_wheel/index.html

[22]  Bair MJ, Robinson RL, Katon W, et al. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003; 163 2433–45.
Depression and pain comorbidity: a literature review.Crossref | GoogleScholarGoogle Scholar | 14609780PubMed |

[23]  Gambassi G. Pain and depression: the egg and the chicken story revisited. Arch Gerontol Geriatr. 2009; 49 103–12.
Pain and depression: the egg and the chicken story revisited.Crossref | GoogleScholarGoogle Scholar | 19836622PubMed |

[24]  Gordon K, Rice H, Allcock N, et al. Barriers to self-management of pain in primary care: a qualitative focus group study. Br J Gen Pract. 2017; 67 e209–17.
Barriers to self-management of pain in primary care: a qualitative focus group study.Crossref | GoogleScholarGoogle Scholar | 27993899PubMed |

[25]  Bair MJ, Matthias MS, Nyland KA, et al. Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression. Pain Med. 2009; 10 1280–90.
Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.Crossref | GoogleScholarGoogle Scholar | 19818038PubMed |

[26]  Swain N, Johnson M. Chronic pain in New Zealand: a community sample. N Z Med J. 2014; 127 21–30.
| 24481383PubMed |

[27]  Jerant AF, von Friederichs-Fitzwater MM, Moore M. Patients’ perceived barriers to self-management of chronic conditions. Patient Educ Couns. 2005; 57 300–7.
Patients’ perceived barriers to self-management of chronic conditions.Crossref | GoogleScholarGoogle Scholar | 15893212PubMed |

[28]  Dixon A, Hibbard J, Tussler M. How to people with different levels of activation self-manage their chronic conditions? Patient. 2009; 2 257–68.
How to people with different levels of activation self-manage their chronic conditions?Crossref | GoogleScholarGoogle Scholar | 22273246PubMed |

[29]  Health Foundation. Helping people helping themselves: a review of the evidence considering whether it is worthwhile to support self management. London: Health Foundation; 2011. [cited 2019 August 1]. Available from: https://www.health.org.uk/sites/default/files/HelpingPeopleHelpThemselves.pdf

[30]  Hays RD, Bjorner J, Revicki RA, et al. Development of physical and mental health summary scores from the Patient Reported Outcomes Measurement Information System (PROMIS) global items. Qual Life Res. 2009; 18 873–80.
Development of physical and mental health summary scores from the Patient Reported Outcomes Measurement Information System (PROMIS) global items.Crossref | GoogleScholarGoogle Scholar | 19543809PubMed |

[31]  Hibbard JH, Mahoney ER, Stockard J, et al. Development and testing of a short form of the Patient Activation Measure. Health Serv Res. 2005; 40 1918–30.
Development and testing of a short form of the Patient Activation Measure.Crossref | GoogleScholarGoogle Scholar | 16336556PubMed |

[32]  Zwier G. A standardized and validated patient survey in primary care: introducing the New Zealand General Practice Assessment Questionnaire. N Z Med J. 2013; 126 47–54.
| 23793177PubMed |

[33]  Ministry of Health. Content Guide 2013/14: New Zealand Health Survey. Wellington: Ministry of Health; 2014. [cited 2019 August 1]. Available from: https://www.health.govt.nz/system/files/documents/publications/content-guide-2013-14-nzhs-dec14-v3.pdf

[34]  National Institute for Health and Care Excellence. Guideline Scope. Chronic pain: assessment and management. London, England; 2020. [cited 2020 June 24]. Available from: https://www.nice.org.uk/guidance/gid-ng10069/documents/final-scope

[35]  Budge C, Carryer J, Boddy J. Learning from people with chronic pain: messages for primary care practitioners. J Prim Health Care. 2012; 4 306–12.
Learning from people with chronic pain: messages for primary care practitioners.Crossref | GoogleScholarGoogle Scholar | 23205380PubMed |

[36]  Molton I, Jensen MP, Ehde DM, et al. Coping with chronic pain amongst younger, middle-aged and older adults living with neurological injury and disease. J Aging Health. 2008; 20 972–96.
Coping with chronic pain amongst younger, middle-aged and older adults living with neurological injury and disease.Crossref | GoogleScholarGoogle Scholar | 18791184PubMed |

[37]  Cheatle MD, Foster S, Pinkett A, et al. Assessing and managing sleep disturbance in patients with chronic pain. Anesthesiol Clin. 2016; 34 379–93.
Assessing and managing sleep disturbance in patients with chronic pain.Crossref | GoogleScholarGoogle Scholar | 27208716PubMed |

[38]  Jank R, Gallee A, Boeckle M, et al. Chronic pain and sleep disorders in primary care. Pain Res Treat. 2017; 2017 9081802
Chronic pain and sleep disorders in primary care.Crossref | GoogleScholarGoogle Scholar | 29410915PubMed |

[39]  Koffel E, Kroenke K, Bair MJ, et al. The bidirectional relationship between sleep complaints and pain: analysis of data from a randomized trial. Health Psychol. 2016; 35 41–9.
The bidirectional relationship between sleep complaints and pain: analysis of data from a randomized trial.Crossref | GoogleScholarGoogle Scholar | 26076002PubMed |

[40]  Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: a biopsychosocial approach. Musculoskeletal Care. 2017; 15 413–21.
Exercise for chronic musculoskeletal pain: a biopsychosocial approach.Crossref | GoogleScholarGoogle Scholar | 28371175PubMed |

[41]  Bee P, McBeth J, MacFarlane GJ, et al. Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery. BMC Musculoskelet Disord. 2016; 17 354
Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery.Crossref | GoogleScholarGoogle Scholar | 27549811PubMed |

[42]  Daenen L, Varkey E, Kellmann M, et al. Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying Science to Practice. Clin J Pain. 2015; 31 108–14.
Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying Science to Practice.Crossref | GoogleScholarGoogle Scholar | 24662498PubMed |

[43]  Smith BE, Hendrick P, Bateman M, et al. Musculoskeletal pain and exercise—challenging existing paradigms and introducing new. Br J Sports Med. 2019; 53 907–12.
Musculoskeletal pain and exercise—challenging existing paradigms and introducing new.Crossref | GoogleScholarGoogle Scholar | 29925503PubMed |

[44]  Solomon M, Wagner SL, Goes J. Effects of a web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial. J Med Internet Res. 2012; 14 e32
Effects of a web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 22353433PubMed |

[45]  Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 2013; 32 207–14.
What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs.Crossref | GoogleScholarGoogle Scholar |

[46]  Greene J, Hibbard JH, Sacks R, et al. When patient activation levels change, health outcomes and costs change too. Health Aff (Millwood). 2015; 34 431–7.
When patient activation levels change, health outcomes and costs change too.Crossref | GoogleScholarGoogle Scholar | 25732493PubMed |

[47]  Francis H, Carryer J, Wilkinson J. Patient expertise: contested territory in the realm of long term condition care. Chronic Illn. 2019; 15 197–209.
Patient expertise: contested territory in the realm of long term condition care.Crossref | GoogleScholarGoogle Scholar | 29466874PubMed |

[48]  Mosen DM, Schmittdiel J, Hibbard J, et al. Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage. 2007; 30 21–9.
Is patient activation associated with outcomes of care for adults with chronic conditions?Crossref | GoogleScholarGoogle Scholar | 17170635PubMed |

[49]  Lee YK, Ng CJ, Low WY. Addressing unmet needs of patients with chronic diseases: impact of the VISIT website during consultations. J Eval Clin Pract. 2017; 23 1281–8.
Addressing unmet needs of patients with chronic diseases: impact of the VISIT website during consultations.Crossref | GoogleScholarGoogle Scholar | 28585242PubMed |

[50]  Zanini C, Maino P, Moller JC, et al. Enhancing clinical decisions about care through a pre-consultation sheet that captures patients’ views on their health conditions and treatments: a qualitative study in the field of chronic pain. Patient Educ Couns. 2016; 99 747–53.
Enhancing clinical decisions about care through a pre-consultation sheet that captures patients’ views on their health conditions and treatments: a qualitative study in the field of chronic pain.Crossref | GoogleScholarGoogle Scholar | 26673108PubMed |

[51]  Self-Management Resource Center. Chronic Pain Self-Management Program. Aptos, California. [cited 2020 July 21]. Available from: https://www.selfmanagementresource.com/programs/small-group/chronic-pain-self-management/