How do practitioners examine individuals living with chronic pain and trauma - are we asking the right questions?
The relationship between chronic pain, adult comorbidities and adverse life experiences is well established in the literature. The maladaptive coping strategies can intensify patients’ experience of pain, or disrupt or lengthen pain management. Identifying trauma earlier in the assessment process may support individuals to cope with their pain management long-term. National Institute of Health and Care Excellence (NICE) guidelines stipulate a biopsychosocial assessment be completed when individuals attend a chronic pain management service. The experiences of practitioners in chronic pain services are vastly under-represented, and such voices are needed to help understand how the biopsychosocial approach is utilised when examining subjective reactions to trauma. It was anticipated that the narratives would reveal how practitioners carry out their examination of the individual patient who present with a chronic pain and trauma. Method: Eight practitioners working in various pain services within the United Kingdom were interviewed using a semi-structured interview method. Participants accounts were audio recorded, transcribed verbatim and analysed through a process of constructivist grounded theory approach. Results: The findings of this study revealed a central storyline of two main processes, highlighting a push-pull dynamic involving Practitioner Awareness and Practitioner Action. Both models explore motivations for change in current assessment practices in pain management services. Practitioner Awareness: Seven subthemes emerged from the data analysis including ‘The complexity of chronic pain and its links to distress’, ‘The subjectivity of trauma and its links to pain’ and ‘Asking the right questions about the onset of pain’. Practitioner Action: Five subthemes were identified as barriers to practice, including ‘Staying in line with the professional remit’, ‘Practitioner uncertainty prevents exploration of trauma’ and ‘Time determines the focus of assessment’. Participants were unlikely to examine chronic pain and trauma directly. Instead, patients were prescribed physical interventions or treatments. Further categories, such as ‘Not asking about trauma results in excluded patients’ and ‘Best practice recommendations’, offer a deeper understanding and a voice to this population. Conclusion: The shared experiences highlight clear challenges encountered by participants when asking questions about trauma during the assessment process in pain services. Fears of non-containment and not staying in professional remit were reported with participants questioning whether they are ‘Asking the right questions?’ This study has contributed to changes in clinical practice, with practitioners requesting a screening tool to be developed for examining a history of trauma with individuals who live with a chronic pain.
chronic pain, trauma, PTSD, post traumatic stress disorder, NICE guidelines, practitioner, pain management, biopsychosocial assessment, International Association for the Study of Pain
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