A team of researchers at Keele University working with colleagues at the Universities of Southampton and Royal Holloway have developed a new framework for GPs to help them better support patients who are suffering distress associated with persistent pain.

Led by Professor Carolyn Chew-Graham, the study looked at the perspectives of both GPs and people with persistent musculoskeletal pain, to explore their understanding of how their condition might cause them to experience distress or depression.

The goal of the qualitative study, which has been published today in the British Journal of General Practice, was to understand how people with persistent pain and GPs distinguished between distress and depression, and to improve interactions between GPs and these patients in order to make consultations more effective and improve outcomes for the patients.

The study involved interviews with both GPs and people with persistent pain, the contents of which were then analysed, and themes identified.

Most participants described challenges they faced in distinguishing between distress and depression in the context of persistent pain, but also described strategies they had to help them make a distinction.

Some of the patients interviewed described how acceptance of their situation was key and involved optimism about the future and creation of a new identity, while some GPs expressed ‘therapeutic nihilism’, with uncertainty about the cause of pain and how to manage people with both pain and distress in primary care consultations. GPs have a role to play in supporting the person come to terms with their pain, explore how the person feels about the future, and support them to adopt self-management strategies.

GPs described the importance of identifying and building on optimism with patients which can then help the patient to move forward and work towards a beneficial outcome from their consultation.

The research team and the Patient Advisory Group devised a framework that might help GPs managing people with persistent pain, which places optimism and recognising the impact of pain on patients at its heart.

Helen Johnson, patient co-investigator said: “Persistent pain is very difficult to accept and come to terms with. At first, you look for why this is happening to you and medication to help. You can spend a long time either in denial or trying to 'get better.'

“Whilst contributing to, and being involved in this research, I have seen many similar thoughts amongst the people with pain who were interviewed (regardless of their pain's origin) and they seem to experience many of the same feelings, anxieties, hopelessness and frustrations as I do.

“I believe this research is useful in that it looks at the whole person and focuses on how people with pain can guide their own treatment and how their General Practitioner can help. This research has highlighted that people with pain are not all categorised as depressed and given antidepressants, but that the GP understands and supports people with pain to enable them to function as well as possible.”

Professor Carolyn Chew-Graham, lead author from Keele University, said: “This work is timely as there has been much criticism of the recent National Institute for Health and Care Excellence (NICE) guideline for assessment of chronic pain and management of chronic primary pain which highlights the importance of patient-centred care and shared-decision-making, little advice about how to do this was included, and the reduction in management options has been highlighted including reduction of medication options and decommissioning of pain clinics.

“The challenge is that these recommendations and possible consequences come at a time of unprecedented workload in primary care. Our model offers a model which might help GPs manage consultations with people with persistent pain and distress.”