Chronic pain in the community : its impact and management needs in primary care
One of the key findings of this thesis was the participants' perception of chronic pain impact. Participants' social-situational contexts, coping activities and help seeking approaches determined the degree of impact perceived in the experience of chronic pain. Experience of chronic pain impact was modified to varying degrees by engagement in coping activities e.g. physical and environmental and/or psychological and emotional, modifications and activities. Differences existed between those coping successfully or unsuccessfully as reflected in their overall coping approaches and/or strategies e.g. "active" or "passive". These approaches had positive or negative consequences for the process of adjustment. Expectations of GPs and primary care services were low. Actual experiences of consultations often contrasted with the ideal. Unmet needs and increasing frustration over repeated failed treatments was reported. Many participants moved on to seek help outwith the NHS e.g. CAM, and/or developed personal coping approaches and strategies. Others continued to consult whilst still believing that their GPs' neither did not care nor could not help them. These participants were amongst the most dependent and least evolved in their personal coping. Several typologies emerged from the thematic inductive analysis e.g. coping and consultations styles. Within these typologies, important socioeconomic differences were identified in the participants' ability to adapt e.g. to modify pain impact by developing successful coping strategies, gaining satisfactory health care treatment and obtaining health professional cooperation in or outwith the NHS. Thus, inequalities in pain experience and access to effective treatments were identified.