Harding Geoffrey, Parsons Suzanne, Rahman Anisur, Underwood Martin
Peninsula Medical School, Universities of Exeter and Plymouth, UK.
Arthritis Rheum. 2005 Oct 15;53(5):691-6. doi: 10.1002/art.21451.
To explore the experiences of diagnosis and management among patients who attended a specialist musculoskeletal pain clinic and the factors influencing their interpretation of these experiences.
A postal questionnaire was sent to potential participants 6-20 months after their first clinic attendance. Data were collected on pain presence, severity, and location; health-related quality of life; psychological distress; and care-seeking behavior. Questionnaire data were used to inform combined purposive and theoretical sampling. In-depth interviews were conducted that probed participants' understanding of their chronic musculoskeletal pain and its management in a specialist musculoskeletal pain clinic.
Fifteen patients were interviewed. Four main themes were identified: spoiled identity (pain limited patients' activities so extensively that it affected their sense of self); diminishing faith in medicine (patients were disappointed with aspects of their care-seeking experience); making sense of pain (patients made sense of their pain by locating their pain within the context of their lives); and learning to live with the pain (an issue for all patients was whether or not their pain would stop or whether they had to learn to live with it).
Developing, implementing, and evaluating approaches to address patients' spoiled identities might allow us to improve patient-centered outcomes in chronic musculoskeletal pain.
探讨在专科肌肉骨骼疼痛诊所就诊的患者的诊断和管理经历，以及影响他们对这些经历理解的因素。
在患者首次就诊6至20个月后，向潜在参与者发送邮政问卷。收集有关疼痛的存在、严重程度和部位；与健康相关的生活质量；心理困扰；以及寻求护理行为的数据。问卷数据用于指导综合目的抽样和理论抽样。进行了深入访谈，探讨参与者对其慢性肌肉骨骼疼痛及其在专科肌肉骨骼疼痛诊所治疗的理解。
对15名患者进行了访谈。确定了四个主要主题：身份受损（疼痛极大地限制了患者的活动，以至于影响了他们的自我意识）；对医学的信心下降（患者对其寻求护理经历的某些方面感到失望）；理解疼痛（患者通过将疼痛置于其生活背景中来理解自己的疼痛）；以及学会与疼痛共处（所有患者面临的一个问题是他们的疼痛是否会停止，或者他们是否必须学会与之共处）。
开发、实施和评估解决患者身份受损问题的方法，可能会使我们改善慢性肌肉骨骼疼痛以患者为中心的治疗效果。
