Strategies to Support Pain Self-Management Among People Living with Chronic Musculoskeletal Pain: A Mixed Methods Design and Content Ideation Study

Background:Chronic musculoskeletal pain is a common condition, for which pain self-management is recommended. Digital tools offer potential to support individuals with chronic pain, but it is unknown to what extent existing tools are responsive to the social context of Pakistanis living with chronic pain and are engaging for them. Objective: This study aimed to explore strategies to enhance engagement with digitally enabled pain self-management tools among people with chronic musculoskeletal pain.Methods: A mixed-methods sequential explanatory design was used. We first reviewed Android app store and published literature to identify content and engagement strategies incorporated in digital tools. Following this, we conducted a narrative study involving adults with chronic musculoskeletal pain to capture their lived experiences and requirements for pain self-management. Review findings were synthesised descriptively, qualitative data were analysed thematically, and overall findings were combined to generate design and content recommendations.Results: Literature and app reviews revealed that digital tools commonly included components related to patient education and physical or mental therapy. They often included engagement features such as personalization and reminders. Dietary advice and peer or social support were less commonly included in digital tools but were commonly discussed during group discussions by individuals living with chronic pain. Nineteen individuals with chronic pain participated in group discussions and described how their pain self-management practices were shaped by cultural beliefs and perceptions and digital health information. These factors also influenced their decision making related to treatment choices and adoption of non-pharmacological strategies. Although participants trusted healthcare professionals but expressed concerns about limited guidance on how to apply clinical advice in their daily lives. Moreover, they identified several requirements for pain self-management tools, including evidence based audio-visual content and incorporating aspects related to symptom monitoring, symptom relief and physical rehabilitation, psychological wellbeing, lifestyle management, social support, patient education. Conclusion:Existing pain self-management tools rarely address the social context of South Asians. While pain self-management is shaped by digital information and cultural beliefs and perceptions, participants valued evidence-based digital resources. Therefore, future research should focus on co-developing these resources to ensure they are clinically meaningful, culturally responsive, and supportive of patient-centred and equitable pain self-management.