Why do you think you still have pain? Individuals’ beliefs on the biopsychosocial factors that contribute to their chronic musculoskeletal pain: a qualitative exploration

Chronic musculoskeletal pain (CMP) is complex with many biopsychosocial factors that contribute to its development. Existing research has established individuals’ beliefs on the biological factors that contribute to CMP, but not psychosocial factors. The aim of this study was to determine individuals’ beliefs on the biopsychosocial factors that contribute to their CMP, with specific focus on beliefs about psychosocial contributors. A preliminary exploration using interpretative phenomenological analysis methods is reported according to the Consolidated Criteria for Reporting Qualitative Research. Adults with CMP were recruited from the general public. Four stages of data analysis were undertaken to identify superordinate and subthemes. In-depth analysis of n = 6 participants’ interviews identified six superordinate themes. Participants with higher disability from their CMP described psychological factors including negative psychological experiences (distress, loss of self-identity, negative thoughts/emotions, and stress), dissatisfaction with healthcare (let down, fobbed off, lack of empathy, lack of trust), and maladaptive coping strategies (catastrophisation, avoidance, external locus of control), and did not believe these contributed to their CMP. Participants with lower disability from their CMP described positive psychological experiences (solution focussed coping, positive attitudes) and believed these contributed to their CMP by reducing its severity. Participants described social factors including historical activities (work, sport, exercise) and believed these contributed to CMP via the perceived impact of activity causing musculoskeletal structural degeneration or injury. Participants believed biological factors such as structural changes (injury, degeneration) were the main cause of the development and persistence of their CMP. Individuals with higher disability and negative psychological experiences did not believe these were contributory to their CMP, while those with lower disability and positive psychological experiences believed these do contribute to CMP by reducing its severity. Biological factors such as musculoskeletal structural changes were considered the main cause of CMP. Social factors were believed to contribute to CMP through the perceived impact of physical activity on structural changes. Beliefs are not in keeping with contemporary understandings of CMP which may limit engagement with interventions such as exercise or psychosocial therapies.