Chronic pain causes great suffering for those affected and treating it is one of the most common assignments in the health service. The aim of the study was to investigate the meaning of the experiences of persons with chronic pain in their encounters with health service staff. The study had a descriptive design with a phenomenological approach based on the perspective of caring science. Interviews were carried out with eight patients. The study showed that patients experienced a positive approach and that the staff had understood the serious nature of the situation. A positive approach can communicate hope and help to strengthen the patient. It is important to ask the patient about how he/she experiences his/her situation and thus gain an insight into this person's lifeworld. Participation entailed being active oneself and calling attention to one's needs and wishes for treatment. The study also showed that a negative approach by the staff played a prominent part in their experiences and appeared to be engraved in their memories. A negative approach is felt as being insulting and belittling. Patients with chronic pain felt that they were discredited and that their experience of their situation was called into question. They had to fight to get care and had to suggest treatments and examinations. There were also patients who had neither been asked about their pain experience nor had the opportunity to assess their pain with an assessment scale. Some of the phases in Travelbee's relationship model could be seen in several of the encounters but not all. The participants did not always feel that the manner of the nursing staff was empathetic or sympathetic, which led to greater suffering.

IntroductionFibromyalgia causes long-term pain. It affects at least 2% of the population, the majority being women. In addition, extended symptoms corresponding to vitamin B12deficiency occur. Findings from several studies have indicated that vitamin B12may be a possible treatment for pain in fibromyalgia. The aim of the proposed study is to evaluate whether vitamin B12decreases pain sensitivity and the experience of pain (ie, hyperalgesia and allodynia) in women with fibromyalgia.Methods and analysisThe study is a randomised, placebo-controlled, single-blind, clinical trial with two parallel groups which are administered mecobalamin (vitamin B12) or placebo over 12 weeks. 40 Swedish women aged 20–70 years with an earlier recorded diagnosis of fibromyalgia are randomised into the placebo group or the treatment group, each consisting of 20 participants. Outcomes consist of questionnaires measured at baseline and after 12 weeks of treatment. A final re-evaluation will then follow 12 weeks after treatment ends. The primary outcome is tolerance time, maximised to 3 min, which is assessed using the cold pressor test. In order to broaden the understanding of the lived experience of participants, qualitative interviews will be conducted using a phenomenological approach on a lifeworld theoretical basis (reflective lifeworld research approach).Ethics and disseminationThe protocol for the study is approved by the local ethical committee at Linkoping (EPM; 2018/294–31, appendices 2019–00347 and 2020–04482). The principles of the Helsinki Declaration are followed regarding oral and written consent to participate, confidentiality and the possibility to withdraw participation from the study at any time. The results will primarily be communicated through peer-reviewed journals and conferences.Trial registration numberNCT05008042.

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