Background & Aims
Musculoskeletal pain, affecting an estimated 1.71 billion people globally, is a leading cause of disability. Managing chronic primary musculoskeletal pain presents challenges, often requiring multimodal, interdisciplinary approaches. Pain perception is deeply personal, and influenced by cultural, linguistic, situational, and individual factors. Effective patient-provider communication, crucial in pain management, aims to understand pain from the patient’s perspective and to facilitate shared decision-making. Research indicates that patients with chronic pain often feel misunderstood and invalidated by healthcare providers, leading to feelings of loneliness and long-term emotional impacts. Effective communication is shown to improve health outcomes. The purpose of this study is to explore patients’ experiences of communicating about chronic primary musculoskeletal pain with healthcare providers during clinical encounters in Ethiopia.
Methods
This research employs Interpretative Phenomenological Analysis to explore individual experiences of communicating about chronic pain with healthcare providers.
Researcher Characteristics: The principal investigator, with a background in physiotherapy, has experience in both clinical and academic roles in Ethiopia. The team comprises physiotherapist, an epidemiologist, and a biostatistician.
Participant Recruitment: Using purposive sampling, participants with diverse experiences of chronic pain, educational backgrounds, and cultural perspectives were selected from Gondar University, Felege Hiwot, and Black Lion hospitals.
Inclusion Criteria: Adults aged 18-64 with chronic primary musculoskeletal pain and proficiency in Amharic. Data Collection: semi-structured interview protocol in Amharic.
Analysis: Followed the IPA approach Rigour: maintained through reflexive journaling, regular team discussions, and adherence to IPA principles, ensuring the trustworthiness of the findings
Results
We completed interviews with 14 participants. The interviews took an average of 55 minutes each. The majority of the participants were females (10/14) with a median of two years of lived experience with musculoskeletal pain. Ten participants had a secondary level of education as their highest level of education achieved, and nine participants reported being employed. All participants had sought treatment for chronic primary pain from one or more health care professionals at the participating hospitals
Seven main themes were identified.
1. Uncertainty about what to communicate and what kind of help to expect
2.Involving family members in communication about chronic pain
3.The desire for more and deeper questions
4.Having trouble describing the pain experience
5.Suitable context for communication
6.Being listened to, heard, and understood
7.Communication approach of the healthcare professional
Conclusions
Communication about chronic pain was challenging for our participants. Not knowing what to communicate to the healthcare professional can be the means of not getting the care they need. Healthcare professionals should contribute in creating better communication opportunities, educate the patients on what chronic pain is and what kind of service (help) they can get can better facilitate communication in this context.
References
Alebie, G., Urga, B., & Worku, A. (2017). Systematic review on traditional medicinal plants used for the treatment of malaria in Ethiopia: Trends and perspectives. Malaria Journal, 16(1), 307. https://doi.org/10.1186/s12936-017-1953-2
Allvin, R., Fjordkvist, E., & Blomberg, K. (2019). Struggling to be seen and understood as a person – Chronic back pain patients’ experiences of encounters in health care: An interview study. Nursing Open, 6(3), 1047–1054. https://doi.org/10.1002/nop2.290
Bendelow, G. (2013). Chronic pain patients and the biomedical model of pain. The Virtual Mentor: VM, 15(5), 455–459. https://doi.org/10.1001/virtualmentor.2013.15.5.msoc1-1305
Blyth, F. M., Briggs, A. M., Schneider, C. H., Hoy, D. G., & March, L. M. (2019). The Global Burden of Musculoskeletal Pain—Where to From Here? American Journal of Public Health, 109(1), 35–40. https://doi.org/10.2105/AJPH.2018.304747
Central Statistical Agency (CSA) [Ethiopia] & ICF. (2016). Ethiopia Demographic and Health Survey 2016. https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf
Col, N., Hull, S., Springmann, V., Ngo, L., Merritt, E., Gold, S., Sprintz, M., Genova, N., Nesin, N., Tierman, B., Sanfilippo, F., Entel, R., & Pbert, L. (2020). Improving patient-provider communication about chronic pain: Development and feasibility testing of a shared decision-making tool. BMC Medical Informatics and Decision Making, 20(1), 267. https://doi.org/10.1186/s12911-020-01279-8
Edmond, S. N., & Keefe, F. J. (2015). Validating pain communication: Current state of the science. Pain, 156(2), 215–219. https://doi.org/10.1097/01.j.pain.0000460301.18207.c2
El-Tallawy, S. N., Nalamasu, R., Salem, G. I., LeQuang, J. A. K., Pergolizzi, J. V., & Christo, P. J. (2021). Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain and Therapy, 10(1), 181–209. https://doi.org/10.1007/s40122-021-00235-2
Ethiopia Population. (2018). World Population Review. https://worldpopulationreview.com/countries/ethiopia-population/
Etikan, I., Musa, S. A., & Alkassim, R. S. (2015). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), Article 1. https://doi.org/10.11648/j.ajtas.20160501.11
Evers, S., Hsu, C., Sherman, K. J., Balderson, B., Hawkes, R., Brewer, G., La Porte, A.-M., Yeoman, J., & Cherkin, D. (2017). Patient Perspectives on Communication with Primary Care Physicians about Chronic Low Back Pain. The Permanente Journal, 21, 16–177. https://doi.org/10.7812/TPP/16-177
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624. https://doi.org/10.1037/0033-2909.133.4.581
Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., Mogil, J. S., Rainville, P., Sullivan, M. J. L., Williams, A. C. de C., Vervoort, T., & Fitzgerald, T. D. (2011). A biopsychosocial formulation of pain communication. Psychological Bulletin, 137(6), 910. https://doi.org/10.1037/a0023876
Henry, S. G., & Matthias, M. S. (2018). Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review. Pain Medicine, 19(11), 2154–2165. https://doi.org/10.1093/pm/pny003
Hodes, R. (1997). Cross-cultural medicine and diverse health beliefs. Ethiopians abroad. Western Journal of Medicine, 166(1), 29–36.
Kahissay, M. H., Fenta, T. G., & Boon, H. (2017). Beliefs and perception of ill-health causation: A socio-cultural qualitative study in rural North-Eastern Ethiopia. BMC Public Health, 17(1), 124. https://doi.org/10.1186/s12889-017-4052-y
Kool, M. B., van Middendorp, H., Boeije, H. R., & Geenen, R. (2009). Understanding the lack of understanding: Invalidation from the perspective of the patient with fibromyalgia. Arthritis and Rheumatism, 61(12), 1650–1656. https://doi.org/10.1002/art.24922
Lall, D., Engel, N., Devadasan, N., Horstman, K., & Criel, B. (2018). Models of care for chronic conditions in low/middle-income countries: A ‘best fit’ framework synthesis. BMJ Global Health, 3(6), e001077. https://doi.org/10.1136/bmjgh-2018-001077
Larson, J. S. (1999). The Conceptualization of Health. Medical Care Research and Review, 56(2), 123–136. https://doi.org/10.1177/107755879905600201
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample Size in Qualitative Interview Studies: Guided by Information Power. Qualitative Health Research, 26(13), 1753–1760. https://doi.org/10.1177/1049732315617444
Mawdsley, L., Twiddy, H., & Longworth, M. (2016). Involvement of Family and Friends in Pain Management Interventions. Journal of Observational Pain Medicine, in press.
McDonald, D. D., Shea, M., Rose, L., & Fedo, J. (2009). The Effect of Pain Question Phrasing on Older Adult Pain Information. Journal of Pain and Symptom Management, 37(6), 1050–1060. https://doi.org/10.1016/j.jpainsymman.2008.06.008
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65(12), 1378–1382.
Melzack, R., & Katz, J. (2013). Pain. Wiley Interdisciplinary Reviews. Cognitive Science, 4(1), 1–15. https://doi.org/10.1002/wcs.1201
Merminod, G., Weber, O., Semlali, I., Terrier, A., Decosterd, I., Rubli Truchard, E., & Singy, P. (2022). Talking about chronic pain in family settings: A glimpse of older persons’ everyday realities. BMC Geriatrics, 22(1), 358. https://doi.org/10.1186/s12877-022-03058-8
Mullan, Z. (2016). Transforming health care in Ethiopia. The Lancet Global Health, 4(1), e1. https://doi.org/10.1016/S2214-109X(15)00300-9
Munday, I., Kneebone, I., & Newton-John, T. (2021). The language of chronic pain. Disability and Rehabilitation, 43(3), 354–361. https://doi.org/10.1080/09638288.2019.1624842
National Guideline Centre (UK). (2021). Evidence review for communication between healthcare professionals and people with chronic pain (chronic primary pain and chronic secondary pain): Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain: Evidence review B. National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK569979/
Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., Korwisi, B., Perrot, S., Svensson, P., Wang, S.-J., Treede, R.-D., & Pain, T. I. T. for the C. of C. (2019). The IASP classification of chronic pain for ICD-11: Chronic primary pain. PAIN, 160(1), 28. https://doi.org/10.1097/j.pain.0000000000001390
Nizza, I. E., Farr, J., & Smith, J. A. (2021). Achieving excellence in interpretative phenomenological analysis (IPA): Four markers of high quality. Qualitative Research in Psychology, 18(3), 369–386. https://doi.org/10.1080/14780887.2020.1854404
Pietkiewicz, I., & Smith, J. (2014). A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. CPPJ, 20, 7–14. https://doi.org/10.14691/CPPJ.20.1.7
Rentmeester, C. (2018). Heidegger, communication, and healthcare. Medicine, Health Care and Philosophy, 21(3), 431–437. https://doi.org/10.1007/s11019-018-9823-4
Skutnabb-Kangas, T., & Heugh, K. (2013). Multilingual Education and Sustainable Diversity Work: From Periphery to Center. Routledge.
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. SAGE.
Smith, J. A., & Osborn, M. (2003). Interpretative Phenomenological Analysis. Qualitative Psychology, 28.
Smith, T. O., Dainty, J. R., Williamson, E., & Martin, K. R. (2019). Association between musculoskeletal pain with social isolation and loneliness: Analysis of the English Longitudinal Study of Ageing. British Journal of Pain, 13(2), 82–90. https://doi.org/10.1177/2049463718802868
Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., … Wang, S.-J. (2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the: International Classification of Diseases: (: ICD-11: ). PAIN, 160(1), 19. https://doi.org/10.1097/j.pain.0000000000001384
van Nes, F., Abma, T., Jonsson, H., & Deeg, D. (2010). Language differences in qualitative research: Is meaning lost in translation? European Journal of Ageing, 7(4), 313–316. https://doi.org/10.1007/s10433-010-0168-y
WHO. (2019). Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
World Bank. (2019, April 12). Ethiopia Overview [Text/HTML]. World Bank. https://www.worldbank.org/en/country/ethiopia/overview
Presenting Author
Abey Abebe
Poster Authors
Abey Abebe
Msc
Queens University
Lead Author
Mulugeta Chala
Lawson Health Research Institute/ St. Joseph's Health Care London
Lead Author
Jordan Miller
BSc
Queen’s University
Lead Author
Geoffrey Bostick (Phd)
University of Alberta
Lead Author
Tadesse Ayele (Phd)
University of Gondar
Lead Author
Topics
- Assessment and Diagnosis