What Works and What Doesn’t in a Self-Management Support Intervention for Individuals with Persistent Pain? A Systematic Review and Meta-Synthesis of Qualitative Studies

H Devan*, L Hale*, D Hempel^ϯ, B Saipe^ϯ, M Perry*
* Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin
^Ϯ Pain Management Service, Capital and Coast District Health Board, Wellington 

 

Introduction: Self-management support interventions focusing on improving self-efficacy and achieving adaptive behavioural change show promising results in improving the well-being of people with persistent pain.

Aims: The primary purpose of this systematic review was to synthesise the perceptions of individuals with persistent pain on the enablers (what works) and barriers (what doesn’t) of incorporating self-management strategies in everyday life after completion of a pain management intervention.

Methods: We included qualitative and mixed method studies exploring the perceptions of individuals with persistent pain after participating in a self-management support intervention. Two reviewers independently assessed the abstracts, full-texts and methodological quality of included studies. We used a thematic analysis approach to synthesise the review findings and a CERQual approach to assess the level of confidence.

Results: Thirty-three studies, with 512 participants were included. The enablers to incorporate self-management strategies included: (1) Self-discovery, (2) Feeling empowered, (3) Supportive ambience (Healthcare providers, Family and Work). The identified barriers were: (1) Sustained motivation, (2) Distress, (3) Unsupportive ambience. The ability to distinguish self (i.e. body, thoughts, feelings and behaviour) from pain is a key cognitive process, which was perceived by the participants to enable acceptance, self-efficacy and the ability to self-manage pain on a daily basis. However, the perceived difficulties (e.g. difficulty to prioritise, limited ability) along with daily stressors (e.g. pain, stress, depression) can make practicing the skills learnt overwhelmingly difficult. Furthermore, poor therapeutic alliance impedes their ability to manage pain.

Conclusions: The efforts to self-manage pain can be exhausting and wane over time after the intervention, thus providing intermittent support in the form of booster sessions and peer support groups may be important. Clinicians need to be cognisant of the importance of person centeredness by means of shared decision-making and guided problem solving to facilitate ongoing self-management.