Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Context
2.2. Recruitment
2.3. Interview Participants
2.4. Data Collection
2.5. Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Pain Treatment Approach
3.2.1. Survey Data
3.2.2. Qualitative Data
“[…] when they see a rheumatologist, they are handed a questionnaire, see the physician who looks into it, and perhaps asks two or three questions, examines the patient and then, that is it. And patients feel insufficiently heard, to be quite frank, after answering all the questions. In general practice, our relationship strives on regular dialog.”(GP14, #24)
“I think, the most important thing is that people who are in pain are informed about where it comes from and what they can do themselves to reduce it. Not just concentrating on the medication, but saying, I’m doing more for my back now, I’m leaving certain things out because they only harm me.”(P03, #246)
“Yes, it’s good to look at what causes the pain, you really need to look. Is it an organic thing, physical or blood test, that was part of it, but also what else is going on in my life, the personal holistic view. To simply ask and say, yes, something has to be changed.”(P17, #79)
“I find it much easier to motivate patients for psychotherapy if I can elaborate with them that the psyche plays a role in pain development and evaluation. […] particularly with older people, it is very difficult to explain why talking about it should help them now. In the end, I would even worry they feel pushed away […].”(GP11, #62)
“[...] of course, when they ask what is the situation otherwise, you already know, now they are asking about the social environment, or now they are just asking.”(P14, #78)
“[...] if you have someone who stands behind you and absorbs a lot, then that’s actually half the battle to making it more bearable. But people who are all alone, I can hardly imagine how they should or can or have to cope with it all.”(P10, #8)
3.3. Non-Pharmacological Interventions
3.3.1. Survey Data
3.3.2. Qualitative Data
“You do not need a lot of room or accessories. […] it has to be feasible in terms of time and not so complicated, because you don’t have time to explain everything to everyone. So, it has to be something you can take home with you.”(GP02, #38)
“[…] I am glad I can go to physiotherapy, and they do the right exercises with me. And I know it helps. Just two months ago I had to take three breaks on my usual walk, and yesterday I did not have to stop at all. Not fast, but it worked, without pain.”(P12, #159)
“[…] I did research on options myself to find out what I can do for my arms, the back, about yoga. Are there things that have a better long-term effect? […] there was no one, not my GP [either] who said do this or that.”(P17, Pos. 9)
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Cohen, S.P.; Vase, L.; Hooten, W.M. Chronic pain: An update on burden, best practices, and new advances. Lancet 2021, 397, 2082–2097. [Google Scholar] [CrossRef] [PubMed]
- Wörz, R.; Horlemann, J.; Müller-Schwefe, G.H.H. Auswirkungen, Chronifizierung, Epidemiologie, zeitgemäße Diagnostik. Schmerzmedizin 2022, 38, 46–50. [Google Scholar] [CrossRef]
- Plass, D.; Vos, T.; Hornberg, C.; Scheidt-Nave, C.; Zeeb, H.; Krämer, A. Trends in disease burden in Germany: Results, implications and limitations of the Global Burden of Disease study. Dtsch. Ärzteblatt Int. 2014, 111, 629. [Google Scholar]
- Friessem, C.H.; Willweber-Strumpf, A.; Zenz, M.W. Chronic pain in primary care. German figures from 1991 and 2006. BMC Public Health 2009, 9, 299. [Google Scholar] [CrossRef] [PubMed]
- Engeser, P.; Becker, M.; Becker, A. Chronischer Schmerz. Z. Allg. 2014, 90, 103–105. [Google Scholar] [CrossRef]
- Becker, A.; Becker, M.; Engeser, P.; Wollny, A.; durch das DEGAM-Präsidium, A.; wurden mit dem AWMF-Formblatt, I. Chronischer Schmerz. Schmerz 2016, 30, 395–406. [Google Scholar] [CrossRef] [PubMed]
- Keßler, J.; Bardenheuer, H. Was ist das eigentlich, Schmerz? In Schmerz, Lass’ Nach! Eine Einführung in die Grundbegriffe der Schmerzmedizin; Springer: Berlin/Heidelberg, Germany, 2018; pp. 1–3. [Google Scholar] [CrossRef]
- Heymanns, A.; Rudolf, H.; Schneider-Nutz, H.; Salem, K.; Strick, K.; Zenz, M. Chronischer Schmerz in der Praxis. Schmerz 2017, 31, 353. [Google Scholar] [CrossRef]
- Hartvigsen, J.; Hancock, M.J.; Kongsted, A.; Louw, Q.; Ferreira, M.L.; Genevay, S.; Hoy, D.; Karppinen, J.; Pransky, G.; Sieper, J.; et al. What low back pain is and why we need to pay attention. Lancet 2018, 391, 2356–2367. [Google Scholar] [CrossRef] [PubMed]
- Müller-Schwefe, G.; Überall, M. Schmerz und Lebensqualität. Gesundheitsökonomie Qual. 2011, 16, S20–S22. [Google Scholar] [CrossRef]
- Breivik, H.; Collett, B.; Ventafridda, V.; Cohen, R.; Gallacher, D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur. J. Pain 2006, 10, 287–333. [Google Scholar] [CrossRef] [PubMed]
- Wenig, C.M.; Schmidt, C.O.; Kohlmann, T.; Schweikert, B. Costs of back pain in Germany. Eur. J. Pain 2009, 13, 280–286. [Google Scholar] [CrossRef]
- Schmerzgesellschaft eV D. Herausforderung Schmerz. 2017. Available online: https://www.schmerzgesellschaft.de/patienteninformationen/herausforderung-schmerz (accessed on 14 January 2025).
- Hylands-White, N.; Duarte, R.V.; Raphael, J.H. An overview of treatment approaches for chronic pain management. Rheumatol. Int. 2017, 37, 29–42. [Google Scholar] [CrossRef] [PubMed]
- Bevers, K.; Watts, L.; Kishino, N.D.; Gatchel, R.J. The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurol. 2016, 12, 98–104. [Google Scholar] [CrossRef]
- Häuser, W.; Bock, F.; Hüppe, M.; Nothacker, M.; Norda, H.; Radbruch, L.; Schiltenwolf, M.; Schuler, M.; Tölle, T.; Viniol, A. 2. Aktualisierung der S3 Leitlinie „Langzeitanwendungen von Opioiden bei chronischen nicht-tumorbedingten Schmerzen „LONTS “. Schmerz 2020, 34, 204–244. [Google Scholar] [CrossRef] [PubMed]
- Kaiser, U.; Nagel, B.; Petzke, F.; Pfingsten, M.; Gärtner, A.; Isenberg, T.; Augustin, K.; Martin, C.; Lindena, G. Vermeidung chronischer Schmerzen in der deutschen Gesundheitsversorgung. Der Schmerz 2021, 35, 45–52. [Google Scholar] [CrossRef] [PubMed]
- Kriegisch, V.; Kuhn, B.; Dierks, M.L.; Achenbach, J.; Briest, J.; Fink, M.; Dusch, M.; Amelung, V.; Karst, M. Evaluation of outpatient medical pain management in Germany: Results of an internet-based cross-sectional survey among pain specialists in outpatient departments. Der Schmerz 2021, 35, 103–113. [Google Scholar] [CrossRef] [PubMed]
- Poß-Doering, R.; Keller, S.; Zugaj, M.; Seidling, H.; Paul, C.; Stolz, R.; Kaufmann-Kolle, P.; Straßner, C. Hausärztliche Versorgung von Patient: Innen mit chronischen nicht-tumorbedingten Schmerzen: Ein Rapid Review im Rahmen des RELIEF-Projekts. [General practitioner care of patients with chronic non-tumor pain: A rapid review within the RELIEF project]. Z. Evidenz Fortbild. Qual. Gesundheitswesen 2024, 185, 1–9. [Google Scholar] [CrossRef] [PubMed]
- Reid, K.J.; Harker, J.; Bala, M.M.; Truyers, C.; Kellen, E.; Bekkering, G.E.; Kleijnen, J. Epidemiology of chronic non-cancer pain in Europe: Narrative review of prevalence, pain treatments and pain impact. Curr. Med. Res. Opin. 2011, 27, 449–462. [Google Scholar] [CrossRef] [PubMed]
- Creswell, J.W.; Clark, V.L.P. Designing and Conducting Mixed Methods Research; Sage Publications: New York, NY, USA, 2017; ISBN 148334701X. [Google Scholar]
- Helfferich, C. The Quality of Qualitative Data: Manual for Conducting Qualitative Interviews; Publishing House of Social Sciences: Wiesbaden, Germany, 2009. [Google Scholar]
- Eccles, D.W.; Arsal, G. The think aloud method: What is it and how do I use it? Qual. Res. Sport Exerc. Health 2017, 9, 514–531. [Google Scholar] [CrossRef]
- Malterud, K.; Siersma, V.D.; Guassora, A.D. Sample size in qualitative interview studies: Guided by information power. Qual. Health Res. 2016, 26, 1753–1760. [Google Scholar] [CrossRef] [PubMed]
- Mills, S.; Torrance, N.; Smith, B.H. Identification and management of chronic pain in primary care: A review. Curr. Psychiatry Rep. 2016, 18, 22. [Google Scholar] [CrossRef] [PubMed]
- Dröge, K. noScribe. AI-Powered Audio Transcription (Version 0.4.1). 2024. Available online: https://github/kaixxx/noScribe#noscribe (accessed on 31 October 2024).
- Braun, V.; Clarke, V. Reflecting on reflexive thematic analysis. Qual. Res. Sport Exerc. Health 2019, 11, 589–597. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Häuser, W.; Schmutzer, G.; Henningsen, P.; Brähler, E. Chronische Schmerzen, Schmerzkrankheit und Zufriedenheit der Betroffenen mit der Schmerzbehandlung in Deutschland. Man. Med. 2014, 52, 540–547. [Google Scholar] [CrossRef]
- Müller-Schwefe, G.H. European survey of chronic pain patients: Results for Germany. Curr. Med. Res. Opin. 2011, 27, 2099–2106. [Google Scholar] [CrossRef] [PubMed]
- Dydyk, A.M.; Conermann, T. Chronic Pain. In StatPearls; StatPearls Publishing LLC.: Treasure Island, FL, USA, 2025. [Google Scholar]
- Darlow, B.; Fullen, B.M.; Dean, S.; Hurley, D.A.; Baxter, G.D.; Dowell, A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. Eur. J. Pain 2012, 16, 3–17. [Google Scholar] [CrossRef] [PubMed]
- Pietilä Holmner, E.; Stålnacke, B.M.; Enthoven, P.; Stenberg, G. “The acceptance” of living with chronic pain—An ongoing process: A qualitative study of patient experiences of multimodal rehabilitation in primary care. J. Rehabil. Med. 2018, 50, 73–79. [Google Scholar] [CrossRef] [PubMed]
- Hestmann, R.; Bratås, O.; Grønning, K. Chronic pain self-management interventions in primary care—Does it make any difference? A qualitative study. BMC Health Serv. Res. 2023, 23, 537. [Google Scholar] [CrossRef] [PubMed]
- Moseley, L. Unraveling the barriers to reconceptualization of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. J. Pain 2003, 4, 184–189. [Google Scholar] [CrossRef] [PubMed]
- Becker, A.; Straßner, C. S1-Leitlinie Chronischer Nicht Tumorbedingter Schmerz AWMF-Register-Nr. 053-0362023. Available online: https://register.awmf.org/assets/guidelines/053-036l_S1_Chronischer_Schmerz_2023-12.pdf (accessed on 15 November 2023).
- Nationale Versorgungsleitlinie Nicht-Spezifischer Kreuzschmerz [Database on the Internet]. Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften 2017. Available online: https://www.leitlinien.de/themen/kreuzschmerz/2-auflage (accessed on 15 November 2024).
- Scherer, M.; Schaefer, H.; Blozik, E.; Chenot, J.F.; Himmel, W. The experience and management of neck pain in general practice: The patients’ perspective. Eur. Spine J. 2010, 19, 963–971. [Google Scholar] [CrossRef] [PubMed]
- Nadeau, S.E.; Lawhern, R.A. Management of chronic non-cancer pain: A framework. Pain Manag. 2022, 12, 751–777. [Google Scholar] [CrossRef] [PubMed]
- Kastaun, S.; Prinz, A.; Hoppe, S.; Gabrys, L.; Wilm, S. Beratung zu Bewegung in der Hausarztpraxis. Z. Allg. 2024, 100, 190–197. [Google Scholar] [CrossRef]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed]
Survey | Interviews | |
---|---|---|
General practitioners n | 131 | 21 |
Gender f (%) | 49 (49) | 11 (52.4) |
Age years mean (range) | 48 (24–74) | 50.6 (31–74) |
Professional experience years mean (range) | 20.5 (1–44) | 21.3 (4–42) |
Physician in specialization training in general practice * n (%) | 8 (6.1) | 2 (9.5) |
Naturopathy specialist n (%) | 33 (25.2) | 4 (19.0) |
Pain therapy specialists n (%) | 26 (19.8) | 2 (9.5) |
Patients n | 252 | 37 |
Gender f (%) | 136 (54) | 22 (58) |
Age years mean (range) | 62 (20–89) | 69.5 (23–85) |
Pain duration 0.5–20 years n (%) | 230 (91) | 37 (100) |
Perceived pain intensity ** mean | 5.5 | 6 |
Item | N * | “Often” % |
---|---|---|
In my practice, chronic non-cancer pain is a cause for consultation. | 114 | 87.1 |
I ask patients what they do themselves to alleviate pain besides taking medication. | 104 | 79.4 |
I make agreements with patients regarding integration of non-pharmacological interventions. | 62 | 47.3 |
I provide information material regarding non-pharmacological interventions. | 49 | 37.5 |
I refer patients to specialized pain therapy or outpatient clinics. | 41 | 31.3 |
I use a structured approach with questionnaires or scales to taking individual medical pain history. | 34 | 26.0 |
Item | N * | % |
---|---|---|
I consulted a physician because of my pain during the last six months. | 164 | 65.1 |
My General practitioner is involved in my pain treatment. | 158 | 62.7 |
An orthopedist is involved in my pain treatment. | 92 | 36.5 |
A physiotherapist is involved in my treatment. | 67 | 26.6 |
A neurologist is involved in my pain treatment. | 41 | 16.3 |
A pain therapy specialist is involved in my treatment. | 18 | 7.1 |
A psychotherapist is involved in my treatment. | 16 | 6.3 |
I go to an outpatient clinic. | 3 | 1.2 |
During the Course of My Pain Treatment, I Was Once Asked Whether | N | % |
---|---|---|
I have or had drug or alcohol related problems | 139 | 55.2 |
I suffer from stress | 137 | 54.4 |
I suffer from depression, anxiety and/or panic attacks. | 136 | 54.0 |
there were traumatizing events in my past | 136 | 54.0 |
I feel alone or lonely | 134 | 53.2 |
I avoid certain activities for fear of pain | 121 | 48.0 |
I am very afraid that my pain could get worse | 117 | 46.4 |
I have difficulties with falling asleep or sleep through | 108 | 42.9 |
I have support from friends and family | 97 | 38.5 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Poß-Doering, R.; Carter, S.; Brinkmöller, S.; Möhler, M.; Dupont, D.; Paul, C.; Zugaj, M.R.; Wurmbach, V.; Balzer, A.; Wensing, M.; et al. Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project. Diseases 2025, 13, 34. https://doi.org/10.3390/diseases13020034
Poß-Doering R, Carter S, Brinkmöller S, Möhler M, Dupont D, Paul C, Zugaj MR, Wurmbach V, Balzer A, Wensing M, et al. Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project. Diseases. 2025; 13(2):34. https://doi.org/10.3390/diseases13020034
Chicago/Turabian StylePoß-Doering, Regina, Sarina Carter, Sabrina Brinkmöller, Melanie Möhler, Dominik Dupont, Cinara Paul, Marco R. Zugaj, Viktoria Wurmbach, Alexandra Balzer, Michel Wensing, and et al. 2025. "Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project" Diseases 13, no. 2: 34. https://doi.org/10.3390/diseases13020034
APA StylePoß-Doering, R., Carter, S., Brinkmöller, S., Möhler, M., Dupont, D., Paul, C., Zugaj, M. R., Wurmbach, V., Balzer, A., Wensing, M., & Straßner, C. (2025). Understanding General Practitioner and Patient Perceptions Regarding Integration of Non-Pharmacological Interventions in Chronic Non-Cancer Pain Management—A Cross-Sectional Mixed-Methods Study in the RELIEF Project. Diseases, 13(2), 34. https://doi.org/10.3390/diseases13020034