Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

BackgroundSelf-management is recommended for patients with chronic back pain. Health professionals' support for self-management can be more effective when working in partnership with patients. The aim of this study was to investigate the associations between patient-professional partnerships and the self-management of chronic back pain. MethodsAn explanatory sequential mixed methods study was undertaken. Adults with chronic back pain referred to pain management clinics participated at baseline and 3-month follow-up. Their pain severity, partnerships with health professionals and self-management ability were measured. Hierarchical linear regression was undertaken to examine the strength of the associations between partnerships and self-management. A subsample was interviewed about experiences of the impact of patient-professional partnerships on their self-management ability, using a grounded theory approach. ResultsA total of 147 patients were recruited and 103 (70%) patients completed the follow-up. A strong association (p<0.001) was detected between patient-professional partnerships and all dimensions of self-management ability. This was validated by interviews with a subsample of 26 patients. Four themes emerged as follows: connecting with health professionals, being supported through partnerships, feeling positive and making progress towards self-management, and acknowledging the impact but feeling no difference. ConclusionsDeveloping a partnership in care may improve patients' ability to gain knowledge, manage side effects and symptoms and adhere to treatment. It helped strengthen health professionals' support and produce a sense of safety for patients. Guiding health professionals in building partnerships where expectations are acknowledged and tailored information and support are provided could be considered as part of the standard education and training. SignificanceThis study identified and validated strong associations between patient-professional partnerships and self-management. Support for self-management alone may not be sufficient, and building partnerships where patients and professionals work together towards agreed goals make an essential contribution to helping increase patients' ability to self-manage chronic back pain.

Objectives To identify barriers to effective pain management encountered by patients with chronic pain within the UK’s National Health Service (NHS). Design Secondary analysis of face-to-face, semistructured qualitative interviews using thematic analysis. Setting A community-based chronic pain clinic jointly managed by a nurse and pharmacist located in the North of England. Participants Nineteen adult (>18 years) patients with chronic pain discharged from a pain clinic, with the ability to understand and speak the English language. Results In general, patients were highly disappointed with the quality of pain management services provided both within primary and secondary care, and consequently were willing to seek private medical care. Barriers to effective pain management were divided into two main themes: healthcare professional-related and health systems-related. Three subthemes emerged under healthcare professionals-related barriers, namely (1) healthcare professionals’ lack of interest and empathy, (2) general practitioners’ (GP) lack of specialised knowledge in pain management and (3) lack of communication between healthcare professionals. Three subthemes emerged under health system-related barriers: (1) long waiting time for appointments in secondary care, (2) short consultation times with GPs and (3) lack of an integrated multidisciplinary approach. Conclusions The patients expressed a clear desire for the improved provision and quality of chronic pain management services within the NHS to overcome barriers identified in this study. An integrated holistic approach based on a biopsychosocial model is required to effectively manage pain and improve patient satisfaction. Future research should explore the feasibility, effectiveness and cost-effectiveness of integrated care delivery models for chronic pain management within primary care.

Background: Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients' health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients' ability to self manage their condition.Objectives: (1) To investigate whether there is a reciprocal relationship between self management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient-professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain.Design and setting: This quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient-professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients' health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients' life situation. Patients were recruited following initial consultation and followed up three months later.Participants: A total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief.Methods: Self-reported measures of HRQoL, patient-professional partnerships and self management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling.Results: There was no association between patients' self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (-038, p < 0.01). A patient-professional partnership was not found to be beneficial for patients' HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (-19.09, p < 0.01).Conclusions: This study suggests that the increase in patients' self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient-professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain. (C) 2016 Elsevier Ltd. All rights reserved.

Patients are encouraged to take an active role in self-managing their chronic back pain and functional problems. However, research suggests that patients do not self-manage, and they expect health professionals to fulfill a comprehensive role in managing pain. A partnership between patients and health professionals is called for, and self-management works best when they share knowledge and work together toward optimal goals. To explore how patients' partnerships with health professionals may influence their ability to self-manage pain by exploring patients' experiences. A grounded theory approach with in-depth, semistructured interviews was undertaken. Each interview was analyzed using constant comparative analysis. This study was nested within a larger study on patient-professional partnerships and the self-management of chronic back pain. Twenty-six patients with chronic back pain were recruited in a community-based pain management service in Northern England, United Kingdom. Three themes emerged: building partnerships with health professionals; being supported by health professionals to self-manage the pain; and experiencing a change in self-management. Five approaches that underpinned health professionals' self-management support were identified. Facilitators of and barriers to a good partnership were reported. This study suggests that a good patient-professional partnership has a positive effect on patients' self-management ability. A theoretical model explaining how such partnership may influence self-management was developed. It is necessary for both patients and health professionals to be aware of their partnerships, which may enhance the effect of pain management services.

Background: Chronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain.Objectives: To evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist.Design: A mixed-methods design consisting of qualitative interviews embedded within a quasi-experimental study.Settings: A community-based nurse-pharmacist led pain clinic in the north of England.Participants: Adult chronic pain (non-malignant) patients referred to the pain clinic.Methods: Pain intensity was the primary outcome. Questionnaires (the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the SF-36 and the Chronic Pain Grade questionnaire) were administered at the baseline, on discharge and at 3-month post-discharge (Brief Pain Inventory and Hospital Anxiety and Depression Scale only). Patient satisfaction was explored using face-to-face, semi-structured qualitative interviews.Results: Seventy-nine patients with a mean age of 46.5 years (SD +/- 14.4) took part in the quasi-experimental study. Thirty-six and nine patients completed the discharge and 3-month follow-up questionnaires respectively. Compared to baseline, statistically significant reductions were noted for two of the outcome measures: pain intensity (P= 0.02), and interference of pain with physical functioning (P= 0.02) on discharge from the service. Nineteen patients participated in qualitative interviews. The patients were, in general, satisfied with the quality of service. Four contributing factors to patient satisfaction were identified: ample consultation time, in-depth specialised knowledge, listening and understanding to patients' needs, and a holistic approach.Conclusions: Nurse and pharmacist managed community-based pain clinics can effectively deliver quality pain management services as they offer an interdisciplinary holistic approach to pain management. Such services have the potential not only to reduce the burden on secondary care but also decrease long waiting times for referral to secondary care. Further research is required to support the development of evidence based referral guidelines to such services. (C) 2015 Elsevier Ltd. All rights reserved.

Chronic back pain is common, and its self-management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self-management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self-management ability. This review aimed to explore the influence of patient-professional partnerships on patients' ability to self-manage chronic back pain, and to identify key factors within these partnerships that may influence self-management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self-manage chronic back pain; patients being actively involved for self-managing chronic back pain; and the influence of patient-professional partnerships on self-management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient-professional partnerships influence self-management. Review findings suggest that a partnership between patients and professionals supports patients' self-management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self-referral or telephone consultation to patients with chronic conditions.

Background: Chronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain. Objectives: To evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist. Design: A mixed-methods design consisting of qualitative interviews embedded within a quasi-experimental study. Settings: A community-based nurse-pharmacist led pain clinic in the north of England. Participants: Adult chronic pain (non-malignant) patients referred to the pain clinic. Methods: Pain intensity was the primary outcome. Questionnaires (the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the SF-36 and the Chronic Pain Grade questionnaire) were administered at the baseline, on discharge and at 3-month postdischarge (Brief Pain Inventory and Hospital Anxiety and Depression Scale only). Patient satisfaction was explored using face-to-face, semi-structured qualitative interviews. Results: Seventy-nine patients with a mean age of 46.5 years (SD 14.4) took part in the quasi-experimental study. Thirty-six and nine patients completed the discharge and 3-month follow-up questionnaires respectively. Compared to baseline, statistically significant reductions were noted for two of the outcome measures: pain intensity (P = 0.02), and interference of pain with physical functioning (P = 0.02) on discharge from the service. Nineteen patients participated in qualitative interviews. The patients were, in general, satisfied with the quality of service. Four contributing factors to patient satisfaction were identified: ample consultation time, in-depth specialised knowledge, listening and understanding to patients’ needs, and a holistic approach. Conclusions: Nurse and pharmacist managed community-based pain clinics can effectively deliver quality pain management services as they offer an interdisciplinary holistic approach to pain management. Such services have the potential not only to reduce the burden on secondary care but also decrease long waiting times for referral to secondary care. Further research is required to support the development of evidence based referral guidelines to such services. 2015 Elsevier Ltd. All rights reserved. Corresponding author at: Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Makkah, Saudi Arabia.

Background: Under-treatment of chronic pain within the community is a global problem. There is a growing interest to evaluate the role of nurses and pharmacists in chronic pain management with an aim to improve access to and quality of pain services. Aim: The research presented in this thesis had two aims: first, to evaluate the effectiveness of pharmacist-led medication review in chronic pain management; second, to evaluate the impact of a community based nurse-pharmacist managed pain clinic. Methods: A systematic review and meta-analysis was conducted to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. For the second aim, a mixed-methods study consisting of a quasi-experimental design and a qualitative descriptive design was undertaken. Pain intensity was the primary outcome. The secondary outcomes included: physical functioning; emotional functioning; quality of life; chronic pain grade and patient satisfaction. Patient satisfaction was evaluated using face-to-face, semi-structured qualitative interviews. Results: Of the 578 papers screened, five RCTs were included in the systematic review and three in the meta-analysis. Compared to the control, the meta-analysis found that patients in the intervention group had: a statistically significant reduction in pain intensity of 0.8 point (95% CI -1.28 to -0.36) and 0.7 point (95% CI -1.19 to -0.20) at 3-months and 6-months respectively; and 4.84 point (95% CI, -7.38 to -2.29) at 3-months and -3.82 point (95% CI, -6.49 to -1.14) at 6-months improvement in physical functioning. Seventy nine patients with a mean age of 46.5 years (SD ±14.4) took part in the quasi-experimental study. Thirty-six and 9 patients completed discharge and 3-month follow-up assessments respectively. Compared to baseline, statistically significant reductions were noted for two of the four outcome measures: pain intensity (P=0.02), and interference of pain with physical functioning (P=0.02) on discharge from the service. The majority of the patients were, in general, satisfied with the service. Four contributing factors to patient satisfaction were identified: ample consultation time; in-depth specialised knowledge; listening and understanding to patients’ needs; and a holistic approach. Conclusion: Community-based pain clinics managed by a nurse and pharmacist have the potential to improve chronic pain management in the community by providing timely access to a specialised pain service, ensuring safe and effective use of analgesics (medication reviews) and promoting self-management (patient education). Both pharmacist-led medication review and nurse-pharmacist managed pain clinics can reduce pain intensity and improve physical functioning The long term impact of the pain clinic could not be fully elucidated from this research as the planned follow-up data collection could not be completed due to decommissioning of the service.

This case study, written as part of my independent nurse prescribing course, will examine a decision to prescribe a strong opioid for an older patient with chronic pain: that is pain that lasts beyond the expected time of tissue healing, or pain due to an ongoing chronic condition ( International Association for the Study of Pain, 1994 ). This case is relevant to my practice as there are a significant number of older patients on my caseload within a primary care-based pain service.