What Are the Barriers and Facilitators for the Self-Management of Chronic Pain With and Without Neuropathic Characteristics?

Elizabeth G. Mann, PhD, RN; Margaret B. Harrison, PhD, RN; Sandra LeFort, PhD, RN; Elizabeth G. VanDenKerkhof, DrPH, RN

Disclosures

Pain Manag Nurs. 2017;18(5):295-308. 

In This Article

Results

Questionnaire items were generally completed by at least 97% of participants, with the most common missing responses noted for the item on the Chronic Illness Resource Survey physician and health care teams scale that asks for a rating of the frequency with which the respondent has been treated as an equal partner in making management decisions and goals (completed by 93% of respondents).

Twenty-six percent of participants (188/710) reported CPNC. The risk of having CPNC was higher in those with lower socioeconomic status, including having no postsecondary education (RR = 1.26, CI = 1.02–1.56) and an annual income of less than $50,000 (RR = 1.34, CI = 1.15–1.54) (Table 1).

All of the barriers and facilitators listed from the literature were selected by at least 17% of study participants. Self-confidence in ability to manage pain (CPNC = 71.2%, CP = 69.9%, RR = 1.02, CI = 0.92–1.14), support from family/friends (CPNC = 57.6%, CP = 41.1%, RR = 1.40, CI = 1.19–1.65), and access to health care services (CPNC = 55.4%, CP = 44.9%, RR = 1.21, CI = 1.03–1.42) were the most commonly selected barriers and facilitators (Figure 1). Fear of making pain worse (CPNC = 42.4%, CP = 21.7%, RR = 1.95, CI = 1.54–2.48) and depression or feeling down (CPNC = 27.7%, CP-14.6%, RR = 1.90, CI = 1.38–2.60) were almost twice as likely to be selected by participants with CPNC compared with those with CP. Responses provided for those selecting "other" were highly variable, with the most commonly provided barrier or facilitator being physical activity (3.5%, n = 25). Because of the small proportion of participants, a comparison between pain groups on reports of physical activity as a barrier or facilitator were not computed.

Figure 1.

Percentage of study participants identifying the listed variables as a self-management barrier or facilitator. *Significant at p < .05. CP = chronic pain without neuropathic characteristics; CPNC = chronic pain with neuropathic characteristics.

There were no group differences in reports of support from family and/or friends and health care providers (Table 2). More than 80% of participants reported that their health care providers listened to their concerns and answered their questions at least a moderate amount of the time. A total of 41% of participants reported that their health care providers did not treat them like equal partners in management, and 28% of participants with CPNC and 31% of participants with CP reported that they had not had specific self-management actions explained to them. Similarly, most participants reported that their family and/or friends listened (CPNC = 73.4%, CP = 69.7%) and encouraged management (CPNC = 77.2%, CP = 71.3%) at least a moderate amount.

Although high self-efficacy was reported by the majority of participants (CPNC = 60.7%, CP = 81.3%), high self-efficacy was 25% less likely to be reported in those with CPNC compared with CP (RR = .75, CI = .66-.85) (Table 3). The risk for low self-efficacy was greater for participants with CPNC on all scales, especially for coping without medications (CPNC = 42.9%, CP = 60.5%, RR = 0.71, CI = .59-.85) and accomplishing goals (CPNC = 63.0%, CP = 83.1%, RR = .76, CI = .67-.85).

Participants with CPNC were 2.3 times more likely to screen positive for moderate to severe depression compared with those with CP (CPNC = 35.6%, CP = 15.5%, RR = 2.30, CI = 1.73–3.06) (Table 4). The risk of reporting all depressive symptoms was higher for individuals with CPNC, including a fivefold increased risk for thoughts of self-harm and/or being better off dead (CPNC = 6.5%, CP = 1.2%, RR = 5.47, CI = 2.1–14.36), and threefold increased risk for feeling bad about self (CPNC = 25.9%, CP = 6.9%, RR = 3.59, CI = 2.40–5.40), having trouble concentrating (CPNC = 21.1%, CP = 5.9%, RR = 3.56, CI = 2.28–5.56), and feeling down, depressed, or hopeless (CPNC = 17.3%, CP = 4.4%, RR = 3.96, CI = 2.37–6.65).

A total of 47% of participants with CPNC rated their pain intensity as severe compared with 25.1% of those with CP (Figure 2), representing an almost doubled risk for severe pain (RR = 1.94, CI = 1.65–2.29).

Figure 2.

Pain intensity reported by participants with chronic pain with neuropathic characteristics (CPNC; n = 188) and chronic pain without neuropathic characteristics (CP; n = 522).

Using a more stringent definition of CPNC, by defining it with both the SLANSS and a probable or possible neuropathic pain diagnosis, resulted in a sample size of 127 (20.6%) with CPNC and 491 with CP (vs. 26.5% = 188/710 with SLANSS only). Ninety-two participants were excluded because of missing responses for pain diagnoses. The risk of moderate to severe depression was similar with the stringent definition compared with the original definition (RR = 2.24, CI = 1.64–3.06 vs. RR = 2.30, CI = 1.73–3.06). However, using the stringent definition resulted in an increased risk for trouble sleeping (RR = 3.03, CI = 2.20–4.17 vs. RR = 1.38, CI = 1.11–1.72), and moving slowly/restlessness (RR = 3.60, CI = 2.15–6.01 vs. RR = 2.00, CI = 1.20–3.33) for participants with CPNC.

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