Chronic shoulder pain is a major problem in the UK. The most effective non-surgical management of chronic shoulder pain is unknown. Suprascapular nerve block (SSNB) injections are one treatment option used in the management of chronic shoulder pain however little is known about its use and application in clinical practice.
This study aimed to explore the experiences and views of clinicians who use SSNB injections for the non-surgical management of shoulder pain. The main objective was to gain an in-depth understanding regarding the application of SSNB injections in clinical practice. The findings may go on to inform future research in this area.
A pragmatic qualitative approach was adopted and underpinned this study.
One rheumatologist, one pain consultant and three physiotherapists who currently use SSNB injections in the non-surgical management of shoulder pain participated in a focus group. The focus group was recorded, transcribed and then analysed using thematic analysis.
Three main themes were identified; Patient Selection, The Intervention and Patient Management. Clinicians in this study currently reserve SSNB injections for patients with long standing shoulder pain that has failed to improve with other treatments including local steroid injections. Variation exists in the approach taken to administer the nerve block as well as the drugs, dosages and volumes used. All clinicians reported that physiotherapy and shoulder exercises played an important part in the overall management of their patients after receiving a SSNB injection.
A major limitation of this study was that only one focus group was undertaken. Undertaking a number of focus groups across a wider geographical region that included the views and experiences of orthopaedic consultants, interventional radiologists and general practitioners would strengthen the findings of this study. Using additional methods such as individual interviews and surveys for triangulation would also improve the credibility of the findings.
Clinicians recognise the lack of theory and evidence guiding clinical practice in this area. Based upon the findings of this small group of clinicians, most felt that SSNB injections may have a wider role to play in managing shoulder pain. Future research may be aimed at targeting specific patient groups with shoulder pain earlier for a SSNB injection, rather than waiting to see if other treatments have failed. This study has provided background information that may be used to inform future exploratory research in this area.
|Date of Award||2017|
|Sponsors||Health Education England & National Institute for Health Research|
|Supervisor||Ann Green (Supervisor)|