Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Claire Fraser* (Corresponding Author), Marcus Beasley, Gary Macfarlane, Karina Lovell

*Corresponding author for this work

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Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatment for patients with chronic widespread pain (CWP). Preventing the onset of CWP offers considerable benefits to the individual and society and the MAmMOTH study is the first aimed at CWP prevention. The study is a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. This nested qualitative study explores patients’ treatment experiences, with a view to understanding their potential influences on acceptability of the intervention.


The MAmMOTH Study recruited 1002 participants, half of whom were randomised to receive tCBT. Participants were eligible for invitation to the trial if they had pain for which they had consulted their GP, or had pain and visited a doctor frequently, and had 2 of 3 risk factors for development of CWP. Participants randomised to tCBT who had completed treatment were eligible for invitation to qualitative interviews for this study. Individual qualitative interviews were conducted with a sub-sample (n = 33) of patients at high risk of developing CWP who had been allocated to the intervention arm. Semi-structured telephone interviews explored treatment experiences and intervention acceptability. Data was analysed using Framework analysis.


Participants presented with a range of musculoskeletal and auto-immune conditions and almost half described their pain as ‘chronic’ on study entry. Many participants perceived the trial intervention to be aimed at treatment of pain rather than prevention of pain. Initial expectations prior to treatment varied, with scepticism more likely for those who had little prior knowledge of CBT approaches. All participants provided positive feedback post intervention particularly in relation to the modality, therapist experience and skills and the intervention. The majority of participants described positive changes in either their subjective level of pain or pain-management post-intervention and some attributed the positive change directly to the intervention as a result of empowerment, increased self-management and cognitive restructuring.


This study extends our understanding of the acceptability and suitability of preventative interventions for chronic widespread pain and provides further evidence for the acceptability of tCBT.

Trial registration

Clinical NCT02668003 (registered 29th January, 2016).

Original languageEnglish
Article number198
Number of pages11
JournalBMC Musculoskeletal Disorders
Publication statusPublished - 10 May 2019

Bibliographical note

The authors would like to thank: the MAmMOTH investigators, Phil Keeley, Gordon Prescott, Paul McNamee, Majid Artus, John McBeth, Philip Hannaford, Gareth Jones, Neil Basu, and John Norrie. Kathy Longley, patient representative from Arthritis Research UK, for help with designing the MAmMOTH Study. The staff and patients at the following practices in Scotland: Mount Florida Medical Centre, Midlock Medical Centre, Buckingham Terrace Medical Practice, Levern Medical Group, Bridgetown Medical Centre, Cardonald Medical Centre, Denburn Medical Practice, Ellon Medical Group, Laurencekirk Medical Centre, Aultbea & Gairloch Medical Practice, Dr. Pearson’s Medical Practice, Cairn Medical Practice, Grantown On Spey Medical Practice, Strathpeffer Medical Practice, Fairfield Medical Practice, and Fortrose Medical Practice. The Scottish Primary Care Research Network coordinators, Samantha Holden in NHS Highland, Tracy Ibbotson in NHS Greater Glasgow & Clyde, and Amanda Cardy in NHS Grampian. Christine Molloy, CBT coordinator at University of Manchester. The therapists delivering the intervention, Anna Pruszynska, Christine Molloy, Clare Stephenson, Gary Lamph, Gary McNamee, Jayne Fox, Mike Fitzsimmons, Marie Pope, Natalie Broad, and Nicola McConnell. The programmers at Centre for Health Centre Randomised Trials (CHaRT), including Mark Forrest, senior IT development manager, and Brian Taylor, senior programmer.

The MAmMOTH study is funded by the Arthritis Research UK Grant no. 20748. Arthritis Research UK had no input into the design of the study, collection, interpretation of data or writing of the manuscript.

Availability of data and materials
The anonymised framework template is available from the corresponding author on reasonable request.


  • Chronic widespread pain
  • Telephone cognitive behavioural therapy
  • Treatment acceptability
  • Patient perspectives
  • Prevention
  • Qualitative


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