| Summary: | Background: The self-management of chronic back pain may be a lifetime task for many patients. Whereas health professionals are experts in providing health services to support patients, the pain itself and its impact can only be experienced by the patients living with it. It is likely that optimum self-management of chronic back pain may only be achieved when patients and professionals develop a good partnership that integrates their complementary knowledge and skills. Aim: To explore patients' perceptions of the nature and influence of partnerships with health professionals, on their ability to self-manage chronic back pain. There were two objectives: the first was to assess the influence of patient-professional partnerships on patients’ ability to self-manage chronic back pain and to identify any associations between them. The second was to explore patients’ perceptions and experiences of the influence of these partnerships on their self-management ability. Methods: First, a systematic review was conducted to identify research undertaken in this area and to identify key factors within patient-professional partnerships that may influence self-management. Second, an explanatory sequential mixed methods study was undertaken in three pain management clinics in Northern England, UK. Patients were recruited following an initial clinic consultation (baseline) and followed up after three months. The aim of the quantitative phase was to detect changes in outcomes (i.e. PIH, PPiC, BPI, HADS, PSEQ and DoloTest) between the baseline and follow-up data collection. Hierarchical linear regression was used to investigate the association between patient-professional partnerships and the self-management of chronic back pain. A complementary qualitative phase using grounded theory was then conducted through in-depth interviews with a purposive subsample of 26 of the patients from phase one. The aim was to explore patients’ perceptions and experiences of the influence of patient-professional partnerships on their self-management ability. Each interview was transcribed and analysed using constant comparative analysis. Results: Seven themes were identified in the systematic review: communication, mutual understanding, roles of health professionals, information delivery, patients’ involvement, individualised care and health care service. These were developed into a model suggesting how factors within patient–professional partnerships may influence the self-management of chronic back pain. One hundred and three (70.1%) patients completed both baseline and follow-up data collection. Patients’ self-management ability, partnerships with health professionals, pain interference, self-efficacy, general health, and anxiety disorder all showed statistically significant improvement at follow-up. Regression analysis showed that improvements in patient-professional partnerships were positively associated with improvements in pain self-management. In-depth interviews identified a range of facilitators of and barriers to a good patient-professional partnership. Five supportive approaches were provided by health professionals in the pain clinics. Patients’ experiences suggested that a good partnership supported the development of their self-management ability. Conclusion: A good patient-professional partnership appears to have a positive impact on patients’ ability to self-manage their chronic back pain through five supportive approaches. The long term impact of the pain clinic could not be fully evaluated, and further research is needed to assess the effectiveness of pain management services of this kind.
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