title: Managing chronic widespread pain in primary care: a qualitative study of patient perspectives and implications for treatment delivery.
abstract: Clinical guidelines recommend a combination of physical, pharmacological and psychological treatments for chronic widespread pain, but published accounts of treatment acceptability are lacking.
  
  
  
  Semi-structured interviews (n = 44) nested within a randomised controlled trial comparing the clinical and cost effectiveness of prescribed exercise, cognitive behavioural therapy (CBT), and combined exercise and CBT to treatment as usual for adults with chronic widespread pain.
  
  
  
  Three main themes emerged from the data: i) the illness context (how people experience chronic pain and associated health services); ii) the identity context (how people react to their symptoms and accommodate these within themselves) and iii) the intervention context (the extent and manner by which the trial interventions models aligned with these responses). Referral to a prescribed exercise programme resonated most closely with participants' tendency to attribute pain to a structural or mechanical defect. Psychological therapy brought with it connotations of social judgement, deviance and stigma. Experience of psychological therapy often exceeded expectation. Participants who engaged in cognitive reflection and behavioural adaptation reported an upward identity shift independent of increased physical exercise behaviour.
  
  
  
  A logical rationale for a health intervention is in itself insufficient to ensure uptake and participation. Potential differences in treatment meaning emphasise the importance of acknowledging different phases of illness acceptance and of providing the most appropriate treatment option for the stage of reconciliation. Health service providers must not only understand people's own perceptions of chronic widespread pain but also the broader spheres of influence in which this pain is experienced.
authors.affiliation: School of Nursing, Midwifery & Social work, University of Manchester, Manchester, UK. penny.bee@manchester.ac.uk.
authors.forename: Penny
authors.identifier: 0000-0002-5600-0400
authors.initials: P
authors.lastname: Bee
authors.affiliation: Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.|Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: McBeth
authors.affiliation: School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.|Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: MacFarlane
authors.affiliation: School of Nursing, Midwifery & Social work, University of Manchester, Manchester, UK.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: Chronic widespread pain; Patient perspectives; Qualitative; Treatment acceptability