title: Barriers to self-management of chronic pain in primary care: a qualitative focus group study.
abstract: BACKGROUND
  Supported self-management is a recommended intervention for chronic pain. Effective self-management should enable an individual to reduce the impact of pain on their everyday life. Clinical guidelines suggest primary care services have a role to play in supporting self-management of chronic pain.
  
  
  OBJECTIVE
  To examine the opinions of primary care healthcare professionals (HCPs) and people with chronic pain and their carers, in order to identify possible barriers to the facilitation and adoption of self-management.
  
  
  METHODS
  A qualitative study using focus groups in locations throughout Scotland.
  
  
  METHODS
  Eighteen focus groups were held with patients and HCPs. Fifty-four patients, nine carers, and 38 HCPs attended the groups.
  
  
  RESULTS
  Four categories of barriers were found. 1) Patient-HCP consultation: some patients felt a discussion about self-management came too late or not at all. Communication and building positive relations were sometimes challenging. 2) Patient experience: the emotional impact of pain was difficult and patients often felt unsupported by HCPs. 3) Limited treatment options: some participants felt there was a tendency for overmedicalisation. 4) Organisational constraints: short appointment times, long waiting lists, and a compartmentalised NHS created challenges.
  
  
  CONCLUSIONS
  This study illustrates some of the barriers faced by HCPs and patients in the facilitation and adoption of self-management of chronic pain. If self-management is to be an important approach to chronic pain, primary care services need to be designed to address the barriers identified.
authors.affiliation: Pain Concern, Edinburgh.
authors.forename: Katy
authors.initials: K
authors.lastname: Gordon
authors.affiliation: Work4ME, Paisley.
authors.forename: Helen
authors.initials: H
authors.lastname: Rice
authors.affiliation: Glasgow Caledonian University, Glasgow.
authors.forename: Nick
authors.initials: N
authors.lastname: Allcock
authors.affiliation: Pain Alliance of Northern Ireland, Belfast.
authors.forename: Pamela
authors.initials: P
authors.lastname: Bell
authors.affiliation: NHS Greater Glasgow and Clyde, Glasgow.
authors.forename: Martin
authors.initials: M
authors.lastname: Dunbar
authors.affiliation: Consultant in anaesthetics and pain management, NHS Fife, Dunfermline.
authors.forename: Steve
authors.initials: S
authors.lastname: Gilbert
authors.affiliation: Pain Concern, Edinburgh.
authors.forename: Heather
authors.initials: H
authors.lastname: Wallace
mesh_terms: D001294:Attitude to Health; D017028:Caregivers; D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy*; D015897:Comorbidity; D017144:Focus Groups; D006801:Humans; D010817:Physician-Patient Relations; D011320:Primary Health Care; D036301:Qualitative Research; D012606:Scotland; D012648:Self Care / Q000523:psychology*
keywords: chronic pain; long-term conditions; primary care; qualitative research; self-management