School of Medicine, Keele University, Keele.
Primary Care Research Centre, University of Southampton, Southampton.
Br J Gen Pract. 2022 Oct 27;72(724):e825-e833. doi: 10.3399/BJGP.2022.0120. Print 2022 Nov.
Low mood and distress are commonly reported by people who have persistent musculoskeletal (MSK) pain, which may be labelled as 'depression'. It is important to understand how pain-related distress is conceptualised and managed in primary care consultations.
To explore understanding of pain-related distress and depression from the perspectives of people with persistent MSK pain and GPs.
Qualitative study with people with persistent MSK pain and GPs from different parts of the UK.
Semi-structured interviews conducted remotely and data analysed thematically.
Most participants reported challenges in distinguishing between distress and depression in the context of persistent MSK pain, but also described strategies to make this distinction. Some people described how acceptance of their situation was key and involved optimism about the future and creation of a new identity. Some GPs expressed 'therapeutic nihilism', with uncertainty about the cause of pain and how to manage people with both persistent MSK pain and distress in primary care consultations, while GPs who could identify and build on optimism with patients described how to help the patient to move forwards.
This study offers a framework for the primary care consultation with patients presenting with pain-related distress. GPs should recognise the impact of persistent MSK pain on the patient and support the person in coming to terms with their pain, explore how the person feels about the future, encourage optimism, and support self-management strategies.
持续存在的肌肉骨骼（MSK）疼痛患者常报告情绪低落和痛苦，这可能被贴上“抑郁”的标签。了解初级保健咨询中如何概念化和管理与疼痛相关的痛苦是很重要的。
从持续存在的 MSK 疼痛患者和全科医生的角度探讨对与疼痛相关的痛苦和抑郁的理解。
在英国不同地区对持续存在的 MSK 疼痛患者和全科医生进行的定性研究。
远程进行半结构化访谈，并进行主题分析。
大多数参与者报告在持续存在的 MSK 疼痛背景下区分痛苦和抑郁存在挑战，但也描述了做出这种区分的策略。一些人描述了如何接受自己的情况是关键，这涉及对未来的乐观和创造新的身份。一些全科医生表达了“治疗虚无主义”，对疼痛的原因和如何在初级保健咨询中管理既有持续的 MSK 疼痛又有痛苦的患者感到不确定，而那些能够识别和利用患者的乐观情绪的全科医生则描述了如何帮助患者向前迈进。
本研究为在初级保健咨询中出现与疼痛相关的痛苦的患者提供了一个框架。全科医生应认识到持续存在的 MSK 疼痛对患者的影响，并支持患者接受自己的疼痛，探讨患者对未来的感受，鼓励乐观情绪，并支持自我管理策略。
