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      A qualitative exploration of GPs’ perspectives on managing chronic nonspecific musculoskeletal pain in Australian general practice – a focus group study

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          Abstract

          Objective: Chronic nonspecific musculoskeletal pain (CNMP) is a complex idiopathic condition that causes significant disruption to patients’ lives, their relationships, and functionality. The cause of CNMP is not fully understood, which makes diagnosis and management challenging. As general practitioners (GPs) are central to the management of chronic pain, their perspectives on managing CNMP are important.

          Purpose: To explore the clinical reasoning GPs use when diagnosing and managing CNMP.

          Methods: A qualitative study design using focus group discussion was conducted with Australian GPs. Five focus group discussion were conducted across Adelaide. All focus group discussions were audio-recorded, and transcripts were coded and analyzed thematically with the program NVivo.

          Results: The main themes remained consistent across the five focus group discussion’s: the ambiguous cause of CNMP; sex differences; developing the “right strategy”; patient-centered care; and verifying vitamin D levels.

          Conclusion: The findings show that GPs use a patient-centered approach tailored to individual patients’ medical history, physical examination findings, and psychosocial health. There was general concern about low levels of vitamin D in patients with CNMP, and vitamin D supplements were recommended if indicated by a patient’s history.

          Most cited references20

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          Chronic pain in Australia: a prevalence study

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            Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

            Background Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. Methods A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. Results GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. Conclusion GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions.
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              Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States

              Introduction A number of studies suggest a link between low levels of 25-hydroxy vitamin D and incidence of acute and chronic pain. Clinical studies of vitamin D supplementation in patients with known vitamin D deficiency have shown mixed results in improving pain scores. Methods In this article, vitamin D deficiency risk factors are observed and adequate levels of 25-hydroxy vitamin D defined. Clinical supplementation with vitamin D is explored, including the schedules used in published clinical trials. Evidence of the effectiveness of vitamin D supplementation for the treatment of chronic pain conditions from double-blind randomized controlled trials (RCTs) is examined. Results The scientific evidence for vitamin D as a treatment option for chronic pain is limited due to lack of RCTs. It cannot be stated conclusively that vitamin D deficiency is directly linked to the etiology or maintenance of chronic pain states. Conclusion There remains a growing body of both clinical and laboratory evidence pointing to a potential relationship between low levels of 25-hydroxy vitamin D and a variety of chronic pain states. More focused research involving large RCTs is necessary. Electronic supplementary material The online version of this article (doi:10.1007/s40122-015-0036-8) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                February 2018
                February 2018
                : 6
                : 1
                : 32-38
                Affiliations
                [1] 1Discipline of General Practice, The University of Adelaide, Adelaide, SA, Australia
                [2] 2Health Sciences Building (2.27), Flinders University, Adelaide, SA, Australia
                Author notes
                CORRESPONDING AUTHOR: Manasi Gaikwad, Discipline of General Practice, University of Adelaide, 178 North Terrace, Level 11, Adelaide, SA 5006, Australia, E-mail: manasi.gaikwad@ 123456adelaide.edu.au
                Article
                FMCH.2017.0125
                10.15212/FMCH.2017.0125
                bcce2969-ffad-4f47-93c0-4d557212b9bf
                Copyright © 2018 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 11 November 2016
                : 12 April 2017
                Categories
                Qualitative Exploration

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                focus group study,Qualitative research,general practitioner,chronic pain

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