How effective is the 'x-ray session' in helping patients understand their pain?: A quasi-experimental design
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Many patients with chronic pain are extensively investigated in the search for a 'cause' of their pain and radiological investigations are one of the most frequent ways to do this. Modern day imaging can provide evidence of pathological process. However, whilst imaging can reveal all manner of variants, these can be present in symptomatic and asymptomatic patients alike. If the patient believes in a mechanical cause of their pain (i.e. abnormality/cause = effect /pain), then they may be less easily satisfied or reassured by the finding of 'irrelevant' results. In reviewing the literature, the evidence suggests that patients’ beliefs about their pain play a prominent role in pain perception, function and response to treatment. It therefore follows that if we can gain a better understanding of patients’ perspective’s of their pain it may lead to the development of better management. The primary aim of this study was to gain insight into the illness experience of those with chronic pain. In particular, how effective was a single cognitive-behavioural intervention (the X-ray session) in helping patients reconceptualise their views of their chronic pain and improve their ability to exert control over the pain experience. The hypotheses were tested using a one-group pretest - post-test design (T2 & T3) with repeated measures (T1 & T4). In order to broaden the understanding of the illness experience, data was also collected during a semi-structured interview (T3). As well as investigating the group as a whole, consideration was given to gender differences. This is because anecdotal clinical observation supports comment in the literature suggesting that men and women differ in their perception, understanding and management of pain. Analysis of the overall questionnaire data failed to show that the X-ray session, on its own, was effective in influencing illness beliefs, distorted thinking or pain related fear of movement (T2 & T3). However, a series of repeated measures analyses of variances with gender as a between subject factor showed that the Illness Perception Questionnaire - Revised (IPQ-R) subscale, emotional distress, changed differently between women and men following the X-ray session. Men's emotional distress increased while women's reduced although neither change was significant on its own. Analysis of baseline data (T1) did confirm one of the hypotheses, that women would report greater pain related fear of movement than men at the start of the programme. While analysis of the questionnaire data failed to demonstrate significant changes, the interviews offered the opportunity to gain a greater insight into the individual’s conceptualisation of their pain. In sum, we know that patients hold implicit theories about the significance of their x-ray results, however, the broader meanings were notably more difficult to access without an in-depth interview. Thus without ascertaining how sophisticated the knowledge and understanding of the illness representation was, or indeed if it is accurate, gaining insight into the patient’s model (in this study) remains limited.