Stefan Elbers

83 Self-management for patients with chronic pain INTRODUCTION Chronic musculoskeletal pain negatively influences daily life functioning, emotional well-being and social participation (Turk et al., 2011). Low back pain and neck pain alone contribute to 1694 years lost to disability (YLD) per 100,000 persons annually, placing these conditions, respectively, first and fourth in the ranking of diseases on global years lived with disability (Vos et al., 2012). The experience of pain interrupts individuals’ ongoing activities, forcing them to choose betweenpursuit of their intendedactionor activity,disengagement or avoidance behaviours. Motivational conflicts such as these constantly interfere with daily life activities and are assumed to have a negative effect on an individual’s well-being and identity (Vlaeyen et al., 2016). In order to maintain sufficient quality of life, successful self-management – the ability to manage symptoms, treatment, physical, psychological and social consequences, and lifestyle changes related to one’s chronic condition – is essential (Barlow et al., 2002; Lorig and Holman, 2003). To facilitate this process, generic self-management interventions are designed to teach persons how to self-regulate their chronic condition. Rather than providing unilateral solutions to disease-specific problems, self-management interventions provide a generic set of skills and competencies (e.g. problem solving, decision making, etc.) in order to facilitate living a meaningful life despite chronic pain. The definition of self-management does not specify how this behavioural adjustment should be achieved. This allows for a large variety of content and delivery modes in self- management interventions. In order to provide more clarity in comparing interventions, Michie and colleagues have developed a taxonomy of behaviour change techniques (BCTs) that enables more precise reporting (Michie et al., 2013). Moreover, classification of components according to this taxonomy facilitates comparison of intervention content and is expected to provide insight into the various intended mechanisms of action. As self-management programmes aim to facilitate behavioural adjustment, they have considerable potential for positive long-term effects on outcomes of importance to patients. However, as newly learned behaviours in the context of physical activity (Sullum et al., 2000) or pain rehabilitation (Turk and Rudy, 1991) are difficult to maintain, it is important to study the long-term outcomes of these interventions. The Present Study Our primary aim was to collect and synthesize all available data on the immediate and long-term (more than six months) effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy,