Beliefs and attitudes about chronic pain among public health professionals: cross-sectional study
Crenças e atitudes sobre dor crônica de profissionais de saúde pública: estudo transversal
Paula Torrezani Sales; Samira Tatiyama Miyamoto; Valeria Valim
Abstract
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: As barreiras do conhecimento científico e do treinamento adequado podem influenciar as competências dos profissionais de saúde no manejo da dor crônica em ambientes não especializados. O objetivo deste estudo foi avaliar as crenças e atitudes de profissionais do Sistema Único de Saúde (SUS) que atuam no cuidado de pacientes com dor crônica na rotina clínica.
MÉTODOS: Trata-se de estudo transversal realizado com profissionais não especialistas em dor da atenção primária e média complexidade, avaliados pelo Inventário de Atitudes frente à dor. Os participantes foram agrupados por local de atuação e tempo de formação para a análise de comparação através do teste t para amostras independentes. Foram calculados os tamanhos de efeito (η² generalizado) e o nível de significância estatística foi definido em p<0,05.
RESULTADOS: Participaram deste estudo 70 profissionais de saúde, que apresentaram crenças indesejáveis a respeito da cura da dor e de comportamentos de solicitude. Esses profissionais também apresentaram crenças desejáveis quanto a influência das emoções, relação da dor com lesão tecidual e possibilidade de controle por quem a sente. Foi observado um efeito do local de atuação, com crenças indesejáveis dos profissionais da atenção primária sobre incapacidade relativa à dor, além de um efeito sobre o tempo de formação para o domínio controle, com crenças menos desejáveis entre aqueles com menos de 10 anos de formação.
CONCLUSÃO: As crenças indesejáveis apresentadas pelos profissionais permitem um diagnóstico situacional que indica a necessidade de educação continuada em dor crônica para implementar treinamentos com práticas baseadas em evidências na rotina de cuidado do SUS.
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References
1 Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand'homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(l):19-27.
2 Smith BH, Fors EA, Korwisi B, Barke A, Cameron P, Colvin L, Richardson C, Rief W, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: applicability in primary care. Pain. 2019;160(l):83-7
3 Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain. 2021;162(11):2737-49.
4 Johnson M, Collett B, Castro-Lopes JM. The challenges of pain management in primary care: a pan-European survey. J Pain Res. 2013;22;6:393-401.
5 Smith BH, Hardman JD, Stein A, Colvin L. Managing chronic pain in the non-specialist setting: a new SIGN guideline. Br J Gen Pract. 2014;64(624):e462-4.
6 Ministério da Saúde. Linhas de Cuidado Secretaria de Atenção Primária [Internet]. 2024 [cited 2024 Jan 15]. Available from:
7 Santiago BVM, Oliveira ABG, Silva GMRD, Silva MFD, Bergamo PE, Parise M, Villela NR. Prevalence of chronic pain in Brazil: a systematic review and meta-analysis. Clinics (Sao Paulo). 2023;78:100209.
8 Mills S, Torrance N, Smith BH. Identification and management of chronic pain in primary care: a review. Curr Psychiatry Rep. 2016;18(2):22.
9 Santos PW, Baptista AF, Santos TC, Hazime FA. Clinical profile of pain in post-COVID-19 patients: systematic review. BrJP. 2023;6(2):179-84.
10 Soares FHC, Kubota GT, Fernandes AM, Hojo B, Couras C, Costa BV, Lapa JDDS, Braga LM, Almeida MM, Cunha PHMD, Pereira VHH, Morais ADS, Teixeira MJ, Ciampi de Andrade D. "Pain in the Pandemic Initiative Collaborators". Prevalence and characteristics of new-onset pain in COVID-19 survivors, a controlled study. Eur J Pain. 2021;25(6):1342-54.
11 National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. 2021; Available from:
12 Scottish Intercollegiate Guidelines Network. Management of chronic pain: A national clinical guideline [Internet]. Edinburgh; 2013. Available from:
13 Brasil. Portaria no 1.083, de 2 de outubro de 2012., Aprova o Protocolo Clínico e Diretrizes Terapêuticas da Dor Crônica [Internet]. 2012 [cited 2023 Nov 30]. Available from:
14 Brasil. Portaria no 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). 2017.
15 Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain.2015;16(9):807-13
16 Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-55.
17 Nijs J, Roussel N, Paul van Wilgen C, Köke A, Smeets R. Thinking beyond muscles and joints: Therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther. 2013;18(2):96-102.
18 World Health Organization (WHO). Guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Genebra; 2023.
19 Ng W, Slater H, Starcevich C, Wright A, Mitchell T, Beales D. Barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain: a systematic review and qualitative evidence synthesis. Pain. 2021;162(8):2154-85.
20 Slade SC, Kent P, Patel S, Bucknall T, Buchbinder R. Barriers to Primary Care Clinician Adherence to Clinical Guidelines for the management of low back pain. Clin J Pain.2016;32(9):800-16.
21 Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S. Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. J Physiother. 2017;63(3):132-43.
22 Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain. 2012;16(1):3-17.
23 Wright LM, Watson WL, Bell JM. Beliefs: many lenses, many explanations. In: Beliefs: the heart of healing in families and illness. 1st Ed. New York: Basic Books; 1996. 19-43p.
24 Ajzen I. Nature and operation of attitudes. Annu Rev Psychol. 2001;52(1):27-58.
25 Ferreira LS, Silva MPM, Saragiotto BT, Magalhães MO. Attitudes and beliefs of Brazilian physical therapists about chronic nonspecific low back pain and its impact on clinical decision-making: An Online Survey Study. Musculoskelet Sci Pract. 2023;67:102832.
26 Simmonds MJ, Derghazarian T, Vlaeyen JWS. Physiotherapists' knowledge, attitudes, and intolerance of uncertainty influence decision making in low back pain. Clin J Pain. 2012;28(6):467-74.
27 García-Martínez E, Soler-González J, Blanco-Blanco J, Rubí-Carnacea F, Masbernat-Almenara M, Valenzuela-Pascual F. Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study. BMC Prim Care. 2022;23(1):9.
28 Bishop A, Thomas E, Foster NE. Health care practitioners' attitudes and beliefs about low back pain: A systematic search and critical review of available measurement tools. Pain.2007;132(l):91-101.
29 Desconsi MB, Bartz PT, Fiegenbaum TR, Candotti CT, Vieira A. Tratamento de pacientes com dor lombar crônica inespecífica por fisioterapeutas: um estudo transversal. Fisioter Pesqui. 2019;26(1):15-21.
30 Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-83.
31 Devonshire E, Nicholas MK. Continuing education in pain management: using a competency framework to guide professional development. Pain Rep. 2018;3(5):e688.
32 von Elm E, Altman DG, Egger M, Pocock SJ, G0tzsche PC, Vandenbroucke JP The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med. 2007;147(8):573.
33 Garcia DM, Pimenta CAM, Cruz DALM. Validação do Inventário de Atitudes frente à Dor Crônica - profissionais. Rev da Esc Enferm USP. 2007;41(4):636-44.
34 Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43.
35 Brasil. Decreto no 7.508, de 28 de junho de 2011. Regulamenta a Lei no 8.080, de 19 de setembro de 1990, para dispor sobre a organização do Sistema Único de Saúde - SUS, o planejamento da saúde, a assistência à saúde e a articulação interfederativa, e dá outras p [Internet]. Brasília; 2011 [cited 2023 Dec 7]. Available from:
36 Leverence RR, Williams RL, Potter M, Fernald D, Unverzagt M, Pace W, et al. Chronic Non-Cancer Pain: A Siren for Primary Care - A Report From the PRImary care MultiEthnic Network (PRIME Net). J Am Board Fam Med [Internet]. 2011 Sep 1;24(5):551-61. Available from:
37 Bartley EJ, Boissoneault J, Vargovich AM, Wandner LD, Hirsh AT, Lok BC, Heft MW, Robinson ME. The influence of health care professional characteristics on pain management decisions. Pain Med. 2015;16(1):99-111.
38 Brown CA, Richardson C. Nurses' in the multi-professional pain team: a study of attitudes, beliefs and treatment endorsements. Eur J Pain. 2006;10(l):13-22.
39 Sit RW, Yip BH, Chan DC, Wong SY. Primary care physicians' attitudes and beliefs towards chronic low back pain: an Asian study. PLoS One. 2015 Jan 30;10(1):e0117521.
40 Petit A, Begue C, Richard I, Roquelaure Y Factors influencing physiotherapists' attitudes and beliefs toward chronic low back pain: Impact of a care network belonging. Physiother Theory Pract. 2019;35(5):437-43.
41 de Jesus-Moraleida FR, Carvalho Arruda Barreto M, de Castro Lima JK, Meziat-Filho N, Lima Nunes AC. The challenging scenario of beliefs and attitudes toward chronic low back pain among final year undergraduate students: a cross-sectional investigation. Musculoskelet Sci Pract. 2021;53:102375.
42 Garcia DM, Mattos-Pimenta CA. Pain centers professionals' beliefs on non-cancer chronic pain. Arq Neuropsiquiatr. 2008;66(2A):221-8.
43 Parsons S, Breen A, Foster NE, Letley L, Pincus T, Vogel S, Underwood M. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. Fam Pract. 2007 Sep;24(4):308-16.
44 Kamper SJ, Logan G, Copsey B, Thompson J, Machado GC, Abdel-Shaheed C, Williams CM, Maher CG, Hall AM. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain. 2020;161(4):694-702.
45 Kopf A, Patel NB. Guia para o Tratamento da Dor em Contextos de Poucos Recursos [Internet]. 1st ed. Third EAGE Eastern Africa Petroleum Geoscience Forum. International Association for the Study of Pain; 2017. 418p. Available from:
46 Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;7;4:50.
Submitted date:
02/07/2024
Accepted date:
04/15/2024
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