# ‘Sometimes I feel like the only physio in the whole wide world, so alone’

## TL;DR

This study explores the challenges and strategies of physiotherapists managing chronic pain in South African primary healthcare settings.

## Contribution

The study provides novel insights into physiotherapists' lived experiences with chronic pain care in resource-limited South African PHC settings.

## Key findings

- Person-centred approaches are valued but difficult to implement due to resource constraints.
- Systemic and personal barriers hinder effective chronic pain management in PHC.
- Improved workforce planning and interdisciplinary collaboration are needed for better care.

## Abstract

High-impact chronic pain (HICP) presents significant challenges within primary healthcare (PHC) settings, particularly in resource-constrained environments such as South Africa. Limited evidence exists regarding physiotherapists’ lived experiences managing this condition in local contexts.

This study explored facilitators and barriers to providing adequate care for individuals with HICP, as experienced by physiotherapists working in Western Cape PHC facilities. It is envisaged that the findings may contribute to curriculum development, policy considerations, and clinical practice enhancement.

A descriptive qualitative approach was employed, and semi-structured virtual interviews were conducted with eight purposively selected physiotherapists from Western Cape PHC facilities. Inductive thematic analysis guided data interpretation.

Analysis revealed four interconnected themes: (1) High-impact chronic pain as a complex and disabling burden in PHC settings, (2) person-centred approaches as key facilitators, (3) systemic and personal barriers constraining effective management, and (4) specific needs for improved HICP care. While person-centred approaches were valued, participants struggled with implementation amid resource constraints.

High-impact chronic pain management in South African PHC settings requires attention to interrelated factors of time, support, and knowledge. While physiotherapists recognise effective approaches, implementation challenges necessitate systemic adjustments.

These insights highlight the necessity for workforce planning reform, professional development in pain management, and enhanced interdisciplinary collaboration to better serve patients with HICP in resource-limited settings.