Experiences of general practitioners explaining central sensitisation to patients with persistent physical symptoms: a focus group study

Abstract

ObjectivePatients with persistent physical symptoms (PPS) require an explanation that is acceptable and comprehensible to them. Central sensitisation (CS) is an explanatory model for PPS and chronic pain that has been broadly applied in the context of pain medicine, but, until recently, not by general practitioners (GPs). We explored how GPs used the CS model in their consultations with patients with PPS.Design and settingA qualitative focus group study among GPs in the Netherlands.MethodsWe instructed 33 GPs on how to explain CS to patients with PPS. After 0.5–1.5 years of using the CS model, 26 GPs participated in focus groups and interviews to report and discuss their experiences with CS as an explanatory model. Audio recordings were transcribed and two researchers independently analysed the data. The text was coded, codes were organised into themes and discussed until consensus was reached.ResultsWe identified eleven themes and grouped these into four categories.The GPs regarded the CS model as evidence-based, credible and giving recognition to the patient. On the other hand, they found explaining the CS model difficult and time-consuming. They tailored the CS model to their patients’ needs and used multiple consultations to explain the model. The GPs reported that the use of the CS model seemed to improve the understanding and acceptance of the symptoms by the patients and seemed to reduce their need for more diagnostic tests. Furthermore, patients seemed to become more motivated to accept appropriate therapy.ConclusionGPs reported that they were able to provide explanations with the CS model to their patients with PPS. They regarded the model as evidence-based, credible and giving recognition to the patient, but explaining it difficult and time-consuming.

Towards a shared understanding of chronic pain

“…For example, it would be worthwhile to study patient-practitioner interaction about chronic pain in primary care contexts as well. There is an increasing awareness amongst primary care healthcare practitioners (e.g., physiotherapists and general practitioners) of the importance of using the biopsychosocial model, but studies report that they experience barriers when adopting this approach in clinical practice (Den Boer et al, 2022;Holopainen et al, 2020;Ng et al, 2021;Van Dijk et al, 2023). These barriers have to do, amongst other things, with challenges that they experience in their communication with patients.…”