How individuals formulate their beliefs about chronic musculoskeletal pain: introducing the dual implicit-explicit processing (DIP) model of pain belief formation - a qualitative exploration

BMC Musculoskelet Disord. 2026 Apr 29. doi: 10.1186/s12891-026-09835-5. Online ahead of print.

Background

Chronic musculoskeletal pain (CMP) is complex with many biopsychosocial factors that contribute to its development. Existing research has established many beliefs that individuals’ hold about their CMP, but the sources of information and mechanisms used to construct beliefs are not well understood. The aim of this study was to observe and describe the mechanisms and sources of information individuals use to formulate their beliefs about CMP.

Methods

A preliminary exploration using interpretative phenomenological analysis methods is reported according to the Consolidated Criteria for Reporting Qualitative Research. Adults with CMP were recruited from the general public. Four stages of data analysis based on Smith and Osborn were undertaken to identify themes on the sources of information and mechanisms used to construct beliefs about CMP.

Results

Individuals’ explicit (conscious) beliefs are grounded in their own research, knowledge, and experience, conversations with friends, family, or others in pain, and conversations with healthcare professionals informed by radiographic investigations. This information is synthesised into stories that make sense to the individual in understanding and explaining their CMP; narratives that are felt not to make sense are rejected as beliefs. When asked to justify beliefs, individuals checked against their own experiences or existing knowledge; if the narrative correlated with experiences or existing knowledge (e.g., wearing heel must contribute to CMP because it hurts while wearing them) then the narrative was justified as an accepted belief. Likewise, if narratives conflicted with own experiences or existing knowledge then it was justified as a rejected belief. Cognitive errors were evident with contradictory beliefs existing simultaneously, and narratives rejected as beliefs despite correlating with experiences or knowledge. These mechanisms explain how individuals formulate explicit, conscious beliefs, however, existing literature suggests that the majority of our beliefs are implicit, formulated automatically and unconsciously, driving motivations, attitudes and behaviours nonetheless. Therefore, we interpret our findings within this context, and propose the Dual Implicit-Explicit Processing (DIP) Model of Pain Belief Formation.

Conclusion

The DIP model may be used by clinicians to target both implicit and explicit mechanisms to help individuals modify their beliefs in line with contemporary evidence, adopt helpful behaviours, and better manage CMP.

PMID:42050555 | DOI:10.1186/s12891-026-09835-5