Sheridan Kate, MacNamara Aine, Whyte Enda, O'Connor Siobhan
School of Health and Human Performance, Dublin City University, Dublin, Ireland.
Pain Res Manag. 2025 Aug 3;2025:4608906. doi: 10.1155/prm/4608906. eCollection 2025.
A supportive healthcare experience that implements a biopsychosocial model of care can empower a person with chronic pain to make informed decisions and engage in self-management behaviours. Despite the positive influence of supportive healthcare, little is known about the presence of healthcare support in under-resourced chronic pain services. This idiographic study explores the lived experience of service users and providers participating in chronic pain services with a specific focus on autonomy support and self-management skills. Semistructured interviews were conducted on service users ( = 7) self-reporting a diagnosis of chronic pain (pain > 3 months) and service providers ( = 5), defined as healthcare professionals with > 3 years of experience in clinical healthcare settings managing pain conditions. All interviews took place online (mean 47 ± 11 min). Interview transcripts were analysed using interpretative phenomenological analysis. Analyses generated four themes: 'biomedical model leads care'; 'lost in a system'; 'I need support' and 'the essentials of self-management'. Both service users and providers described regular experiences of invalidation and biomedical approaches to pain management. Long waitlists, a lack of multidisciplinary services, short appointment times and a lack of educational resources all impacted the development of self-management skills in service users. Despite clinical guidelines recommending a biopsychosocial model of care, the biomedical model remains the dominant approach in chronic pain management, reflecting a persistent gap between evidence and practice. Service users and providers desire access to multidisciplinary services that support a biopsychosocial model of care. Healthcare professionals cannot deliver what service users expect due to macro-, meso- and microlevel factors. Future research is needed to explore practical solutions to deliver pain services that optimise the development of self-management skills where existing infrastructure and resources negatively impact service delivery. Suggested approaches include enhancing autonomy-supportive communication by healthcare providers and ensuring early access to high-quality educational materials.
一种实施生物心理社会护理模式的支持性医疗体验，可以使慢性疼痛患者有能力做出明智的决策并参与自我管理行为。尽管支持性医疗有积极影响，但对于资源不足的慢性疼痛服务中医疗支持的存在情况却知之甚少。这项个案研究探讨了参与慢性疼痛服务的服务使用者和提供者的生活经历，特别关注自主性支持和自我管理技能。对自我报告诊断为慢性疼痛（疼痛超过3个月）的服务使用者（n = 7）和服务提供者（n = 5）进行了半结构化访谈，服务提供者被定义为在临床医疗环境中管理疼痛状况有超过3年经验的医疗专业人员。所有访谈均在线进行（平均47±11分钟）。使用解释性现象学分析对访谈记录进行了分析。分析产生了四个主题：“生物医学模式主导护理”；“在系统中迷失”；“我需要支持”和“自我管理的要素”。服务使用者和提供者都描述了疼痛管理中经常出现的无效化和生物医学方法的经历。长等候名单、缺乏多学科服务、预约时间短以及缺乏教育资源都影响了服务使用者自我管理技能的发展。尽管临床指南推荐生物心理社会护理模式，但生物医学模式仍然是慢性疼痛管理的主导方法，这反映了证据与实践之间持续存在的差距。服务使用者和提供者希望获得支持生物心理社会护理模式的多学科服务。由于宏观、中观和微观层面的因素，医疗专业人员无法提供服务使用者所期望的服务。需要未来的研究来探索切实可行的解决方案，以提供能够优化自我管理技能发展的疼痛服务，因为现有的基础设施和资源对服务提供产生了负面影响。建议的方法包括加强医疗提供者的自主性支持沟通，并确保尽早获得高质量的教育材料。
