Upper limb pain in primary care: health beliefs, somatic distress, consulting and patient satisfaction.
BACKGROUND
Beliefs and mental well-being could influence decisions to consult about upper limb pain and satisfaction with care.


OBJECTIVE
To describe beliefs about upper limb pain in the community and explore associations of beliefs and mental health with consulting and dissatisfaction.


METHODS
Questionnaires were mailed to 4998 randomly chosen working-aged patients from general practices in Avon. We asked about upper limb pain, consulting, beliefs about symptoms, dissatisfaction with care, somatizing tendency (using elements of the Brief Symptom Inventory) and mental well-being (using the Short-Form 36). Associations were explored by logistic regression.


RESULTS
Among 2632 responders, 1271 reported arm pain during the past 12 months, including 389 consulters. A third or more of responders felt that arm pain sufferers should avoid physical activity, that problems would persist beyond 3 months, that a doctor should be seen straightaway and that neglect could lead to permanent harm. Consulters were significantly more likely to agree with these statements than other upper limb pain sufferers. The proportion of consultations attributable to such beliefs was substantial. Dissatisfaction with care was commoner in those with poor mental health: the OR for being dissatisfied (worst versus best third of the distribution) was 3.2 (95% CI 1.2-8.5) for somatizing tendency and 2.4 (95% CI 1.3-4.7) for SF-36 score. Both factors were associated with dissatisfaction about doctors' sympathy, communication and care in examining.


CONCLUSIONS
Negative beliefs about upper limb pain are common and associated with consulting. Somatizers and those in poorer mental health tend, subsequently, to feel dissatisfied with care.
Palmer
K T
KT
MRC Environmental Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK. ktp@mrc.soton.ac.uk
Calnan
M
M
Wainwright
D
D
O'Neill
C
C
Winterbottom
A
A
Watkins
C
C
Poole
J
J
Coggon
D
D
D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D034941:Upper Extremity / Q000503:physiopathology