title: 'It feels like someone is hammering my feet': understanding pain and its management from the perspective of people with multiple sclerosis.
abstract: BACKGROUND
  Pain affects around 63% of people with multiple sclerosis (pwMS). Biomedical treatments demonstrate limited efficacy. More research is needed to understand pain from the individual's perspective in order to better inform a patient-centred approach that improves engagement, self-management and outcome.
  
  
  OBJECTIVE
  The objective of this paper is to explore pwMS' experience and responses to pain, and their perspectives on pain management.
  
  
  METHODS
  Twenty-five in-depth, semi-structured telephone interviews were conducted. Interviews were audiotaped, transcribed and analysed using an inductive thematic analysis approach with elements of grounded theory.
  
  
  RESULTS
  Key themes included vivid descriptions of pain and beliefs that pain is unpredictable, a sign of damage and may worsen. Anger was a common emotional response. Two dominant pain management themes emerged: one related to pain reduction and another to acceptance. Those focusing on pain reduction appeared to engage in cycles in which they struggled with symptoms and experienced continued distress.
  
  
  CONCLUSIONS
  Findings identify pain-related beliefs, emotional reactions and disparate pain-management attitudes. All may influence pwMS' responses to pain and what they ask of their clinicians. Uncovering pwMS' personal beliefs about pain, and introducing a broader biopsychosocial understanding of pain in the clinical context, may provide opportunities to rectify potentially unhelpful management choices and enhance pain acceptance.
authors.affiliation: Health Psychology Section, Institute of Psychiatry, King's College London, UK.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Harrison
authors.affiliation: Health Psychology Section, Institute of Psychiatry, King's College London, UK.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Bogosian
authors.affiliation: MS Specialist Outpatient Neurology Service, King's College London, UK.
authors.forename: Eli
authors.initials: E
authors.lastname: Silber
authors.affiliation: Health Psychology Section, Institute of Psychiatry, King's College London, UK.
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
authors.affiliation: Health Psychology Section, Institute of Psychiatry, King's College London, UK rona.moss-morris@kcl.ac.uk.
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D010146:Pain / Q000209:etiology* / Q000523:psychology*; D059408:Pain Management / Q000379:methods / Q000523:psychology*; D055815:Young Adult
keywords: Multiple sclerosis; experiences; management; pain; qualitative; thematic analysis