Chronic musculoskeletal pain (CMP) affects approximately ¼ of adults worldwide and is considered an urgent global public health concern. CMP negatively impacts the quality of life of the individual in addition to a large societal financial burden. Pain science education (PSE) is an increasingly popular and potentially promising intervention to support individuals with CMP. The primary aim of this thesis was to investigate the effectiveness and experiences of PSE for adults with CMP. To address this research aim a multiphase mixed-methods research design was used. This included; a mixed-methods systematic review and meta-analysis of PSE; a systematic review and meta-analysis of the inter-individual differences in response to PSE; and a quasi mixed-methods feasibility study of a PSE informed pain management programme (PMP). The findings of the mixed-methods systematic review found PSE interventions do not produce clinically meaningful improvements in pain and disability but do produce clinically meaningful improvements in kinesiophobia and pain catastrophising in the short and medium term, respectively. There were tendencies for greater effects where PSE was combined with other interventions and it was proposed combining PSE with a PMP may be particularly fruitful. The qualitative component suggested that PSE interventions can facilitate pain reconceptualisation in some individuals and this may enhance their ability to cope with their condition. Some, but not all participants underwent pain reconceptualisation which raised the question whether PSE may be effective for some but not others, implying individual differences in response to PSE. The second systematic review investigated inter-individual differences in disability responses to PSE in people with CMP. There was insufficient evidence for the notion of clinically important inter-individual differences but given the small number of studies included further work is needed to draw any firm conclusions. The qualitative component of the feasibility study identified the potential of conceptual change theory as a framework for exploring and developing pain reconceptualisation. The first systematic review generated two synthesised findings comprised of several key principles, such as allowing the patient to tell their story, that may enhance the patient experience and effectiveness of PSE. The findings from these primary and secondary studies informed the development of a protocol for a pilot multi-site, single blind, parallel group randomised controlled trial (RCT) investigating the effectiveness of a PSE informed PMP for adults with CMP. The protocol will seek to meet these key principles when delivering the PSE. This is an important next step to explore if delivering PSE in this proposed optimal manner is effective for improving outcomes in people with CMP. Collectively, this thesis has developed the understanding of the effectiveness and experiences of PSE for adults with CMP and provided fruitful research avenues to further this understanding.
|Date of Award
|John Dixon (Supervisor), Cormac Ryan (Supervisor) & Denis Martin (Supervisor)