Healthcare professionals’ barriers and facilitators to implement pain education after following a chronic pain course; a mixed method study

Chronic pain (pain that persists beyond normal expected healing times or for >3 months) affects around 20% of the population (Breivik et al., 2006). The prevalence of chronic pain is higher than any other chronic disease(Rapport, September 2010; Report, September 2010), including cancer, heart disease, and diabetes. Chronic pain has a tremendous personal and socioeconomic impact: it causes the highest number of years lived with disability("Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013," 2015) and is the most expensive cause of work-related disability(Andersson, 1999; Waddell & Burton, 2001). Chronic pain also decreases life expectancy, independently of socio-demographic factors(McBeth et al., 2009; Torrance et al., 2010).
Over the past decades, the scientific understanding of chronic pain has revealed that biopsychosocial factors contribute to the intensity, functional impact and persistence of pain(Fillingim, 2005; Lumley et al., 2011; McLean et al., 2005; Meeus & Nijs, 2007; Wijma et al., 2016). Factors such as comorbidities, physical fitness, behaviour, psychosocial characteristics and environmental aspects can all influence the pain a person experiences(Fillingim, 2005; Lumley et al., 2011; McLean et al., 2005; Meeus & Nijs, 2007; Wijma et al., 2016). This improved understanding of chronic pain has shifted management strategies away from pure biomedical treatments, such as lumbar fusion surgery(Wang et al., 2014), injections or pharmacotherapy, to multimodal approaches acknowledging the complex biopsychosocial nature of chronic pain. Such multimodal approaches often include patient self-management.