Planning and developing an intervention to improve the psychological wellbeing of people living with persistent pain: De-Stress Pain

Background

People with persistent musculoskeletal (MSK) pain often report depressive symptoms. Distress and depression have been found to predict the development of chronic pain conditions. Evidence suggests pain-related distress is qualitatively different from depressive illness, and current referral pathways and available interventions are sub-optimal for people with persistent MSK pain and distress. We aimed to develop and test the acceptability and proof of concept of an intervention to reduce pain-related distress in people with chronic MSK pain.

Methods

The Person-Based Approach (PBA)(1) informed the processes undertaken to inform intervention development. This included semi-structured interviews with people with persistent pain and with General Practitioners (GPs); and a stakeholder discussion with social prescribers. Patient and Public Involvement (PPI) representatives had input throughout all development work. Findings from these activities were triangulated to inform the development of a prototype intervention which was tested in a repeated-measures, mixed methods proof-of-concept study called De-Stress Pain .

The De-Stress Pain intervention offered 4-6 social prescriber sessions over 12 weeks, and access to a study website. 16 participants were recruited from general practices, and 4 social prescribers were recruited from Primary Care Networks (PCNs) and charitable organisations. Both quantitative measures and qualitative interviews were completed by participants at baseline and 12 weeks post-baseline. Quantitative measures included questions about mood (DAPOS, WEMWBS, 4DSQ), pain chronicity, pain intensity and musculoskeletal health (MSK-HQ). Semi-structured interviews with participants explored the participants’ context, their experiences of pain related distress, and their experiences of the intervention. Social prescribers were interviewed to explore their experiences of delivering the intervention. Interviews were analysed using thematic analysis.

Results

The De-Stress Pain intervention was acceptable both to patients and to social prescribers. Some participants experienced positive changes such as improved mood, increased hope and increased activity. The social prescribers (“De-Stress Coaches”) provided accountability and supported motivation. All measures of mood showed improvement. Limited time and money were identified as barriers to engagement, along with participants holding the view that increasing pleasurable activities was indulgent. Some participants were already socially engaged and busy at the point of entering the study.

Conclusions

We have confirmed the intervention is needed, acceptable and welcomed by people with pain. Social prescribers found the intervention acceptable to deliver. We identified the barriers that need to be addressed in future versions of the intervention.