Perspectivas e experiências de indivíduos com dor crônica de ombro tratados com terapia cognitivo funcional : estudo qualitativo

Abstract

Introduction: Chronic shoulder pain is a highly prevalent musculoskeletal condition, characterized by a frequently persistent clinical course and a negative impact on individuals’ functionality, emotional aspects, and quality of life. Evidence indicates that psychosocial factors significantly influence the pain experience and clinical outcomes, reinforcing the need for biopsychosocial approaches in the management of this condition. In this context, Cognitive Functional Therapy (CFT) emerges as a patient-centered intervention aimed at modifying beliefs, behaviors, and coping strategies related to pain. Objective: To understand the experiences, perspectives, and perceived changes of individuals with chronic shoulder pain before and after treatment with Cognitive Functional Therapy. Method: This is a longitudinal qualitative study nested within a randomized controlled trial, conducted with adult individuals with chronic shoulder pain. Semi-structured interviews were carried out before the beginning of the intervention and after eight weeks of CFT treatment. Data were analyzed using reflexive thematic analysis, adopting a contextualist perspective to identify patterns of meaning related to perceptions, beliefs, behaviors, and pain management strategies over time. Results: Before treatment, participants presented predominantly biomedical understandings of shoulder pain, associated with fear of movement, functional limitations, emotional distress, and mainly passive pain management strategies. After the intervention, gradual changes were identified in the way pain was understood, with an expansion toward a biopsychosocial perspective, reduced fear, increased confidence in movement, resumption of functional activities, and a transition toward active self-care strategies. CFT was perceived as a space for listening, dialogue, and individualized care, fostering the strengthening of the therapeutic alliance and the development of autonomy. Conclusion: Cognitive Functional Therapy was associated with significant changes in the perceptions and experiences of individuals with chronic shoulder pain, contributing to a broader understanding of pain, greater active engagement in treatment, and strengthened self-management. These findings highlight the potential of biopsychosocial approaches for the care of chronic shoulder pain and reinforce the importance of patient-centered interventions in the rehabilitation context.