Keele Research Repository

Background Low mood and distress are commonly reported with by people who have persistent musculoskeletal pain and may be labelled as 'depression'. It is important to understand how pain-related distress is conceptualised and managed in primary care consultations. Aim To explore understanding of pain-related distress and depression from the perspectives of people with persistent musculoskeletal (MSK) pain and general practitioners. Design and Setting Qualitative study with people with persistent pain and general practitioners, from different parts of the UK. Methods Semi-structured interviews were conducted remotely and data analysed thematically. Results Most participants described challenges distinguishing between distress and depression in the context of persistent pain but described strategies to make this distinction. Some people described how acceptance of their situation was key and involved optimism about the future and creation of a new identity. Some GPs expressed 'therapeutic nihilism', with uncertainty about the cause of pain and how to manage people with both pain and distress in primary care consultations, whilst GPs who could identify and build on optimism with patients described how to help the patient to move forwards. Conclusions This study offers a framework for the primary care consultation with patients presenting with pain-related distress. GPs should recognize the impact of pain on the patient and support the person come to terms with their pain, explore how the person feels about the future, encourage optimism, and support self-management strategies.