Impact of the COVID-19 pandemic on the perception of treatment and chronic musculoskeletal pain in users of a family health unit: qualitative study

Faria, Maria de Paula; Freitas, Letícia Jonas de; Soares, Paula Nunes Cordeiro; Oliveira, Anamaria Siriani de; Silva, Tainan de Castro

doi:10.5935/2595-0118.20240004-en

Maria de Paula Faria

Data Collection

Conceptualization

Project Management

Research

Methodology

Writing – Preparation of the original

Writing - Review and Editing

Visualization

University of São Paulo, School of Medicine, Multiprofessional Residency Program in Comprehensive Health Care, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-4253-2748

Letícia Jonas de Freitas

Conceptualization

Project Management

Methodology

Writing - Review and Editing

Validation

University of São Paulo, School of Medicine, Department of Health Sciences, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-3924-231X

Paula Nunes Cordeiro Soares

Conceptualization

Writing - Review and Editing

University of São Paulo, School of Medicine, Multiprofessional Residency Program in Comprehensive Health Care, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-5004-3135

Anamaria Siriani de Oliveira

Conceptualization

Methodology

Writing - Review and Editing

Supervision

University of São Paulo, School of Medicine, Department of Health Sciences, Ribeirão Preto, SP, Brazil

University of São Paulo, School of Medicine, Department of Physiotherapy, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0001-5854-0016

Tainan de Castro Silva

Conceptualization

Writing - Review and Editing

University of São Paulo, School of Medicine, Department of Physiotherapy, Ribeirão Preto, SP, Brazil

http://orcid.org/0000-0002-7660-7912

Correspondence to: Anamaria Siriani de Oliveira E-mail: siriani@fmrp.usp.br

Conflict of interests: none – Sponsoring sources: none.

Associate editor in charge: Maria Belén Salazar Posso https://orcid.org/0000-0003-3221-6124

Identification	Age	Gender	Time of pain	Occupation	Diagnosis and imaging
Patient 1	42 years	Female	5 years	Percussionist	Rotator cuff syndrome (ultrasound: bilateral supraspinatus tendinopathy and bursitis)
Patient 2	52 years	Female	6 years	Housewife	Back pain
Patient 3	35 years	Female	14 years	Housewife	Chronic pelvic pain (X-ray examination: femoral osteochondrosis)
Patient 4	45 years	Female	5 years	Unemployed (previous profession: saleswoman)	Back pain
Patient 5	65 years	Female	20 years	Retired – Housewife	Back pain
Patient 6	58 years	Male	8 years	Retired – general services assistant.	Knee osteoarthritis (X-ray examination: reduction of medial femorotibial joint space next to D)

Categories	Subcategories	Definition	Quote	Codes	Topics
Experience with CMP during the pandemic	Pain perception	Individuals’ understanding of the presence of pain	(...). I was even more... I was very confined and very still, not much, and the more I stayed at home [...] because we had no way of going out, of walking. In my case, it seems that people are even more inclined to feel pain, right? (Patient 4) (...) My pain during the pandemic, in a way, improved, I think in a way because the movement decreased. (Patient 1)	Worsening of pain intensity Fear and uncertainty Concern about contamination Pain relief Reduced workload, sedentary lifestyle, and social isolation	Multidimensional impact of pain and coping strategy
	Control actions for pain	Actions taken by individuals to relieve pain symptoms	(...) I had to take some measures on my own. So sometimes, the drugs I take on my own is dipyrone, and I behave as if I had been to the doctor, remembering the treatment he said and doing it. (Patient 3) (...) Usually we felt a bit of pain, a bit too much, so I tried to rest, rest more, so I could rest a bit, right? (Patient 6)	Drugs Rest Self-management
	Understanding factors that improve pain	Individuals’ knowledge of actions and strategies that help control and relieve pain	(...) I tried to do the activities I usually do, I try to set goals and I don’t stand there thinking ‘Ahh, I’m in pain, I’m in pain!’, I take the focus off of it even though I know it exists. (Patient 3) (...) thinking about the routine, I’m aware that if I go back to having healthier habits ... I already have a healthier eating habit [...] so I think I need to add exercise to my routine. Make it a routine, you know... every day ehhh, do it... I think that if I managed to lose weight, exercise more, maybe I’d be able to notice more of a difference in the pain. (Patient 2)	Healthy habits Physical exercise Rest Self-management Self-knowledge
Access to health services during the pandemic	Seeking care due to pain	Search for health care due to worsening of pain symptoms	(...) I did have it..., but we avoided it... because there was a peak when the contagion was very high, when the health centers were very crowded with COVID patients, so sometimes we felt pain and we avoided it.” (Patient 2)	Emergency care Multi-professional care Avoidance of care Reception Guidance Physiotherapeutic care	Characteristics of the health service and individual-centered care
Access to health services during the pandemic	Experience during care	Individuals’ perceptions during health care received to assess pain symptoms	(...) The people at the center would say: “No... let’s lengthen it like this, let’s change the booklet like this, try this, try that” So who... who really gives me support for pain is the center, right?” (Patient 1) (...) ah I had to go straight, I have a card that I can go and book my appointment with the orthopedist, eh. [...], but my orthopedist, he’s... he looks me in the face and says: ‘There’s nothing he can do! You’re already on the physiotherapy waiting list. (Patient 1)	Satisfaction Resolvability Frustration Indifference
Quality of life, physical and mental health aspects	Perception of the present moment	Feeling of understanding of their current situation and experience.	(...). Today I went out, did a million things, stood for a long time and got in the car about 10 times, so I’m a bit tired. Anything that takes me out of my routine, the pain comes, you know? (Patient 2) (...) My emotions are pretty shaken up, 15 days ago we lost my daughter’s father-in-law. It was quite an impact for me, you know. But then we get more tense, you get stuck.” (Patient 4) (...). I had to stop handicrafts, but I already have the idea of seeing what I can do, right, so the mind always remains a mind, so... inspiring.” (Patient 3)	Stress Tiredness Irritation Sadness Grief Motivation Encouragement	Influence of pain on quality of life and future life prospects
Quality of life, physical and mental health aspects	Perspective of health in the future (next 10 years)	Feeling of expectations about the future in the next 10 years of life.	(...) I wonder if I’ll ever make it (laughs). When we were kids, we didn’t even think we’d reach 40, let alone 70! I don’t think much about it. But I tell my husband, when he retires, we’re going to live on a ranch by the river, that’s all!” (Patient 5) (...). Really? I’m so unmotivated... it makes me sad. With the world, with people, [...]. I can’t get a job, I’ve looked for several and I’ve been looking. So, I’m fine, I’m pretty discredited to tell you these days. I have no expectations of tomorrow, you know... I don’t...” (Patient 4)	Demotivation Frustration Responsibility Hope Life project

Quotes – Topic 1
Q1 “This pain has been with me since before the pandemic. [...] I felt that during the pandemic I was in even more pain. I think it’s psychological, I don’t know, something related to that seems to have made the pain more pronounced” (Patient 2).
Q2 “So at the time of the pandemic, the pain was even a little more intense in relation to this: people being in the daily routine of staying more at home in isolation, without contact with other people; access to health was also more restricted. So you were feeling (pain), but you thought it was better not to go to the clinic, because the clinic was more focused on treating Covid patients. And then, in this way, it gets more intense, right, because you feel at the moment that it’s intense, you can’t cope, there’s no way you can seek help, because you know that if you did, you could put yourself at greater risk of contamination” (Patient 3).
Q3 “I was even more... I was very confined and very still, not much, and the more I stayed at home [...] because we had no way to go out, to walk... it seems that people are even more likely to feel the pain in my case, right”? (Patient 4).
Q4 “My pain during the pandemic period, in a way, it got better, I think in a way because it reduced movement. Yeah... since I work with percussion, I use my arms a lot where my chronic pain is more localized, which is in my shoulder. At the time, we had a... the demand for work dropped a lot and with that my arm, um... I think it had more rest and it got better” (Patient 1).
Q5 “During the pandemic, it (the pain) didn’t increase. [...] There was no difference. What I remember was more the worry about being vaccinated” (Patient 6).
Q6 “During the pandemic we didn’t go out, just indoors, right? Then at home we used hot water bags, those bags to try to relax and take drugs, a muscle relaxant. They gave it to me here (at the health unit), I think it was a relaxant, but I took it and it made me very sleepy” (Patient 4).
Q7 “I had to take some measures on my own. So sometimes the drugs I take on my own is dipyrone, but I behave as if I’d gone to the doctor, remembered the treatment he’d said and did it” (Patient 3).
Q8 “We usually felt a bit of pain, a bit too much, so we tried to rest, rest more, rest a bit, right? (Patient 6).
Q9 “Thinking about the day to day, I’m aware that if I go back to having healthier habits... I already have a healthier eating habit [...] so I think I need to add exercise to my routine. Make it a routine, you know... every day, mhmm... do it... I think that if I managed to lose weight, exercise more, maybe I’d be able to notice more of a difference in the pain” (Patient 2).
Q10 “It was good... the exercises, the stretching with the group (exercise group at the health unit), it was really good, but I can’t do it at home” (Patient 4).
Q11 “When I’m in pain, I can’t do much and then I stop, you know? I relax a bit in bed, start stretching. I don’t insist on doing anything” (Patient 5).
Q12 “I’ve tried to do the activities I usually do, I try to set myself goals and I don’t sit there thinking ‘Ahh, I’m in pain, I’m in pain!’, I focus on it even though I know it’s there. It’s worked well for me, right, because if I go back to just looking at this pain, I’ll realize that it’s hurting a lot and it hurts a lot... then you think you can’t do anything” (Patient 3).

Quotes – Topic 2
Q13 “Oh yes... I did have it..., but we avoided it... because there was a peak when the transmission was very high, the health centers were very crowded with COVID patients, so sometimes we felt pain, and we avoided it” (Patient 2).
Q14 “The people at the center would say: “No! Let’s stretch like this, let’s change the booklet like this, try this, try that” So who... who really gives me support for pain is the center, right”? (Patient 1).
Q15 “During the pandemic I looked for... well, not so much related to pain, because when the weather gets cold, I start with respiratory symptoms, and since it was necessary to do screening to say if it wasn’t COVID, then I even looked. But when it came to pain, I tried to follow what the doctors always told me to do. [...] I’ve tried to control my mind, right, my emotions, so as not to think too much about “pain, pain, pain”. And when I feel that it’s unbearable, I take medicine that gives me relief and continue with my activities” (Patient 3).
Q16 “What really supports me in dealing with the pain is the health center, you know! In fact, during the pandemic, there was a day when my back locked up, and they provided me with individual care. The guys (physiotherapy interns) came and released the muscles in my back because there was nothing else to be done at that moment. So, the best care I receive for pain is at the health center” (Patient 1).
Q18 “Oh! I had to go straight to the orthopedist. I have a card... where I can go directly and schedule my appointment with the orthopedist [...]. But my orthopedist, at the time, looked me in the eye and said: ‘There’s nothing to be done! You’re already on the waiting list for physiotherapy.’ So, I asked: ‘What about the pain?’. And he said: ‘If you have pain, take a painkiller (anti-inflammatory drug).’ That’s when I sought help at the health center” (Patient 1).

Quotes – Topic 3
Q19 “Yeah... today I went out, I did a million things in the street early, I stood for a long time and I got in the car about 10 times, I left 10 times, so I’m a bit tired. Anything that takes me out of my routine, the pain comes, you know”? (Patient 2).
Q20 “My pain, mhmm... (laughs) it’s been increasing, probably because now the workload is... back to normal [...]. ] And today, we’re going through a very heavy stress, so it’s... let’s put it this way, a delicate moment, but even so, we’re a family that goes through delicate moments very united, so we don’t have this thing of despair, right... or loneliness or... you know, it’s very difficult, even because we don’t give ourselves space to feel it, so to tell you the truth. It’s been a very turbulent week, mine had a problem with her eyes, she burned both strings with eyeliner. She’s recovering now, she has five days to get her sight back. My younger sister had a miscarriage yesterday, lost the baby, so we’re going through a really turbulent time, but our turmoil is controlled” (Patient 1).
Q21 “Our emotions are really shaken, we’re really shaken, 15 days ago we lost my daughter’s father-in-law. It was quite an impact, quite an impact for me, you know. It shook me emotionally. But then you get more tense, you get stuck” (Patient 4).
Q22 “Ahhh...I feel good, you know. I’m always really focused... in this case, I have a problem with my hip and I’m trying to find an alternative treatment, something to relieve my pain, but I’ve been feeling fine, despite these problems with pain. I had to stop handicrafts, but I already have the idea of seeing what I can do, right, so the mind always remains a mind, so...inspiring” (Patient 3).
Q23 “It’s like two feelings, right, like: I’m always very grateful to God for everything, and I’m always a bit fed up with not being able to [...] it’s a bit annoying because you can’t reach a context, a denominator. ‘Oh, so it’s fibromyalgia’, ‘Oh, let’s get a blockade’, ‘Oh, let’s take an anti-inflammatory’, ‘Oh, let’s rest’, ‘Let’s exercise’, ‘Let’s lose weight’. There are millions of things, but nobody can really define the reason for the pain, and then you live with that pain and it bothers you a lot” (Patient 2).
Q24 “Wow, am I ever going to make it?” (laughs) When we were kids, we didn’t even think we’d make it to 40, let alone 70! I don’t think much about it. I think: like I say to my husband “I can’t retire, because today I’ve retired”, but when he retires we’re going to live on a ranch by the river, that’s all”! (Patient 5).
Q25 “I do everything a person has to do at home with all these problems, I don’t give in, but I’m not someone who has much expectation of the future.... Especially because I don’t think any body can take that much drugs for that long... I take 14 pills a day [...] ‘Then I want to be 60 and healthy’, I’m not healthy anymore, you know? (Patient 2).
Q26 “Really? I’m so unmotivated... I’m so unmotivated... it makes me sad. I’m really unmotivated! With the world, with people, with everything we see on the news. [...] I can’t get a job, I’ve looked for several and I’ve been looking. So I’m fine, I’m pretty discredited to tell you these days, I don’t see myself at 55, I don’t know! I wouldn’t be able to tell you today. I have no expectations of tomorrow, you know... I don’t...” (Patient 4).
Q27 “I’m going to have to work hard, I’m going to have to fight hard! The world is very screwed up and we work in the social area and we’re going to have more and more to do in order to improve all this” (Patient 1).
Q28 “Ah, that depends on the consequences of what comes next, right! Then today you’ll have to stop doing things... Like the weather, there are things you won’t be able to do. You have to know how to take the conditions we have”! (Patient 6).

[1] Correspondence to: Anamaria Siriani de Oliveira E-mail: siriani@fmrp.usp.br

Brasil

Brasil

Impact of the COVID-19 pandemic on the perception of treatment and chronic musculoskeletal pain in users of a family health unit: qualitative study

ABSTRACT

BACKGROUND AND OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

HIGHLIGHTS