Abstract
INTRODUCTION: This qualitative study investigated clinician perspectives on the relevance and significance of goal adjustment in the treatment of chronic pain. Although a common experience for many people living with chronic pain, goal adjustment remains underexplored in the therapeutic literature. Exploring clinicians' experiences can optimize treatment strategies for individuals whose chronic pain imposes functional limitations, and where significant adjustments to important life aspirations are required. METHODS: Semi-structured interviews were conducted with 14 experienced pain clinicians, including medical specialists, physiotherapists, and clinical psychologists. The interviews explored three areas: the relevance of goal adjustment in clinical practice, factors that enhance and hinder flexible goal adjustment, and treatment strategies for redirecting patient efforts towards alternative more viable aspirations. An inductive thematic analysis was performed to identify key themes from the data. RESULTS: Clinicians unanimously endorsed the view that goal adjustment issues commonly occur when treating chronic pain. The thematic analysis highlighted the importance of flexible goal adjustment and the distress caused by letting go of goal ambitions. The consequences of problematic or inflexible goal adjustment are explored, along with barriers and facilitators of goal adjustment in chronic pain. Themes such as rigid self-identity, cognitive rigidity, limited understanding of chronic pain, and emotional distress were identified as barriers. The role of family, health professionals, and other social influences is also discussed. Therapeutic approaches emphasize realistic and meaningful goals, timing, rapport, trust, values-based goals, and validating distress. DISCUSSION: The findings suggest that goal adjustment is a well-recognized component of chronic pain treatment. Experienced pain clinicians identified that the successful resolution of the challenges of goal adjustment and the implementation of effective strategies to adopt realistic expectations is critical for positive patient outcomes. This study underscores the importance of integrating goal adjustment frameworks into chronic pain management to enhance therapeutic efficacy.