title: Making sense of aches and pains.
abstract: BACKGROUND
  The uncertainty about the status of upper limb disorders (ULDs), particularly the non-specific conditions, is believed to have consequences for clinical management and patient care.
  
  
  OBJECTIVE
  This paper presents evidence about how sufferers with ULDs respond to their pain, how their pain is managed, when and who they go to for formal help and how sufferers evaluate the care they receive.
  
  
  METHODS
  The data analysis is derived from face-to-face, informal interviews with sufferers with a broad spectrum of upper limb disorders (n = 47). These informants were selected according to strict criteria from a 'screening' postal survey of the working population (25-64 years) in south-west England (n = 2781).
  
  
  RESULTS
  Ideas about causation were crucial to understanding patterns of illness action and help seeking behaviour. The common strategy was to wait and see what happens as the pain was believed to be a natural part of the ageing process. Explanations invoking psychosocial and work related causes were less common and tended to be used when biomechanical explanations were no longer appropriate. Self-management was the preferred strategy but orthodox practitioners were usually the first choice for formal care. Complementary and alternative medicines (CAM) were popular but were used to complement orthodox care. Practitioners were evaluated mainly in terms of their ability to alleviate pain.
  
  
  CONCLUSIONS
  There is a need for orthodox and non-orthodox care to be closely integrated in primary care and GPs should not depend on orthodox medications alone when caring for patients with upper limb pain.
authors.affiliation: MRC HSRC, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. m.w.calnan@bristol.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Calnan
authors.forename: D
authors.initials: D
authors.lastname: Wainwright
authors.forename: C
authors.initials: C
authors.lastname: O'Neill
authors.forename: A
authors.initials: A
authors.lastname: Winterbottom
authors.forename: C
authors.initials: C
authors.lastname: Watkins
mesh_terms: D000328:Adult; D000367:Age Factors; D003131:Combined Modality Therapy; D004739:England; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010148:Intractable Pain / Q000175:diagnosis / Q000628:therapy; D017060:Patient Satisfaction; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D034941:Upper Extremity