Activating waitlists: Identifying barriers and facilitators to pain self-management while waiting.

Objectives: Waitlists for pain management services are often extensive, risking psychological and physical decline and patient non-engagement in treatment once accessed. Currently, for outpatient pain management, no standardised waiting list interventions exist, resulting in passive waiting. To arrest prospective wait-related decline(s), this study aimed to identify the barriers and facilitators to pain self-management while waiting, forming the foundation for a waitlist intervention development.

Design: An inductive qualitative approach was utilised to explore the barriers and drivers of pain self-management while waiting for chronic pain management.

Method: Semi-structured interviews, underpinned by the Theoretical Domains Framework and COM-B model, were conducted with people waiting for pain management services (N = 38). Interviews were audio-recorded, transcribed verbatim, and analysed via reflexive thematic analysis.

Results: The analysis demonstrated four thematised barriers and one facilitator: (1) Shunted Around the System (barrier); (2) The Information Gap (barrier); (3) Resisting Adaptation (barrier); (4) Losing Hope (barrier); and (5) Help Yourself or Lose Yourself (facilitator).

Conclusion: This study demonstrates the severe emotional and motivational impact of waiting, increasing treatment disengagement. The waitlist represents a prime opportunity for prehabilitation to protect wellbeing and optimise self-management engagement. Infrastructural and interpersonal barriers of poor communication and healthcare professional pain invalidation must be addressed to improve emotional wellbeing and motivation to engage with planned treatment. Enhancing self-efficacy, pain acceptance, self-compassion, and internal HLOC are fundamental to increasing pain self-management. These can all be met within a prehabilitation framework. This study is foundational for the development of psychological prehabilitation in outpatient chronic pain management.