Developing a patient-centred evidence-based intervention to address distress in the context of chronic MSK pain

People with chronic musculoskeletal pain are often diagnosed with co-morbid depression, and commonly prescribed antidepressants.

However, there is strong evidence to suggest that distress in the context of pain is qualitatively different from clinical depression, and that patients may not want, and do not respond well, to psychopharmacological interventions.

For primary care professionals (particularly general practitioners, GPs) this poses a dilemma on how best to manage patients’ psychological distress within their own care, and who to refer to.

We therefore plan a body of research in three stages: Stage 1) A qualitative study, conducting semi-structured interviews with patients and general practitioners which will enable and exploration of how both these groups understand pain-related distress in contrast to ‘depression’, how patients and practitioners negotiate and make decisions about diagnosis, management, and referral pathways, and which interventions patients have found most useful and acceptable.

Stage 2) A cross sectional questionnaire study of people with chronic MSK pain and people with clinical depression will use a latent profile analysis approach to identify items that characterise pain-related distress and distinguish it from clinical depression.

The identification of a set of reduced questions that predict pain- related distress will be used to inform eligibility and an education content in stage 3.

Stage 3) We will develop a new framework of pain-related distress from the results of these studies, and then develop, and carry out proof-of-concept testing of, a new patient-centred intervention to reduce pain-related distress.

We will design an intervention, informed by stages 1 and 2, developed in partnership with our patient advisory group (PAG).

We will test our intervention for acceptability and proof of concept with 20 patients recruited from NHS settings, including primary care and physiotherapy clinics.

The final output of this project will be an acceptable, patient-centred and patient-led intervention that is likely to include an on-going interactive bespoke website, combined with personalised and individual advice and support in social reactivation and managing pain and mood.