Embodiment and Chronic Pain: Implications for Rehabilitation Practice

Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions

In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.

The impact on physical performance, pain and psychological wellbeing of chronic low back pain patients during 12-weeks of equine- facilitated therapy intervention

Equine - Facilitated Therapy (EFT), an equine environment, and horses themselves can meet many physical and mental health needs beyond diagnostic categories. The horse's ability to produce a walk-like movement and the participant's ability to connect to non-judgemental living creatures, both of which can benefit participation and construct a positive self-image for chronic pain patients. The objective of this study is to evaluate the impact of EFT on perceived physical performance, level of pain, pain acceptance, depression and anxiety, and quality of life within a 12-week intervention for chronic low back pain (LBP) patients. Twenty-two LBP patients received EFT led by physical therapists as part of the public health services. A mixed method design combining quantitative and qualitative methods was employed to detect the outcome of the intervention. The data were collected via questionnaires, interviews, and patient data repositories. An interview was voluntary for participants and included questions of one's health, visits to the pain clinic during 6 months and an open-ended question about the intervention. The coding of the data was completed independently by two persons using thematizing. The welfare of the attending horses was taken into consideration in basic training and for the research setting. Statistical analysis and paired t-tests detected the changes during a 12-week intervention. The results suggest a significant increase in Canadian Occupational Performance Measure (COPM) levels of satisfaction with self-selected performances. The Raitasalo's version of Beck's Depression Inventory (RBDI) level of anxiety and Chronic Pain Acceptance Questionnaire (CPAQ) did not change, whereas a decline in the amount of perceived RBDI depression was found combined with increased levels of SF-36 Mental Change Scores and COPM satisfaction with performance. Only two of the 22 participants returned with reoccurring symptoms after 6 months to the pain clinic. The participant interviews revealed three important domains of experience during coding: physical-, psychological-, and social that link to the research question and suggest impact for the recovery from the human-animal interaction.

Chronicling the chronic: narrating the meaninglessness of chronic pain

This article proposes a way of narrating chronic pain: the telling of a chronicle Recent work in the medical humanities has been critical of traditional approaches to illness narratives. In line with this criticism, we argue that the experience of chronic pain resists internally coherent, plot-driven-in other words, Aristotelian-narrative. Drawing on phenomenological studies, we state that chronic pain is an utterly meaningless experience due to its relentless continuation over time. It therefore defies any narrative search for a higher meaning or purpose as well as the search for a coherent and progressive 'plot'. However, we reject the idea that chronic pain could therefore only be captured in the form of a meaningless, unshareable and chaotic anti-narrative. Instead, we propose that chronic pain could be borne witness to through the speech act of chronicling-an ongoing telling about ongoing suffering. Building on work of contemporary philosophers Philippe Lacoue-Labarthe and Jean-Luc Nancy, we examine what the chronicle entails by touching on three themes: time, meaning, and the body. First, we argue that chronicling allows people to bear witness to chronic pain's purposeless continuation over time, thereby affirming the utter meaninglessness of the experience. Second, we argue that it is precisely in the affirmation of this meaninglessness that a different kind of meaning can be experienced: a meaning which cannot be detached from the sensory experience of telling and listening itself. Third, we examine how chronicling chronic pain could allow the muted and painful body to once again meaningfully express itself to others.

"If You Don't Keep Going, You're Gonna Die": Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain

BACKGROUND AND OBJECTIVES

Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP.

RESEARCH DESIGN AND METHODS

Using van Manen's phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66-83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding.

RESULTS

Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going.

DISCUSSION AND IMPLICATIONS

This study contributes a vivid illustration of older adults' CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.

Older migrants' experience of existential loneliness

Background:

With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

Aim:

This study explored older migrants’ experience of existential loneliness.

Research design:

Qualitative study.

Participants and research context:

Data were collected through interviews (n = 15) with older (>65) migrants’ in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

Ethical considerations:

The study was conducted in accordance with the principles of research ethics.

Findings:

The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

Discussion:

Ethical reflection and knowledge about how older migrants’ life story can lead to experiencing existential loneliness, could be of use in care for older migrants’.

Conclusion:

This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

"Making Peace with Our Bodies": A Qualitative Analysis of Breast Cancer Survivors' Experiences with Qigong Mind-Body Exercise

Objectives: Breast cancer treatment leaves breast cancer survivors (BCS) with an array of lasting side effects, including persistent postsurgical pain (PPSP). In this study, we explored the perceptions of BCS with PPSP as they learned Qigong mind-body exercise (QMBE), a multimodal practice rooted in Traditional Chinese Medicine. Methods: Participants included 18 female BCS treated for stage 0-III breast cancer and experiencing PPSP. Participants were taught QMBE over 12 weeks. Semi-structured interviews were conducted before and after the intervention. Results: BCS disclosed a disconnect between mind and body that emerged during treatment. They perceived QMBE as moving meditation, which enabled them to reconnect mind and body, lessen their pain, and make peace with their bodies. Conclusion: These women's experiences both inform the promise of integrating QMBE and related mind-body exercise into PPSP clinical practice guidelines and suggest new areas of research regarding the role of multimodal interventions for holistic healing in BCS.

Fostering Holistic Hand Therapy: Emergent Themes of Client Experiences of Mind-Body Interventions

Mind-body interventions are a viable holistic approach to rehabilitation; however, evidence for mind-body approaches in hand therapy is lacking. This study explored the experiences of clients with musculoskeletal disorders undergoing two mind-body interventions within hand therapy. Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants' experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process. The following three themes emerged as results: insight on the body, relaxation and relief, and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant. Positive participant experiences support further consideration of mind-body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.

Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework

Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.

Facilitation of a Person-Centered Approach in Health Assessment of patients with chronic pain: An Ethnographic Study

A phenomenologically derived assessment tool, Hermes, was developed in a rehabilitation setting for adopting the central ideals of person-centered care and patient participation into health-assessment practices in nursing. This focused ethnographic study aimed at exploring the feasibility of using Hermes for enabling the application of these ideals into assessment of patients with chronic pain upon admission to a rehabilitation center. Participants were patients with chronic pain, enrolled in rehabilitation, and their nurses. Data were collected by participant observation and interviews, and analyzed by thematic analysis. By the use of Hermes, the impact of illness was explored through supportive connection and dialogue with open, reflective, and interpretative features; understanding of the illness situation was enhanced; and possibilities provided in adjusting to health issues of concern. In sum, Hermes facilitated person-centered participation of patients with chronic pain in their health assessment and made a phenomenological philosophy usable in nursing-assessment practices.

Illness as the saturated phenomenon: the contribution of Jean-Luc Marion

During the last few decades, many thinkers have advocated for the importance of the phenomenological approach in developing the understanding of the lived experience of illness. In their attempts, they have referred to ideas found in the history of phenomenology, most notably, in the works of Edmund Husserl, Martin Heidegger, Maurice Merleau-Ponty and Jean-Paul Sartre. The aim of this paper is to sketch out an interpretation of illness based on a yet unexplored conceptual framework of the phenomenology of French thinker Jean-Luc Marion. Focusing on concepts of the saturated phenomenon and flesh, the paper develops an interpretation of illness as the saturated phenomenon, which highlights a variety of dimensions of illness already elaborated within the phenomenology of medicine, such as the affective dimension of illness, the disruptive dimension of illness, the transformed perception of the self in illness, mineness of flesh in illness and the inexpressible and hermeneutical dimension of illness. In addition to that, the paper explores some of the consequences the proposed interpretation of illness offers regarding the nature of illness and health. It is argued that illness in its essence is very similar to the experience of other saturated phenomena, suggesting that the difference between them does not lie within the character of the affective givenness, but rather within the dynamic relationship between the affective givenness and its conceptualization. It is also shown that the experience of health is compatible with the experience of saturation and thus is not limited to the tacit and harmonious background state.

Living a Life Full of Pain: Older Pain Clinic Patients' Experience of Living With Chronic Low Back Pain

Chronic low back pain (CLBP) is older adults' most common pain complaint and is associated with many physical and psychosocial consequences, which have been quantitatively examined. However, little research has qualitatively examined the experience itself of CLBP in later life. Study objective was to understand older adults' lived CLBP experience. Guided by van Manen's phenomenological method, 21 pain clinic patients aged 66 to 83 completed semistructured interviews. Under the main theme "living a life full of pain," results are reflected in four existential subthemes: (a) Corporeality: The pain is relentless and constantly monitored, (b) Temporality: To live with pain is to live by pacing day and night, (c) Relationality: Pain creates limits that can be tested or obeyed, and (d) Spatiality: Manipulating the space around me to accommodate the pain. Findings improve understanding of the patient experience of late life CLBP and highlights the importance of empathy and patient-centeredness when treating older adults.

A review in gait rehabilitation devices and applied control techniques

PURPOSE

The aim of this review is to analyse the different existing technologies for gait rehabilitation, focusing mainly in robotic devices. Those robots help the patient to recover a lost function due to neurological gait disorders, accidents or after injury. Besides, they facilitate the identification of normal and abnormal features by registering muscle activity providing the doctor important data where he can observe the evolution of the patient.

METHOD

A deep literature review was realized using selected keywords considering not only the most common medical and engineering databases, but also other available sources that provide information on commercial and scientific gait rehabilitation devices. The founded literature for this review corresponds to control techniques for gait rehabilitation robots, since the early seventies to the present year.

RESULTS

Different control strategies for gait analysis in rehabilitation devices have been developed and implemented such as position control, force and impedance control, haptic simulation, and control of EMG signals. These control techniques are used to analyze the force of the patient during therapy, compensating it with the force generated by the mechanism in the rehabilitation device. It is observed that the largest number of studies reported, focuses on the impedance control technique. Leading to include new control techniques and validate them using the necessary protocols with ill patients, obtaining reliable results that allows a progressive and active rehabilitation.

CONCLUSIONS

With this exhaustive review, we can conclude that the degree of complexity of the rehabilitation device influences in short and long-term therapeutic results since the movements become more controlled. However, there is still a lot of work in the sense of motion control in order to perform trajectories that are more alike the natural movements of humans. There are many control techniques in other areas, which seek to improve the performance of the process. These techniques may possibly be applicable in gait rehabilitation devices, obtaining controllers that are more efficient and that adapts to different people and the necessities that entail every disease. Implications for Rehabilitation Rehabilitation helps people to improve the activities of their daily life, allowing them to observe their progress in the functional abilities as the months pass by with intensive and repetitive therapies. There is a mobility issue when the patient needs to move to the hospital or to the laboratory, which is not always feasible. For overcoming it, patients use the equipment at home to perform their daily therapy. However, they need the sufficient knowledge about its operation, also about the therapeutic movements, the therapy duration and the movement speed. Besides, is necessary to place the equipment in a proper and lively environment that helps to forget or reduce pain while the patient moves his joints progressively. The purpose of robotic rehabilitation devices is to generate repetitive and progressive movements, according to the motor disability. There are training trajectories to follow, which motivate patients to generate active movements. The benefits of robotic rehabilitation depend on the ability of each patient to adapt to the speed and load variations generated by the device, improving and reinforcing motor functions in therapy, especially in patients with advanced disabilities in early rehabilitation. Multi-joint rehabilitation devices are more effective than single-joint rehabilitation devices because they involve a higher number of muscles in the therapy. The greater the number of degrees of freedom (DoF) of the device, it cushions its effect in the patient because the inertia is reduced and higher torques are generated. The assistive technological devices allows to explore different rehabilitation techniques that motivate the patient in therapy, increasing appropriately the energy and pressure in the blood which is reflected in gradually recovering his ability to walk.

Development of Hermes, a New Person-Centered Assessment Tool in Nursing Rehabilitation, Through Action Research

In this article, an action-research project has been outlined, aimed at exploring ways for developing an assessment tool, underpinned by phenomenology, which would enhance a person-centered approach to the participation of patients in nursing assessment and care planning in rehabilitation. Participants were nurses in physical rehabilitation and a consultant. Data were collected by interviews and observation of the documentation on the tool. The tool, Hermes, was adopted in practice. Through its use, important person-centered assessment practices were enhanced and several aspects of its phenomenological grounding were supported. Hermes has potential for facilitating the transfusion of phenomenology into nursing practice.

Group supervision for healthcare professionals within primary care for patients with psychosomatic health problems: a pilot intervention study

BACKGROUND

In primary health care, efficacious treatment strategies are lacking for these patients, although the most prominent symptoms accounting for consultation in primary care often cannot be related to any biological causes.

AIM

The aim was to explore whether group supervision from a specific phenomenological theory of psychosomatics could provide healthcare professionals treating patients with psychosomatic health issues within primary care a deeper understanding of these conditions and stimulate profession-specific treatment strategies. Our research questions were as follows: (i) What is the healthcare professionals' understanding of psychosomatics before and after the intervention? (ii) What are the treatment strategies for this group of patients before and after the intervention?

METHODS

The study was an explorative qualitative intervention pilot study. The six participants from a primary healthcare setting in a medium-sized city in Sweden participated in the study. A supervision group was formed, based on a mix of professions, age, gender and years of clinical experience. Supervision consisted of one 75-minutes meeting every month during the course of 6 months. Participants were interviewed before and after the supervision intervention.

FINDINGS

The study showed two distinct categories emerged from the data. One category of healthcare professionals espoused a psycho-educative approach, while the other lacked a cohesive approach. The supervision improved the second category of healthcare professionals' understanding of psychosomatics. The psycho-educative group did not change their understanding of psychosomatics, although they felt strengthened in their approach by the supervision. Profession-specific strategies were not developed.

IMPLICATIONS

This pilot study indicates that a relatively short supervision intervention can aid clinicians in their clinical encounters with these patients; however, further research is necessary to ascertain the value of the specific phenomenologically based supervision intervention.

Vocal Music Therapy for Chronic Pain Management in Inner-City African Americans: A Mixed Methods Feasibility Study

BACKGROUND

To date, research on music for pain management has focused primarily on listening to prerecorded music for acute pain. Research is needed on the impact of active music therapy interventions on chronic pain management.

OBJECTIVE

The aim of this mixed methods research study was to determine feasibility and estimates of effect of vocal music therapy for chronic pain management.

METHODS

Fifty-five inner-city adults, predominantly African Americans, with chronic pain were randomized to an 8-week vocal music therapy treatment group or waitlist control group. Consent and attrition rates, treatment compliance, and instrument appropriateness/burden were tracked. Physical functioning (pain interference and general activities), self-efficacy, emotional functioning, pain intensity, pain coping, and participant perception of change were measured at baseline, 4, 8, and 12 weeks. Focus groups were conducted at the 12-week follow-up.

RESULTS

The consent rate was 77%. The attrition rate was 27% at follow-up. We established acceptability of the intervention. Large effect sizes were obtained for self-efficacy at weeks 8 and 12; a moderate effect size was found for pain interference at week 8; no improvements were found for general activities and emotional functioning. Moderate effect sizes were obtained for pain intensity and small effect sizes for coping, albeit not statistically significant. Qualitative findings suggested that the treatment resulted in enhanced self-management, motivation, empowerment, a sense of belonging, and reduced isolation.

CONCLUSIONS

This study suggests that vocal music therapy may be effective in building essential stepping-stones for effective chronic pain management, namely enhanced self-efficacy, motivation, empowerment, and social engagement.

Touching the Lived Body in Patients with Medically Unexplained Symptoms. How an Integration of Hands-on Bodywork and Body Awareness in Psychotherapy may Help People with Alexithymia

Medically unexplained symptoms (MUS) are a considerable presenting problem in general practice. Alexithymia and difficulties with mental elaboration of bodily arousal are hypothesized as a key mechanism in MUS. In turn, this inability influences the embodied being and participating of these patients in the world, which is coined as 'the lived body' and underlies what is mostly referred to as body awareness (BA). The present article explores a more innovative hypothesis how hands-on bodywork can influence BA and serve as a rationale for a body integrated psychotherapeutic approach of MUS. Research not only shows that BA is a bottom-up 'bodily' affair but is anchored in a interoceptive-insular pathway (IIP) which in turn is deeply connected with autonomic and emotional brain areas as well as verbal and non-verbal memory. Moreover, it is emphasized how skin and myofascial tissues should be seen as an interoceptive generator, if approached in the proper manual way. This article offers supportive evidence explaining why a 'haptic' touch activates this IIP, restores the myofascial armored body, helps patients rebalancing their window of tolerance and facilitates BA by contacting their bodily inner-world. From a trans-disciplinary angle this article reflects on how the integration of bodywork with non-directive verbal guidance can be deeply healing and resourcing for the lived body experience in MUS. In particular for alexithymic patients this approach can be of significance regarding their representational failure of bodily arousal.

The embodiment of assistive devices-from wheelchair to exoskeleton

Spinal cord injuries (SCIs) place a heavy burden on the healthcare system and have a high personal impact and marked socio-economic consequences. Clinically, no absolute cure for these conditions exists. However, in recent years, there has been an increased focus on new robotic technologies that can change the frame we think about the prognosis for recovery and for treating some functions of the body affected after SCIs. This review has two goals. The first is to assess the possibility of the embodiment of functional assistive tools after traumatic disruption of the neural pathways between the brain and the body. To this end, we will examine how altered sensorimotor information modulates the sense of the body in SCI. The second goal is to map the phenomenological experience of using external tools that typically extend the potential of the body physically impaired by SCI. More specifically, we will focus on the difference between the perception of one's physically augmented and non-augmented affected body based on observable and measurable behaviors. We discuss potential clinical benefits of enhanced embodiment of the external objects by way of multisensory interventions. This review argues that the future evolution of human robotic technologies will require adopting an embodied approach, taking advantage of brain plasticity to allow bionic limbs to be mapped within the neural circuits of physically impaired individuals.

Meanings of "acceptance" for patients with long-term pain when starting rehabilitation

PURPOSE

The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme.

METHODS

Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis.

RESULTS

The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, "the only way forward". Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one's ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, "no way forward" the integration of the aching body in sense of self was impossible and pain was incomprehensible, unacceptable and unfair. Pain was the cause of feeling stuck in the body, affecting the sense of self and the person's entire life.

CONCLUSIONS

The meaning of acceptance was related to acceptance of the persistency of pain, to how the individual related to the lived body and the need for changes in core aspects of self, and to the issue of whether to include others in the struggle of learning to move on with a meaningful life.

IMPLICATIONS FOR REHABILITATION

Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes. The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation. The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process. The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.

Revising the negative meaning of chronic pain - A phenomenological study

OBJECTIVES

Chronic pain may disable the body, depress the mind and ruin the quality of life. The aim of this study was to use the participants' personal experiences to explore the meaning of the experience of chronic pain and to find successful ways to manage chronic pain.

METHODS

Thirty-four participants with chronic pain were interviewed. The transcribed interviews were analysed using Giorgi's phenomenological method consisting of four phases: (1) reading the transcriptions several times, (2) discriminating meaning units, (3) collecting meaning units into groups and (4) the synthesis.

RESULTS

The participants stated that the key to managing chronic pain was to reconsider the individual meaning of the experience of pain. As a result of the interviews, seven subthemes were found based on the 'Negativity of chronic pain', namely, 'State of reflection', 'Reconsidering values', 'Acceptance of pain', 'Support network', 'Altered self', 'Joys in life' and 'Pain dissociation'.

CONCLUSIONS

Pain is an aversive sensation, which leads to the conclusion that the meaning of the experience is also negative, but it can be reversed. In clinical practice, the focus should be on revising the subjective meaning of pain in order to manage pain and to restore positivity in personal life.

"How to conquer a mountain with multiple sclerosis". How a climbing expedition to Machu Picchu affects the way people with multiple sclerosis experience their body and identity: a phenomenological analysis

BACKGROUND

People with multiple sclerosis (MS) frequently complain of chronic or fluctuating fatigue, sometimes accompanied by pain. From a phenomenological point of view, both fatigue and pain are seen as aspects of suffering which adversely affect the physical, psychological, social and even existential dimensions of the individual life.

OBJECTIVE

The present study discusses changes in identity and body awareness in people with MS who completed a 5-d trekking to Machu Picchu in Peru in 2012, after having completed a physical training schedule for several months.

METHOD AND DESIGN

All nine participants took part in a focus group organized after the trip. The Interpretative Phenomenological Analysis (IPA) was used to gain insight in their experiences and to refine pre-existing theoretical understanding of body awareness and identity.

RESULTS

Our phenomenological analysis clarified how aspects of the participants' identity and body experience before, during and after the journey influenced major daily themes as "body", "lived body", "behaviour" and "relationship" and how this contributed to a meaningful experience. When participants describe how they started looking at their own identity more consciously after being watched through the others' eyes, this resulted in a joyful transcending of their bodily power and endurance. In general, our data suggest that the more extreme, positive lived body experiences during the expedition were necessary for optimizing daily "routine" functioning.

CONCLUSION

Participating in Machu Picchu expedition appeared to have a deep and profound effect on body awareness and identity. Participants experienced their body once again as theirs, owning it and above all, allowing it to be a source of strength, joy and meaningfulness. While MS determined their lives prior to the journey, they now could look at MS as a part of what they are, without totally being absorbed in it. So being a patient with MS before, resulted in merely having MS after the climb. Implications for Rehabilitation Patients experience illness as a disruption of their previous life. A phenomenological approach deals with the lived experience and the concept of body awareness, the meaningful experience of living in the world through the body. This approach complements biomedical viewpoints as providing different. Suffering from a chronic and unpredictable disease like multiple sclerosis (MS) can disturb the implicit and harmonious relation between the body, the mind and the world, already at an early stage. Factors including physical training, professional guidance, social support, becoming a role model and completing a unique expedition outside of national and natural comfort borders may contribute to changes in body and identity experience.

Although unseen, chronic pain is real-A phenomenological study

Background Research has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients' perspective. Methods Thirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi's four-phase phenomenological method. Results The participants' chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants. As a result from the interviews, subthemes such as "Being disbelieved", "Adolescents' pain is also disbelieved", "Denying pain", "Underrating symptoms", "The pain is in your head", "Second-class citizen", "Lazy pain patient", and "False beliefs demand passivity" were identified. Conclusions In health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice. Implications The Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.

Physical activity perceptions and beliefs following total hip and knee arthroplasty: a qualitative study

BACKGROUND

Despite improvements in pain and physical capacity experienced by patients following total hip arthroplasty (THA) and total knee arthroplasty (TKA), recent studies suggest that levels of physical activity may not change. This study aimed to qualitatively explore people's beliefs and perspectives about physical activity at 6 months following THA or TKA for the treatment of osteoarthritis (OA).

METHODS

Semi-structured interviews were conducted with 10 participants (age range 51-78 years) at 6 months post-arthroplasty surgery. Participants were recruited from a concurrent larger quantitative study examining quantitative physical activity levels via accelerometers. Interviews were transcribed, coded and analysed using a thematic approach.

RESULTS

Participants described greater capacity to be physically active post-surgery despite no increase in objective measures. Three themes emerged from the interviews relating to the participants perspective of physical activity after surgery: (1) physical activity is for enjoying living; (2) new limitations on physical activity: age and comorbidities; and (3) personal beliefs about physical activity: it is enough to know you can.

CONCLUSION

Individual beliefs and perceptions are important in understanding factors influencing physical activity following THA and TKA. Health practitioners should examine this when developing management plans aimed at optimizing physical activity.

Holism and embodiment in nursing: using Goethean science to join 2 perspectives on patient care

Holism is a central concept in nursing theory, yet recently, embodiment has become prominent in the literature. Epistemological foundations from modern and contemporary philosophy are discussed and their relationship to nursing practice is explored to investigate the concepts of holism and embodiment. Nurses practice holistic care within the patient encounter while patients live an embodied experience. This creates inherent dissonance in the nurse-patient interaction. Goethean science is presented as a way to reconcile this discrepancy, to allow the nurse to better understand the patient's embodiment and, by default, his or her own embodiment. A new perspective of how nursing practice can use Goethean science and an embodied perspective are presented as a means to actualize Carper's fundamental pattern of knowing of personal knowledge within the nurse-patient interaction. With this approach, the nurse is able to examine the phenomenon of the patient with the patient to explore the essential nature that makes the patient who he or she is and what he or she is trying to become. During this exploration, the nurse uses the senses, language, and a critical mind to do what no machine or test could-to see the underlying meaningfulness and internal coherence of the patient. The intuitive revelation would expose nursing interventions simultaneously. Moving beyond the myopic perspective of how to keep "person" central to the nursing metaparadigm, nursing is beginning to see the embodiment of the patient as a means for understanding and providing care for patients. The challenge that remains is for nurses to see their own embodiment and reflect on if or how it is at odds with the necessity of providing holistic care to patients.

Complex symptomatology among young women who present with stress-related problems

INTRODUCTION

In Scandinavia and globally, mental health and stress-related problems among adolescent girls and young women are public health concerns that need attention. The aim of this study was to investigate mental health and somatic symptoms with a special focus on internalised problems, self-image and body-mind aspects of body perception in a group of adolescent girls and young women presenting with stress-related problems at a youth-friendly Swedish health centre, and to compare them with normative and clinical reference groups.

METHODS

The participants were 47 adolescent girls and young women, aged 17-25 years. The adult self-report (ASR), social analysis of social behaviour (SASB) and body perception questionnaire (BPQ) were used to measure multiple symptom areas.

RESULTS

Compared to reference groups, adolescent girls and young women report complex symptomatology with high levels of internalised problems such as anxiousness, depression and somatic complaints. This manifested in attention problems, negative self-image and perceived bodily discomfort and distrust.

CONCLUSION

Adolescent girls and young women emerging into adulthood present complex symptomatology of stress-related problems. This study gathered valuable information about their symptoms when they were seeking help. These young women showed higher symptom frequency than normative groups, and similar or higher symptom frequency than other clinical groups. Our findings of internalised and cognitive problems, including impaired self-image and body perceptions, point to the need for preventive strategies and tailored multidisciplinary interventions involving body-based methods to meet this complexity. Using tenets of stress theory, the complex symptomatology may be understood as logical responses to overwhelming stimuli and demands that exceed their ability to cope and disturb their 'equilibrium'. However, the complex gendered interplays between various external/internal stressors and a broad range of stress responses and health outcomes need further study in a long-term perspective.

Touch and relate: body experience among staff in habilitation services

In habilitation centres staff meet children with different impairments, children who need extensive support and training while growing up. A prevailing biomedical view of the body in habilitation services is gradually becoming supplemented by a perspective on the body as constantly involved in experiencing and communicating, the latter involving also the bodies of the therapists. Investigating body experience in habilitation staff in their encounters with the children may provide concepts that make it easier to reflect on what is going on in the interaction. When shared among larger number of peers and supported by further research in the field, reflected body experience may become a substantial aspect of professional self-knowledge. Our aim with this study was to contribute to the understanding of what it means to be a body for other bodies in the specific relational context of child habilitation, and more specifically to investigate what role the therapists’ body experience may play for professional awareness and practice. In the study, five physiotherapists and three special-education teachers spoke of physical and emotional closeness (the body as affection) but also of a provoking closeness (the body as provoked) with the children and of how their own body experience made them more attentive to the children's experience (the body as reference). Situations that included bodily limitations (the body as restriction) were described, as were situations where the body came into focus through the gazes of others or one's own (the body as observed). The body was described as a flexible tool (the body as tool), and hands were given an exclusive position as a body part that was constantly communicating. Three shifts of intentionality that form a comprehensive structure for this body experience were discerned. When professional reflection is evoked it may further body awareness, deepen reflection in practice and strengthen intercorporeality.

The "silenced" voices of women cancer survivors: bodily experiences from an existential perspective

This study explores women's embodiment from an existential-phenomenological approach. Gynecological cancer was chosen as the condition of interest to understand socially formed gender via female bodies as a lived experience of socially and historically situated women. This empirical material is based on individual interviews with 10 Portuguese cancer survivors. A phenomenological-hermeneutical method, inspired by Ricoeur (1976), was used to extract the meaningful content from the women's experiences. These narratives include life changes and recovery transitions in and through the lived body. By seeing cancer survival in terms of the lived body, this study opens the possibility of articulating a deeper and clearer understanding of people's experience of cancer trauma with gender-sensitive health services.

Central gender theoretical concepts in health research: the state of the art

Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (i.e., a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.

Experiences with spinal cord stimulator in patients with chronic neuropathic back pain

Neuropathic pain is a complex, chronic, and disabling condition that has physical, functional, and psychosocial repercussions. Although the estimated prevalence of neuropathic pain in the general population ranges from 1.5% to 8%, neuropathic pain is frequently underdiagnosed and undertreated. The aims of this study were to examine the experience of patients treated with spinal cord stimulation as a pain-relieving treatment and how this may influence the patient's ability to participate in everyday life activities. A qualitative approach based on seven telephone interviews was performed. The participants were recruited from a university hospital in Norway, and all used spinal cord stimulation as a pain-relieving treatment. Qualitative content analysis was used. Two thematic findings emerged: (1) pain relief with spinal cord stimulation as a complex and individual experience and (2) challenges in adaptations in everyday life with spinal cord stimulation. Findings indicate that spinal cord stimulation can offer pain relief that can help patients achieve a meaningful life despite chronic pain. Spinal cord stimulation also may have disadvantages that should be considered before offering this treatment. It seems evident that extended information needs about working mechanism of SCS and precautions as well as follow-up are required to meet unexpected challenges in adaptation. Here the nurse has an important role when informing and following this patient group.

The role of narrative and metaphor in the cancer life story: a theoretical analysis

Being diagnosed with cancer can be one of those critical incidents that negatively affect the self. Identity is threatened when physical, psychological, and social consequences of chronic illness begin to erode one's sense of self and challenge an individual's ability to continue to present the self he or she prefers to present to others. Based on the notion of illness trajectory and adopting a Ricoeurian narrative perspective, this theoretical paper shall explore the impact of cancer disease on identity and establish the crucial importance of metaphor in the narratives of life with cancer. Findings indicate that in cancer narratives the illness experience supplies the narrative structure with temporal and spatial meeting points that make the narrative comprehensible and meaningful. Cancer forces identity changes not only from having to endure the long-term physical and psychosocial effects of the disease, but also from inevitable existential questions about life's meaning. Improved medical knowledge today means improved ethnomedical practices. Metaphor can bridge the gap between the cancer experience and the world of technology and treatment, helping patients to symbolically control their illness.

Living an unfamiliar body: the significance of the long-term influence of bodily changes on the perception of self after stroke

The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi's understanding of the embodied self and Leder's concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that 'cannot' demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors' intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self.

Learning about oneself through others: experiences of a group-based patient education programme about irritable bowel syndrome

BACKGROUND

People with irritable bowel syndrome (IBS) often experience severe illness-related troubles in their everyday lives. Many persons also perceive their disease-related knowledge to be insufficient, and they feel dissatisfied with their inability to improve well-being. Previous research about patient education and IBS has emphasized biomedical outcomes of symptoms, health-promoting behaviours, coping and health-related quality of life, rather than people's experiences.

AIM

To explore people's experiences of participating in a multidisciplinary group-based patient education programme about IBS and of the influence of this programme on everyday life with illness.

METHODS

Focus group interviews were performed with 31 persons after their participation in the patient education programme. Interpretive description guided the inductive analysis of data. The study was approved by the local research ethics committee.

FINDINGS

The analysis revealed four patterns; being part of a safe community, learning about oneself through others, understanding and controlling the body and illness as a whole, and being outside of the community. The pattern of learning about oneself through others can be described as a reciprocal activity of learning by listening to, telling and observing others. Being among similar others had created feelings among most of the focus group participants of being part of a safe community where taboo subjects related to IBS-symptoms could be outspoken. Understanding the body and illness as a whole had enhanced their ability to interpret bodily signals and to handle trouble some situations with greater self-confidence, and this regained their access to the social everyday world.

CONCLUSION

The combination of reciprocal sharing of experiences and the provision of professional scientific knowledge during the patient education programme together contributed to a growing readiness to improve well-being in everyday life, for most of the participating individuals. This was based on new understandings of the body and illness as a whole and of new abilities to make knowledge-based decisions about what strategies to use in overcoming illness-related troubles.

Insights from a physiotherapist's lived experience of osteoarthritis

Osteoarthritis (OA) of a hip joint, with subsequent total hip joint replacement surgery, is portrayed in the literature in terms of quantitative research studies, where the person living with the hip disappears in objective statistical analyses, or in qualitative studies where one person's story is fragmented within thematic findings. This phenomenological study of a physiotherapist's (Peter) lived experience of OA offers insights relevant to practice. In the initial stages of the disease, Peter was too close to 'see' the possibility of OA as a diagnosis. As the pain limited what he could do, he needed to reinvent ways of retaining his sense of 'self'. The pain worsened; there was nothing that relieved it. The experience became one of endurance, leading to a moment when he decided the time had come to have surgery. Post-surgery, the journey of recovery was one of the feelings vulnerable. He wanted guidance and re-assurance. Paradoxically, recovery showed itself as 'forgetting' the body. The insights call for therapists to listen to the experience of clients and be alongside side them as they struggle with vulnerability. Sharing an understanding of the nature of the experience can bring confidence to clients.

Experiences of abdominal massage for constipation

AIM

This study aims to illuminate participants' experiences of receiving abdominal massage for constipation.

BACKGROUND

Abdominal massage has been found to decrease the severity of constipation and abdominal pain, but little is known about how patients experience receiving abdominal massage.

DESIGN

The present study is a qualitative descriptive study, based on individual interviews.

METHOD

Nine adults receiving abdominal massage for constipation were invited to participate. Semi-structured interviews were conducted in Sweden between 2005-2007. The interviews were transcribed and subjected to qualitative content analysis.

RESULTS

Four themes were formulated: 'being on one's guard', 'becoming embraced by safe hands', 'being touched physically and emotionally' and 'feeling vulnerable'. The participants reported that they were on guard, i.e. they were sceptical about whether or not abdominal massage was effective and suitable. However, as the massage sessions continued, they found the massage pleasant and began to feel embraced and in safe hands. They described how the abdominal massage made them feel as 'being touched physically and emotionally' and their bowel habits were improved. Along with the improvements, their agony was gone and they felt relieved. However, they considered their new condition fragile and they felt vulnerable to relapse.

CONCLUSIONS

Abdominal massage was experienced as pleasurable, and after treatment, the participants felt more comfortable with their bowel function. Participants described abdominal massage as affecting the whole person.

RELEVANCE TO CLINICAL PRACTICE

Abdominal massage has been shown to be an effective intervention for constipation. A crucial aspect is that nurses need to be sensitive and respect the intimacy associated with the abdomen.

A phenomenological analysis of bodily self-awareness in the experience of pain and pleasure: on dys-appearance and eu-appearance

The aim of this article is to explore nuances within the field of bodily self-awareness. My starting-point is phenomenological. I focus on how the subject experiences her or his body, i.e. how the body stands forth to the subject. I build on the phenomenologist Drew Leder's distinction between bodily dis-appearance and dys-appearance. In bodily dis-appearance, I am only prereflectively aware of my body. My body is not a thematic object of my experience. Bodily dys-appearance takes place when the body appears to me as "ill" or "bad." This is often the case when I experience pain or illness. Here, I will examine three versions of bodily dys-appearance. Whereas many phenomenological studies have explored cases of bodily dys-appearance, few studies have focused on the opposite of bodily dys-appearance, i.e. on bodily modes of being where the body appears to the subject as something good, easy or well. This is done in this article. When the body stands forth as good, easy or well to the subject, I suggest that the body eu-appears to this person. The analysis of eu-appearance shows that the subject can attend to her or his body as something positive and that this attention need not result in discomfort or alienation. Eu-appearance can take place in physical exercise, in sexual pleasure and in some cases of wanted pregnancies. I also discuss, briefly, the case of masochism.