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Title: How do patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain influence the process of care? A systematic review.

Authors and affiliation: Parsons S1, Harding G2, Breen A3, Foster N4, Pincus T5, Vogel S6, Underwood M1

1 Centre for Health Sciences, Barts and The London, Queen Mary’s School of Medicine and Dentistry, UK;
2 Peninsula Medical School, UK
3 IMRCI, Anglo-European College of Chiropractic, UK
4 Primary Care Sciences Research Centre, Keele University, UK
5 Department of Psychology, Royal Holloway, University of London, UK
6 Research Centre, British School of Osteopathy, UK

Email address: s.p.parsons@qmul.ac.uk

Introduction: Chronic musculoskeletal pain (CMP) is a major health problem for which it appears difficult to provide satisfactory care. This may be due to patients’ and practitioners’ different pain causation beliefs and treatment expectations and the lack of a clear evidence base for the efficacy of many treatments. We undertook a systematic review of previous research in this area to explore the influence of patients’ and primary care practitioners’ beliefs on the process of care.

Objective: To systematically review empirical work exploring the influence of patients’ and primary care practitioners’ beliefs and expectations on the process of care for chronic musculoskeletal pain.

Methods: We searched nine computerized databases to identify studies that we quality appraised using the Critical Appraisal Skills Programme Checklists. We analysed data from the included qualitative studies thematically and integrated data from the included quantitative studies into our thematic analysis.

Results: We obtained 12994 references from our literature search, of which 113 full articles were obtained. 24 out of 113 articles were quality appraised. Nineteen articles reporting fifteen studies were included in the final analysis (Thirteen qualitative and two quantiative). All of the included studies only studied GPs. Themes identified included patients’ and practitioners’ beliefs 1) about pain, 2) about accessing and receiving treatment, 3) about diagnosis and referral and 4) about patient education. Patients and practitioners both wanted clear communication within the consultation and to be respected, but conflicts existed on nearly all other aspects of the consultation, such as beliefs about pain causation, pain diagnosis and in the impact of pain on an individual’s identity.  Some of those conflicts appear insurmountable at present and may lead to difficulties in achieving positive consultation outcomes such as patient and practitioner satisfaction.

Conclusion: Addressing these conflicts may be difficult without changes to the culture of healthcare and to patients’ beliefs about how they should access health care.