A summary of findings from the pre-intervention interviews, with additional quotes and implications for future trial planning
| Theme | Additional example quotes and/or notes* | Implications for future trial planning |
| Pain changed who I am | “…you’re in pain the whole time… (you) can’t move and somebody’s got to help you out of bed, which really at 48 I shouldn’t be like that. … I feel I’m always going to be a person with pain…” (Patient D) “I like to think that I’m quite strong but equally I feel that…I’ve given up. I’m frustrated (because) I’m hurting. I can’t escape”. (Patient E) | Patients’ damaged sense of identity—and the related psychological processes that feed into it—should be kept as a core target of the hybrid treatment and measured for pre-post intervention changes. |
| Pain and sleep did not occur in psychosocial vacuum | No one single quote could satisfactorily illustrate the complexity of the psychosocial contexts described by the participants, and without risks of revealing their identities.* Example adversities cited included ill health, mental health problems, car or work accidents, assaults, relationship breakdown, problems experienced by dependents or close family members, being a carer, job redundancy/ unemployment, financial difficulties, homelessness, and bereavement. | While the current hybrid treatment has room to support flexible treatment delivery for patients with complex needs, more considerations should be given to the context in which the treatment is being delivered, as well as to practical support required to enable the most disadvantaged/burdened patients to access treatment. |
| Participants were not treatment naïve | “You just try to help yourself a little bit but, whether that’s a good or bad thing I don’t know”. (Patient A) “I’m trying to think myself healthy…I’ve tried …books … having your room right and spraying your pillow … all sorts of things…” (Patient D) “…there wasn’t nothing that I haven’t already seen or read or something before….” (Patient E) | Self-help treatments may not be considered as a satisfactory treatment option by this non-treatment naïve clinical population. An active alternative treatment with therapist contact may be a more appropriate control intervention in future trials. |
| Pain was thought to be the primary cause of sleep problems | “I’m not just gonna blame the pain…I’ve got a (teenage) son who’s causing … I’m not naïve to think that’s not a contributing factor (to sleep problems)… And I do stress … that’s just in my nature”. (Patient D) “(when) I wasn’t sleeping the pain seemed more unbearable… Unbearable, (because) I was tired… And I felt run down it just seemed worse I think…” (Patient E) | If patients hold a rigid belief that sleep will never improve unless pain is resolved, it would be difficult to get their buy-in to the Hybrid CBT on offer. As such, these beliefs need to be addressed upfront in the information sheet or during recruitment, to improve treatment uptake and subsequent adherence. |
| Participants were dissatisfied with the services available | “Most doctors these days don’t…give the time of day. They’ve got your prescription written out before you go in”. (Patient C) “(Interviewer: So have you talked to anybody about your pain and sleep?) Only my GP…And they sort of got painkillers. They don’t really like to give sleeping tablets anymore. Um… They advised over the counter ones…which work to an extent …” (Patient B) “I don’t feel that this surgery offers a lot of (non-drug treatments)…it can give (medication), but obviously I’ve stopped taking all tablets now for 5 weeks and I can’t see if there’s a difference from taking tablets to the placebo effect of fear that at least by reaching for the tablet there was something to help me”. (Patient E) | The issue of validation (or the lack thereof) is not unique to chronic pain patients, but highlights the importance for future trials to provide generic clinical skills training to the study therapists (health psychologists in the current study, or other suitably trained allied healthcare professionals with appropriate expertise in future trials). This will allow the provision of quality therapist contact, which is valued by our target patient group. |
| Participants’ treatment expectations were high | “…just to help control pain and sleeping…you can’t work miracles but it might be something that can help me…To be honest … I’m hoping … you might have the magic cure, you never know”. (Patient A) “A bit more sleep. More than anything. I find if I’m tired, … the pain seems worse or I’m just not able to cope with it as well…So my theory is if I can just get a bit more sleep I can perhaps cope better with the pain”. (Patient B) | Proactive management of patients’ treatment expectations at the outset of treatment, or as early as the enrolment stage in future trials, may help minimise attrition and unnecessary demoralisation. |
*Additional notes.
CBT, cognitive behavioural therapy.