title: Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review.
abstract: BACKGROUND
  Musculoskeletal (MSK) pain is one of the most predominant types of pain and accounts for a large portion of the primary care workload.
  
  
  OBJECTIVE
  To systematically review and integrate the findings of qualitative research to increase understanding of patients' experiences of chronic non-malignant MSK pain.
  
  
  METHODS
  Synthesis of qualitative research using meta-ethnography using six electronic databases up until February 2012 (Medline, Embase, Cinahl, Psychinfo, Amed and HMIC).
  
  
  METHODS
  Databases were searched from their inception until February 2012, supplemented by hand-searching contents lists of specific journals for 2001-2011 and citation tracking. Full published reports of qualitative studies exploring adults' own experience of chronic non-malignant MSK pain were eligible for inclusion.
  
  
  RESULTS
  Out of 24 992 titles, 676 abstracts, and 321 full texts were screened, 77 papers reporting 60 individual studies were included. A new concept of pain as an adversarial struggle emerged. This adversarial struggle was to: 1) affirm self; 2) reconstruct self in time; 3) construct an explanation for suffering; 4) negotiate the healthcare system; and 5) prove legitimacy. However, despite this struggle there is also a sense for some patients of 6) moving forward alongside pain.
  
  
  CONCLUSIONS
  This review provides a theoretical underpinning for improving patient experience and facilitating a therapeutic collaborative partnership. A conceptual model is presented, which offers opportunities for improvement by involving patients, showing them their pain is understood, and forming the basis to help patients move forward alongside their pain.
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Francine
authors.initials: F
authors.lastname: Toye
authors.affiliation: Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Coventry, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Seers
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Allcock
authors.affiliation: Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Briggs
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eloise
authors.initials: E
authors.lastname: Carr
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: JoyAnn
authors.initials: J
authors.lastname: Andrews
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Barker
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology; D036301:Qualitative Research; D012649:Self Concept; D013315:Stress, Psychological / Q000209:etiology; D055815:Young Adult