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Matthias MS, Miech EJ, Myers L, Sargent C, Bair MJ. "She Makes Me Feel Like an All-Star": Patients’ Experiences with Self-Management Education in an Intervention for Chronic Musculoskeletal Pain. Paper presented at: Society of General Internal Medicine Annual Meeting; 2012 May 11; Orlando, FL.
Background Chronic pain is prevalent, costly, and exerts a significant burden on both primary care providers (PCPs) and patients. In this study, we elicited patients' experiences following completion of a stepped-care intervention for chronic musculoskeletal pain. Methods We conducted qualitative interviews with patients who participated in the intervention arm of a randomized controlled trial for chronic pain management at a VA Medical Center. Step 1 of the intervention consisted of analgesic treatment coupled with pain self-management strategies, followed by brief cognitive behavioral therapy in Step 2. A nurse care manager delivered all elements of the intervention via telephone. At the end of this trial, we asked patients open-ended questions about their experiences in the RCT. Interviews were audio-taped, transcribed, and checked for accuracy. Sampling continued until theoretical saturation was reached. We used grounded theory and constant comparative methods to analyze the data. Results Patients (N = 26) were 24 to 62 years old; four were women; all had moderate to severe chronic musculoskeletal pain. While patients varied in their descriptions of the stepped-care intervention and the self-management education received in the study, they all spoke of the important role played by the nurse care manager. Three themes emerged related to the nurse care manager's role in pain self-management. Theme 1, Finding What Works: Patients appreciated having someone they knew to talk to about different options pain self-management: "The best part is having somebody there to talk to, to go over ideas you have about what works and what doesn't, and get feedback on your progress." (Participant 7) Theme 2, Being Held Accountable: Patients felt accountable to the nurse. They knew she would call them, and they wanted to be able to tell her (truthfully) that they were using their self-management strategies. "It kept me accountable.Usually nobody asks me, 'Are you walking? Stretching?' I don't want to lie to her, so I do it, where normally I'd just do nothing." (Participant 19) Theme 3, Motivation/Emotional Support: For some, the nurse's phone calls provided motivation to continue with their self-management strategies. For others, emotional support was more critical: "When I got off the phone, I felt better. I was more relaxed and I felt that somebody's helping me. You're in a bad spot and somebody cares enough to lend a hand. It was a big deal. It's comforting." (Participant 25) One veteran simply valued the personalized attention: "She makes me feel like I'm an all-star." (Participant 11) Conclusions This study highlights the important role played by a nurse care manager in helping patients self-manage their chronic pain. Specifically, the nurse helped patients find different self-management options, held patients accountable in self-management goals, and provided emotional support and motivation to patients. Incorporating nurses into pain management in primary care may potentially alleviate some of the burden on PCPs caring for patients with chronic pain.
