Background & Aims
Chronic pain affects around 20% of the population worldwide.(1,2) This condition is one of the leading causes of disability and morbidity around the world(3,4) and is associated with a signifi cant impact on caregivers(5) as well as substantial direct and indirect societal costs.(5,6) A wide range of educational interventions have been developed to help patients suffering from chronic pain, such as low back pain or fi bromyalgia, to improve pain self-management.(7-10) However, these interventions have been associated with limited effects on chronic pain outcomes. In addition to methodological limitations (i.e., heterogeneity in intervention content, intensity and delivery methods)(9,10), this lack of effectiveness could be explained by the under-utilization of a person-centered approach to care.(11) Therefore, this review aimed to systematically synthesize data from quantitative and qualitative studies on the educational needs and preferences of adult patients with chronic pain.
Methods
We conducted a convergent integrated mixed methods systematic review according to Joanna Briggs Institute (JBI) guidelines.(12) We collaborated with multidisciplinary pain experts and a person with lived experience of chronic pain to conduct the review. We included quantitative, qualitative, and mixed methods studies. We targeted studies that focused on the educational needs identifi ed as being important(13) by patients with chronic pain and studies evaluating patient preferences when it comes to pain education delivery characteristics.(14) We searched original studies and grey literature in seven databases, from January 1990 to November 2023, without language restriction. We assessed the methodological quality of included studies using the Mixed Methods Appraisal Tool (MMAT).(15) Quantitative and qualitative data were analyzed using an inductive thematic synthesis(16), followed by a convergent data synthesis.(17)
Results
We screened a total of 47,784 records from which 57 studies were included (n=7,595 patients). Most studies were conducted in Europe (25/57;44%) and North America (15/57;26%), and published between 2013-2023 (43/57;75%). Chronic pain was of the musculoskeletal type in the majority of studies (38/57;67%), followed by multiple types (11/57;19%). Most of the included studies were qualitative (32/57;56%), followed by quantitative (22/57;39%). The majority of qualitative studies (31/32;97%) and half of quantitative studies (11/22;50%) were of high methodological quality (? 4/5 MMAT criteria). The main educational needs identifi ed were understanding the pain condition and treatment plan, what to expect in terms of pain progression over time, how to taper opioids, alternative pain management strategies and how to use them, and how to manage daily activities to avoid worsening of pain. The most frequently reported preferences for education were to feel listened to and cared for when seeking information from health professionals, to receive consistent information, to have access to a variety of educational formats in combination with in-person education, to involve caregivers and to receive practical information accompanied by pictures and stories from peers.
Conclusions
This study identifi ed patients’ main educational needs and preferences in the context of chronic pain, most of which have emerged from recent studies. The key educational needs involved understanding treatments and how to manage the impact of pain on one’s life. In terms of preferences, an approach based on partnership with health professionals and access to peers’ support to receive information applicable in daily life were highlighted. Nevertheless, the importance of identifi ed needs and preferences has yet to be validated in patients suffering from various chronic pain-generating conditions, such as neuropathic pain or cancer-related pain, and in relation to different social determinants (e.g., gender, ethnicity). The results of this review could help guide future studies on needs and preferences and inform the development of educational interventions aimed at improving chronic pain self-management, particularly in patients with chronic musculoskeletal chronic pain.
References
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Presenting Author
Caroline Côté
Poster Authors
Caroline Côté
PhD (cand.)
Université Laval
Lead Author
Marie-Pierre Gagnon
PhD
Université Laval
Lead Author
Laurence Bourque
M.Sc
Université Laval
Lead Author
Géraldine Martorella
RN
Florida State University
Lead Author
Andréane Richard-Denis
MD
Université de Montréal
Lead Author
Matina Mwanack
PhD (cand.)
Université Laval
Lead Author
Lesley Norris Singer
PT
McGill University
Lead Author
Michael Verret
MD
University of Ottawa
Lead Author
Line Guénette
D.Pharm
Université Laval
Lead Author
Lynn Gauthier
PhD
Université Laval
Lead Author
Marc-Aurèle Gagnon
M.Sc
Université Laval
Lead Author
Simon Ouellet
RN
Université Laval
Lead Author
Mélanie Bérubé
NP
Université Laval
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain