Barriers and facilitators to biopsychosocial management of chronic primary pain; an exploration of Canadian athletic therapists’ perspectives

Abstract

Background and objectives. One in 5 Canadians experience pain which persists longer than 3 months. The magnitude, duration and impact of that pain is determined not only by biological factors, but psychological, sociocultural and behavioral ones as well. This concept is best understood through the lens of the biopsychosocial model of disease, which is now considered most appropriate for chronic pain management. Given that certified athletic therapists (CAT(C)) in clinical practice frequently are in contact with patients experiencing chronic pain, it is essential that they be well prepared to manage this condition. Previous research has found that other healthcare professionals struggle to address psychosocial factors which influence chronic pain outcomes; athletic therapists have not been included in these studies. In this study, I will use a knowledge translation framework to assess CAT(C)s’ knowledge of current pain physiology and influencing factors, and their attitudes and beliefs regarding the management of chronic primary pain. In addition, I will explore what barriers and facilitators CAT(C)s identify to incorporating a biopsychosocial approach in the management of chronic primary pain. Methods. Forty-four CAT(C)s from six provinces completed the Knowledge and Attitudes of Pain Questionnaire. I then conducted in-depth semi-structured interviews with 10 athletic therapists to further explore barriers and facilitators to the use of a biopsychosocial approach to chronic pain management. The transcribed interviews were analyzed using reflexive thematic analysis and the resulting themes were compared to relevant behaviour change constructs from the Theoretical Domains Framework, which was also used to create the interview guide. Results. We reported the mean scores of KNAP scales; knowledge of pain physiology and influencing factors (81.79%), treatment orientation (63.46%) and the total score (76.30%). We identified six themes and 23 subthemes; themes include therapist beliefs about pain, common approaches to chronic pain management, athletic therapy in the community, training or experience in chronic pain management, communication, and the affective side of treating chronic pain. Conclusion. Athletic therapists face numerous barriers in the management of chronic pain, including knowledge gaps, and further research, training and organizational support is recommended.