Chronic illness
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Spinal cord stimulation (SCS) is a last resort treatment for chronic pain consisting of an implantable pulse generator connected to leads placed in the epidural space of the spinal cord. Effective in reducing chronic pain, however, efficacy has been found to decrease over time. Psychological factors affecting outcome of SCS have been investigated through quantitative methods, but these have failed to provide confident predictors. We aimed to investigate via a qualitative approach, the experience of SCS following 1 year of therapy. ⋯ The findings provide context for the patients' experience of SCS. This research suggests that improved preparation prior to SCS including information provision, CBT and contact with expert patients may be of value.
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To improve understanding of the sources of frustration for people with chronic pain and consider the potential influence of frustration on the chronic pain experience and relationships with health professionals. ⋯ If patients think that their pain is not being believed this is clearly a barrier to an effective consultation. Communication with chronic pain patients may improve if the frustration of living with an invisible, debilitating condition that is hard to diagnose and treat is explicitly (and perhaps repeatedly) acknowledged by the health professional.
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This paper reports finding from a study that focused on people living with chronic pain, chronicling their experiences of pain and emotional distress, and their social and personal narratives. ⋯ Narratological distress is the internal battle between two unwanted narratives: The elusive delegitimizing narrative of denial, which seeks to ignore the experience of pain; and the narrative that acknowledges the pain, but with the price of accepting oneself as "ill" or "disabled."
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Randomized Controlled Trial
Moderators of chronic disease self-management programs: who benefits?
The Stanford University Chronic Disease Self-Management Program (CDSMP) has resulted in moderate beneficial outcomes in randomized controlled trials. A study of a modified CDSMP in England suggested that younger participants, those with lower initial self-efficacy and those with greater depression benefited most from the program. ⋯ There were no consistent moderating effects across four outcomes and two programs and little evidence to suggest that any groups should be targeted for program recruitment. The CDSMP appears to remain useful to a wide range of people with chronic illness.
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To understand general practitioners' (GPs) and practice nurses' (PNs) experiences of managing multimorbidity in deprived areas and elicit views on what might help. ⋯ Professionals' discussions of the difficulties that they face personally and attempt to help those most in need reflect both the continuing existence of the 'inverse care law' and the need for whole system changes to enhance the effectiveness of primary care for patients with multimorbidity in deprived areas.