Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Topic
Summary
To explore patients’ journey through an interdisciplinary pain management program (IPMP), including what participants learnt, how their behaviours changed and their overall subjective experience of the program.
Dates: December 2024 - February 2026
Implementation sites: Metro South Pain Rehabilitation Centre
Partnerships: The Hopkins Centre
Healthcare Improvement Community of Practice (HICOP)
Aim
To use findings to inform the development of a more person-centred IPMP for uptake in practice.
Outcomes
Learnings went beyond concepts and strategies taught. Most participants shifted from a pain avoidance/alleviation approach to learning how to live a fuller life with pain.
- Participants began to reconnect with valued activities but needed ongoing support to sustain this progress, highlighting the importance of IPMPs considering their role in a person’s broader life journey.
- Participants benefit from connecting to others with shared experiences of persistent pain. Peers support peers in learning and implementing strategies and concepts taught.
- The focus group was an important part of the learning process, helping participants feel validated, learn from others, process and apply information.
- Improvement opportunities include environmental, clinician and group dynamics consideration.
Background
Persistent pain is a costly problem for the individual, their support network, and society in general. In 2020, an estimated 645,000 Queenslanders were living with persistent pain, costing the Queensland economy nearly $30 billion per year. National costs are expected to rise from $139 billion in 2018 to $215.6 billion by 2050.
Beyond the financial costs, persistent pain is also associated with significant personal suffering and losses for the person with pain, in the contexts of meaningful life roles, independence and daily functioning, physical health, mental health, social connection, and quality of life. With this high burden of disease, it is imperative that persistent pain care is yielding outcomes that improve the individuals’ outcomes and reduce the health burden on society. IPMPs, which routinely integrate the biological, psychological and social elements of pain, are the preferred practice for persistent pain care. Whilst IPMP efficacy, patient experiences, satisfaction and what patients feel is important to learn about pain has been examined, there is a paucity of research into what people actually learn during IPMPs. This is despite “education” being considered a vital component of IPMPs and acknowledgement from people living with pain that learning about and understanding pain is an essential foundational step in the healing journey towards a meaningful life. Additionally, the importance of understanding participants' experiences in IPMPs, and the factors that influence participants’ engagement, knowledge retention and behaviour change, is increasingly recognised, with group processes being seen as a potential therapeutic component in itself. Understanding patients’ learnings from IPMPs, and the possible mechanisms of change, can help fill a gap between knowledge that is posited to improve patient trajectories and what patients actually learn and benefit from learning about.
Exploring participant experiences throughout an IPMP journey can help provide insight into how these processes occurred, as well as factors that influence participants' experience of the program. Findings can be used to develop a more person-centred IPMP for uptake in practice, with greater emphasis on what participants benefit from in an IPMP rather than what clinicians feel should be included. The Metro South Pain Rehabilitation Centre (MSPRC) runs a low-intensity IPMP called Engage.
Engage is a six-week education-based program run by a physiotherapist, psychologist and occupational therapist. In weeks one to five, participants attend a two-hour interactive in-person group session run by two Allied Health clinicians from MSPRC. In week Six, one clinician provides an individual follow-up phone call to each participant for treatment planning to individualise the patients ongoing rehabilitation needs. Engage incorporates pain science education, helps participants to understand and address the biopsychosocial contributing factors to their own pain experience, incorporates acceptance and commitment therapy and contextual-behavioural approaches to living with pain and related psychological experiences, addresses flare-up management and graded activity, and explores individual goals and needs for future rehabilitation.
This study explored what participants learned, how their behaviours changed, and their subjective experiences throughout the Engage journey. Findings are informing the development of a more person-centred IPMP for uptake in
practice
Methods
Participants were recruited using a convenience sample of patients attending one of three scheduled Engage programs run between February and July 2025. Participants were those who were eligible to attend Engage and consented to participate in the study. Seven data collection points occurred: a pre-Engage telephone interview to understand participants baseline of activity, pain understanding and expectations of Engage; five focus groups held immediately after each group session exploring what participants learnt, if behaviours were changing and participants experience of the group; a post-Engage telephone interview exploring participant learnings, behavioural changes, pain understanding and participants’ overall experience of Engage. Nineteen participants provided consent, with nineteen pre-program phone interviews being conducted one to two weeks prior to the programs start date. Fifteen semi-structured focus groups were held in total; five for each of the three eligible Engage groups. Thirteen post-program interviews were conducted four to six weeks after participants completion of the Engage program. The majority of data collection was done by a research assistant external to the pain clinic. Reflexive Thematic Analysis was used to generate themes and patterns across the data. Analysis was inductive and recommendations on how to improve Engage were generated based on both semantic and latent meanings. Guided by findings from the data, a co-design workshop was conducted with four participants and four researchers to explore opportunities for improving Engage. Our reflexive thematic analysis generated the overarching theme “Becoming Unstuck: Unlocking a potentiality for a life beyond (and with) pain”.
The four themes generated provided insight into the participants learnings and how their behaviours changed as a result of attending Engage:
- I’m not the only one stuck in Painland;
- Becoming better equipped for living with my pain;
- I can and want to begin to re-engage with the world beyond Painland;
- Becoming unstuck is an ongoing process that requires ongoing support.
Learnings extended beyond the concepts and strategies taught in Engage. Engage helped people to move from feeling alone and isolated in their pain experience, to connecting with others who understood what they were going through. In learning concepts and strategies taught in Engage, several participants attitude and approach towards their pain changed and they developed more agency in their life. Most participants began to re-engage in some aspects of their life again, feeling supported by clinicians and peers in this process. But the need for ongoing support to continue to re-engage in the world again was identified, and for some participants, this was outside the scope of the pain clinic.
Several improvements to Engage have been implemented including: six-week program; introducing an optional post-Engage group “coffee and chat” session to help facilitate group factors that positively impacted learning and behavioural change; better preparing people for Engage including expectation setting; reducing barriers to attending Engage (traffic and carparking considerations); new post-Engage group offerings including Tai Chi, Yoga and psychological strategies group; once/month social outing facilitated by MSPRC to help with participants connection to the community.
Discussion
It was important that this project was grounded in real clinical practice within a pain clinic. Engage is an established IPMP designed by clinicians who considered both the evidence base for program content and the characteristics of their patient cohort, including relevant topics, program length, and purpose. While previous research has identified what participants believe is important to learn in pain education interventions, this study sought to understand what patients actually learn during an IPMP, and how, if at all, their behaviours change. This offered insight into important aspects of an IPMP that extend beyond content and strategies, and it informed the redesign of the Engage group. Exploring participants’ journeys – from pre-program, through the program, to post-program – helped tell the broader narrative of moving from isolation in their pain experiences to connecting with others, learning concepts and strategies and being supported to apply these, and beginning to re-engage with aspects of their life again.
Participant learnings therefore extended beyond the formal program content, and the Engage program has been re-designed to help harness the factors that were seen to be important in facilitating this patient journey. Strengths of this project included being grounded in established clinical practice, which supported the rapid translation of research findings. Exploring participants’ week by week experiences offered deeper insight into what they found valuable in each session and the mechanisms that supported learning and behavioural change. Using a research assistant external to the pain clinic created a safer space for honest feedback, reducing the influence of clinical relationships or concerns about repercussions. The co-design workshop further strengthened the project by promoting a person-centred approach to redesigning Engage, allowing data-driven recommendations to be explored and refined collaboratively. The research team—comprising clinician researchers, academics, and a person with lived experience—brought diverse perspectives that enriched the project’s design, implementation, and analysis.
Limitations of the project included its focus on a single IPMP, meaning the findings are not generalisable to the broader population. The focus groups may have acted as an additional treatment component, potentially influencing participants’ learning and behavioural change.
It is acknowledged that the clinician and researcher lens shaped the analysis and interpretation of the data.
However, given that the principal investigator is an experienced clinician in persistent pain management and IPMP delivery, this perspective can also be viewed as a strength, offering informed insight into the nuances of the program and participant experiences. If replicated, the study could use focus groups after every second in-person session to improve efficiency. A follow-up interview six months after
program completion would help assess whether learnings and behavioural changes were retained and identify what support participants need to continue re-engaging with the world. Findings may be of interest for other services delivering IPMPs or group-based
programs. A second layer of analysis could also be applied to the data, focusing on the group processes observed throughout Engage and how these might be harnessed to further improve IPMPs.
References
1. Queensland Health Clinical Excellence Division (2020). Pain is Everybody’s Business - Mapping of Persistent Pain Services Across Queensland. Brisbane, Australia
2. The cost of pain in Australia | Deloitte Australia | Deloitte Access Economics, Healthcare, Public sector
3. NSW Agency for Clinical Innovation (2017). Pain Management programs – which patient forwhich program?. Sydney, Australia.
4. Romm, M., Ahn, S., Fiebert, I., & Cahalin, L. (2021) A Meta-Analysis of Group-Based Pain Management Programs: Overall Effect on Quality of Life and Other Chronic Pain Outcome Measures, with an Exploration into Moderator Variables that Influence the Efficacy of Such Interventions, Pain Medicine, 22 (2), 407 – 429, https://doi.org/10.1093/pm/pnaa376
5. Goksör, C., Mannerkorpi, K., & Bergenheim, A. (2021). Experiences with an educational program for patients with chronic widespread pain: a qualitative interview study. Scandinavian journal of pain, 22(2), 279–287. https://doi.org/10.1515/sjpain-2021-0080
6. Li, Y., & Hapidou, E. G. (2021). Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement.
Journal of Patient Experience, 8, 23743735211007834.
7. Leake, H. B., Moseley, G. L., Stanton, T. R., O'Hagan, E. T., & Heathcote, L. C. (2021). What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain, 162(10), 2558–2568. https://doi.org/10.1097/j.pain.0000000000002244
8. Commonwealth of Australia (2021). National Strategic Action Plan for Pain Management. Canberra: Commonwealth of Australia. https://www.health.gov.au/resources/publications/the-national-strategic-action-plan-for-pain-management
9. Toye, F., Belton, J., Hannink, E., Seers, K., & Barker, K. (2021). A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies. Pain Medicine, 22(6), 1333-1344. https://doi.org/10.1093/pm/pnaa373
10. Wilson, M. K., Wilson, D. J., Searle, A. K., & Mackintosh, S. F. (2025). Consumer perspectives of the group itself in group-delivered programs for people with chronic pain: A systematic review and meta-synthesis. The journal of pain, 30, 104774. https://doi.org/10.1016/j.jpain.2024.104774
Key contact
Kelly Walsh
Senior Physiotherapist
Metro South Pain Rehabilitation Centre