How do people with chronic pain explain their use, or non-use, of pain-related healthcare services? A qualitative study of patient experiences

Abstract

Purpose

This study aims to explore how people with chronic pain explain their use or non-use of pain-related healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use.

Materials and methods

We conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach.

Results

Four key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups.

Conclusions

Beliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use.

Implications for Rehabilitation

• Different use of pain-related healthcare services for people with chronic pain could be related to differences in perceived needs, beliefs and values and appraisal of previous healthcare.

• It may be helpful to explore the perceived needs and beliefs of those seeking healthcare due to chronic pain.

• Previous healthcare experiences may impact and should be explored.

Keywords:

• Chronic pain
• healthcare use
• rehabilitation
• healthcare experiences
• qualitative study

Author contributions

Søren Mose: Conceptualisation, Methodology, Validation, Formal analysis, Investigation, Writing – Original Draft. Cecile Rud Budtz: Methodology, Validation, Formal analysis, Writing – Review & Editing. Helle Rønn Smidt: Methodology, Validation, Formal analysis, Writing – Review & Editing. Peter Kent: Conceptualisation, Methodology, Writing – Review & Editing. Anne Smith: Conceptualisation, Methodology, Methodology, Validation, Formal analysis, Writing – Review & Editing. Johan Hviid Andersen: Conceptualisation, Methodology, Writing – Review & Editing. David Høyrup Christiansen: Conceptualisation, Methodology, Writing – Review & Editing, Supervision.

Declaration of interest

None.

Additional information

Funding

We would like to thank Susanne Nissen Sagoo for her assistance with the transcription of data. This study is part of a PhD project financially supported by: VIA University College, the Health Research Foundation of Central Denmark Region, the Danish Rheumatism Association, NIDO Denmark, the Health Foundation and The Association of Danish Physiotherapists. We would like to thank all funding organisations.