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García-Dopico N, Terrasa JL, González-Roldán AM, Velasco-Roldán O, Sitges C. Unraveling the Left-Right Judgment Task in Chronic Low Back Pain: Insights Through Behavioral, Electrophysiological, Motor Imagery, and Bodily Disruption Perspectives. THE JOURNAL OF PAIN 2024; 25:104484. [PMID: 38307439 DOI: 10.1016/j.jpain.2024.01.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Bodily disruptions have been consistently demonstrated in individuals with chronic low back pain. The performance on the left-right judgment task has been purposed as an indirect measure of the cortical proprioceptive representation of the body. It has been suggested to be dependent on implicit motor imagery, although the available evidence is conflicting. Hence, the aim of this case-control observational study was to examine the performance (accuracy and reaction times) and event-related potentials while performing the left-right judgment task for back and hand images in individuals with chronic low back pain versus healthy controls, along with its relationship with self-reported measurements and quantitative sensory testing. While self-reported data suggested bodily disruptions in the chronic low back pain sample, this was not supported by quantitative sensory testing. Although both groups displayed the same performance, our results suggested an increased attentional load on participants with chronic low back pain to achieve equal performance, measured by a higher N1 peak amplitude in occipital electrodes, especially when the effect of contextual images arises. The absence of differences in the reaction times for the left-right judgment task between both groups, along with inconsistencies in self-reported and quantitative sensory testing data, could question the involvement of implicit motor imagery in solving the task. In conclusion, our results suggest disrupted attentional processing in participants with chronic low back pain to solve the left-right judgment task. PERSPECTIVE: Although there are no differences in the performance of the left-right judgment task (hits, reaction times) between chronic low back pain patients and controls, the analysis of event-related potentials revealed that patients require a higher cognitive load, measured by N1 peak amplitude.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Ana M González-Roldán
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Kurz R, Hebron C. "Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain". Physiother Theory Pract 2024; 40:983-998. [PMID: 36373211 DOI: 10.1080/09593985.2022.2144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.
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Affiliation(s)
- Raffaela Kurz
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
- Physiotherapy MSK Department, Sussex Community NHS Foundation Trust, Horsham Hospital, Hurst Road, Horsham RH12 2DR, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, UK
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Tweedlie L, Simonds L, Hanna P, Lui DF. A narrative exploration of identity in adults with de novo scoliosis. Health (London) 2023; 27:701-718. [PMID: 35042399 PMCID: PMC10423435 DOI: 10.1177/13634593211067892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adult de novo scoliosis is a chronic health condition characterised by a curvature in the ageing spine. It can cause debilitating back pain and significant visible differences. Yet there has been very limited research on the psychological effects of this condition, particularly around identity. Therefore, we undertook semi-structured interviews to explore the ways in which individuals with scoliosis understood their identity. Findings from narrative analysis highlight the ways in which individuals negotiate their identity in relation to their social roles, their ability to control their condition and things around them, the extent to which their condition is visible and the extent to which they experienced physical pain from their condition. This article concludes by highlighting the relationship between identity and scoliosis and offers practical implications and suggestions for future research.
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Affiliation(s)
| | | | | | - Darren F Lui
- St George’s University Hospitals NHS Foundation Trust, UK
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Camerota F, Mariani R, Cordiano G, Di Trani M, Lodato V, Ferraris A, Pasquini M, Celletti C. The Language of Pain in the Hypermobile Ehlers-Danlos Syndrome: Metaphors as a Key to Understanding the Experience of Pain and as a Rehabilitation Tool. Brain Sci 2023; 13:1042. [PMID: 37508973 PMCID: PMC10377642 DOI: 10.3390/brainsci13071042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Ehlers-Danlos syndromes are a heterogeneous group of Heritable Connective Tissue Disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Among the different types, the hypermobile Ehlers-Danlos syndrome is the most frequent and includes generalized joint hypermobility as the major diagnostic criterion. Joint hypermobility in hypermobile Ehlers-Danlos syndrome is often associated with pain that does not always allow the use of effective pain-reducing treatments. Patients with hEDS constantly describe their pain in detail. Eighty-nine patients with hEDS diagnoses were recruited and evaluated. They were asked to describe their pain in writing. The texts were examined through Linguistic Inquiry and Word Count. Correlational analyses were conducted between pain perception and language. A comparison of high/low pain perception and the quality of metaphors was carried out. The results showed that language quality varies depending on how much pain is perceived. The greater the pain is perceived, the lesser the positive effects and the greater the negative effects and dehumanizing metaphors are being used. Moreover, a greater pain seems to be related to a verbal experience of greater isolation and less self-care. In conclusion, the use of metaphors is a useful tool for examining illness experience and may help clinicians in the rehabilitation program.
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Affiliation(s)
- Filippo Camerota
- Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy
| | | | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, and Health Studies Sapienza, University of Rome, 00133 Rome, Italy
| | - Valentina Lodato
- Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandro Ferraris
- Laboratory of Medical Genetics, Department of Experimental Medicine, San Camillo Forlanini Hospital, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Celletti
- Physical Medicine and Rehabilitation, Umberto I University Hospital, 00161 Rome, Italy
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Alkandari M, Hollywood A. People's experiences living with peripheral neuropathy: a qualitative study. FRONTIERS IN PAIN RESEARCH 2023; 4:1162405. [PMID: 37449296 PMCID: PMC10338106 DOI: 10.3389/fpain.2023.1162405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Peripheral neuropathy is a neurological disorder characterised by pain, numbness, or tingling due to nerve damage. Peripheral neuropathy is one of the main health issues in Kuwait and is a rising concern which affects a large proportion of the population, therefore the lived experience needs to be explored to identify areas for improvement in care. This qualitative study explored the experiences of people living with peripheral neuropathy in Kuwait. Methods Semi-structured interviews were conducted with 25 participants recruited from the Neurology Outpatient Clinic of the Ibn Sina Hospital in Kuwait. The interview questions explored their experiences and understanding of pain along with the impact on their daily life. The interviews were audio recorded, transcribed and translated into English then coded using NVivo 12. Thematic analysis was conducted to identify patterns and themes in the data. Results Three major themes were identified including treatment beliefs (perceived effectiveness of treatment and seeking alternative treatments), the barriers to pain management (medication side effects, relationships with healthcare professionals and lack of information and access to healthcare), and the impact on quality of life (impact on work and social, physical, and psychological consequences). Self-efficacy was a key construct and over-arching theme that was discussed in all aspects, which finds reflection in the protection motivation theory. Discussion This paper presents the experiences of people living with peripheral neuropathy and highlights there is scope for improvement of current treatments in Kuwait. Self-management strategies are recommended alongside prescribed medication and healthcare professionals are encouraged to use a patient-centered approach. More importantly, information and support on the condition to promote coping strategies and self-efficacy should be adopted to improve quality of life. These findings can be implemented locally and globally to improve the quality of care provided to people living with peripheral neuropathy.
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Cooper K, Mandy W, Butler C, Russell A. Phenomenology of gender dysphoria in autism: a multiperspective qualitative analysis. J Child Psychol Psychiatry 2023; 64:265-276. [PMID: 36089890 PMCID: PMC10087378 DOI: 10.1111/jcpp.13691] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Autistic people are overrepresented in gender clinic settings, but limited evidence is available to guide clinical decision making for this patient group. We aimed to generate a comprehensive understanding of the phenomenology of gender dysphoria in autistic people. METHODS We conducted a multi-perspectival interpretative phenomenological analysis (IPA), from five different perspectives; autistic young people and adults with experience of gender dysphoria, parents of young people, and clinicians working with autistic people with gender dysphoria in both adult and young person settings (n = 68). RESULTS IPA analysis resulted in two themes, 'discovering gender identity' and 'the complexities of moving towards gender comfort'. Participants agreed that there was often an interaction between gender dysphoria and features of autism such as sensory sensitivities. There was relative consensus across groups about the need for autism adaptations to be made in gender clinics. Autistic adults were more likely to see autism as an important identity than young people, but both groups were clear that autism did not impair their understanding of gender. In contrast, some parents and clinicians working with young people expressed concern that autism did impact self-understanding. DISCUSSION While the groups tended to agree on the ways in which particular features of autism can compound gender dysphoria, there were a range of perspectives on the ways in which autism impacted on self-knowledge. CONCLUSION Recommendations for adaptations when working with autistic people with gender dysphoria are presented.
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Affiliation(s)
- Kate Cooper
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
| | - William Mandy
- Research Department of Clinical, Educational, and Health Psychology, London, UK
| | | | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
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7
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Chala MB, Donnelly C, Ghahari S, Wondie Y, Abebe A, Miller J. An Interpretative Phenomenological Analysis of Living with Chronic Low Back Pain in Ethiopia. J Pain Res 2022; 15:4031-4045. [PMID: 36575721 PMCID: PMC9790163 DOI: 10.2147/jpr.s389827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background People with chronic low back pain experience myriads of problems from living with their condition. This study aimed to explore the lived experience of people with chronic low back pain in Ethiopia. Design This is a qualitative semi-structured study design which used an interpretative phenomenological analysis approach for data analysis. Participants Fifteen adults (10 women and 5 men) with chronic low back pain (duration ≥ 3 months) with age ranging from 19 to 66 years old were interviewed. Setting Participants were recruited from the outpatient departments of the University of Gondar hospital in Gondar, Ethiopia. Methods Data was collected through an in-depth semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed through an iterative process, beginning with a line-by-line coding to identify the lived experience of chronic low back pain. Findings Five main themes related to the lived experience of people with chronic low back pain emerged: 1) CLBP impacts life on a day-to-day basis, 2) The invisibility of pain results in misunderstanding, misjudgment, and loneliness, 3) The cause of pain is a mystery, 4) The search for the cure is a quest, 5) Each person has their ways of managing, coping, and living with pain. Conclusion The findings from this study improve our understanding of the experience of people with chronic low back pain and its impact on their day-to-day life in Ethiopia. The findings from this study could inform the development of culturally centered chronic low back pain interventions such as self-management programs in the Ethiopian context.
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Affiliation(s)
- Mulugeta Bayisa Chala
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Correspondence: Mulugeta Bayisa Chala, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Tel +1-613-328-3604, Email
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Yemataw Wondie
- Department of Psychology, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
| | - Abey Abebe
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
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8
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Ho JT, Krummenacher P, Lenggenhager B. Not my body, not my pain? Pain perception and placebo analgesia in individuals with body integrity dysphoria. Cortex 2022; 153:44-54. [PMID: 35588553 DOI: 10.1016/j.cortex.2022.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022]
Abstract
Acute and chronic states of physical pain are inherently linked to our bodily perception. Bodily illusion paradigms have demonstrated that an experimentally induced sense of body disownership can modulate both acute and chronic pain. Insight into the relationship between enduring clinical alterations in body perception and pain is much more limited. The current study examined both pain perception and placebo analgesia in Body Integrity Dysphoria (BID), a clinical model of long-term alterations of bodily disownership: in its most commonly studied variant, people feel like a part of their body does not belong to them, leading to a desire for amputation of a physically healthy limb. Heat stimulations were applied before and after a placebo intervention (sham analgesic cream) to the desired and the undesired leg of 19 patients with BID with a unilateral leg amputation desire. Pain perception was assessed using pain thresholds, and ratings for pain intensity and pain unpleasantness. Results show that pain perception and placebo efficacy were lower for the undesired than for the desired leg, demonstrating a potential link between a clinical disorder of body ownership, pain perception, and placebo analgesia.
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Affiliation(s)
- Jasmine T Ho
- University of Zurich, Department of Psychology, Zurich, Switzerland; Brainability, LLC, Zurich, Switzerland.
| | - Peter Krummenacher
- Brainability, LLC, Zurich, Switzerland; Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, Psychotherapy and Psychosomatics, Zurich, Switzerland.
| | - Bigna Lenggenhager
- University of Zurich, Department of Psychology, Zurich, Switzerland; Department of Psychology, University of Konstanz, Konstanz, Germany.
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Quixadá AP, Miranda JGV, Osypiuk K, Bonato P, Vergara-Diaz G, Ligibel JA, Mehling W, Thompson ET, Wayne PM. Qigong Training Positively Impacts Both Posture and Mood in Breast Cancer Survivors With Persistent Post-surgical Pain: Support for an Embodied Cognition Paradigm. Front Psychol 2022; 13:800727. [PMID: 35265005 PMCID: PMC8900705 DOI: 10.3389/fpsyg.2022.800727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors (BCS) with persistent postsurgical pain (PPSP) over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open (EO), eyes open relaxed (EOR) and eyes closed (EC). Assessments were made before and after the Qigong training. The association between categorical variables (angle and mood) was measured by Cramer's V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs.
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Affiliation(s)
- Ana Paula Quixadá
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
- *Correspondence: Ana Paula Quixadá,
| | - Jose G. V. Miranda
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
| | - Kamila Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Jennifer A. Ligibel
- Zakim Center for Integrative Therapies and Healthy Living, Harvard Medical School, Dana Farber Cancer Institute, Boston, MA, United States
| | - Wolf Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Evan T. Thompson
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
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Saelaert M, Mertes H, Moerenhout T, Van Cauwenbergh C, Leroy BP, Devisch I, De Baere E. A qualitative study among patients with an inherited retinal disease on the meaning of genomic unsolicited findings. Sci Rep 2021; 11:15834. [PMID: 34349199 PMCID: PMC8339116 DOI: 10.1038/s41598-021-95258-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/05/2021] [Indexed: 12/30/2022] Open
Abstract
Exome-based testing for genetic diseases can reveal unsolicited findings (UFs), i.e. predispositions for diseases that exceed the diagnostic question. Knowledge of patients’ interpretation of possible UFs and of motives for (not) wanting to know UFs is still limited. This lacking knowledge may impede effective counselling that meets patients’ needs. Therefore, this article examines the meaning of UFs from a patient perspective. A qualitative study was conducted and an interpretative phenomenological analysis was made of 14 interviews with patients with an inherited retinal disease. Patients assign a complex meaning to UFs, including three main components. The first component focuses on result-specific qualities, i.e. the characteristics of an UF (inclusive of actionability, penetrance, severity and age of onset) and the consequences of disclosure; the second component applies to a patient’s lived illness experiences and to the way these contrast with reflections on presymptomatic UFs; the third component addresses a patient’s family embedding and its effect on concerns about disease prognosis and genetic information’s family relevance. The complex meaning structure of UFs suggests the need for counselling procedures that transcend a strictly clinical approach. Counselling should be personalised and consider patients’ lived illness experiences and family context.
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Affiliation(s)
- Marlies Saelaert
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Tania Moerenhout
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.,Bioethics Centre, University of Otago, Dunedin, New Zealand.,Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Bart P Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium.,Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Division of Ophthalmology & Center for Cellular & Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
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11
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Plank A, Rushton A, Ping Y, Mei R, Falla D, Heneghan NR. Exploring expectations and perceptions of different manual therapy techniques in chronic low back pain: a qualitative study. BMC Musculoskelet Disord 2021; 22:444. [PMID: 33990196 PMCID: PMC8122532 DOI: 10.1186/s12891-021-04251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) prevalence has steadily increased over the last two decades. Manual therapy (MT) is recommended within a multimodal management approach to improve pain and disability although evidence investigating the patients' experience of MT is scarce. OBJECTIVE To explore expectations and perceptions of MT techniques in people with CLBP. METHODS A qualitative study embedded sequential to an experimental trial using semi-structured interviews (SSI) explored participants' experiences of thrust, non-thrust and sham technique. Purposive sampling enabled variance in age and CLBP duration. An evidence informed topic guide was used. Data were analysed using thematic analysis (TA). Respondent validation and peer debriefing enhanced trustworthiness. The Consolidating Criteria for Reporting Qualitative Studies (COREQ) reported methodological rigour. FINDINGS Ten participants (50% male) with a mean age of 29.1 years (Standard Deviation (SD): 7.9, range: 19-43), a mean pain intensity of 4.5 on a Numeric Rating Scale (NRS) 0-10 (SD: 1.5, range: 2-7), a mean Oswestry Disability Score (ODI) of 9 (SD: 4.6, range: 2-17) and a mean Tampa Scale of Kinesiophobia (TSK) score of 38.6 (SD: 4.8, range: 30-45) participated. Four themes were identified: understanding of pain; forming expectations; perception of care; re-evaluation of body awareness and management. Understanding of CLBP is formed by an individuals' pain perception and exchange with social environment. This, combined with communication with physiotherapist influenced expectations regarding the MT technique. CONCLUSION Expectations for MT were formed by an individual's social environment and previous experience. A treatment technique is perceived as positive if its characteristics are aligned with the individual's understanding of pain and if care is delivered in an informative and reassuring manner.
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Affiliation(s)
- A Plank
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,School of Physical Therapy, Western University, London, Ontario, Canada
| | - Y Ping
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - R Mei
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - N R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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12
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Munday I, Kneebone I, Rogers K, Newton-John T. The Language of Pain: Is There a Relationship Between Metaphor Use and Adjustment to Chronic Pain? PAIN MEDICINE 2021; 23:2073-2084. [PMID: 33729513 DOI: 10.1093/pm/pnaa467] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Metaphor, frequently used in chronic pain, can function as a communicative tool, facilitating understanding and empathy from others. Previous research has demonstrated that specific linguistic markers exist for areas such as pain catastrophizing, mood, as well as diagnostic categories. The current study sought to examine potential associations between the types of pain metaphors used and diagnostic category, disability, and mood. DESIGN Online cross-sectional survey in Sydney, Australia. SUBJECTS People with chronic pain (n = 247, age 19-78 years, M = 43.69). METHODS The data collected included demographics, pain metaphors, the Brief Pain Inventory (BPI) and the Depression, Anxiety, and Stress Scales (DASS-21). Associations between metaphor source domains, obtained via Systematic Metaphor Analysis, and scores on the BPI, DASS-21, as well as diagnostic group were considered using binary logistic analysis. RESULTS Use of different pain metaphors was not associated with pain intensity, however the extent to which pain interfered with daily life did have a relationship with use of metaphorical language. Preliminary support was found for an association between the use of certain pain metaphors and self-reported diagnostic categories, notably Endometriosis, Complex Regional Pain Syndrome, and Neuropathic pain. CONCLUSIONS There may be specific linguistic metaphorical markers to indicate pain interference and for particular diagnoses. Appreciation of pain metaphors has potential to facilitate communication and enhance understanding in interactions between clinicians and people with chronic pain.
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Affiliation(s)
- Imogene Munday
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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13
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Skúladóttir H, Gunnarsdóttir TJ, Halldórsdóttir S, Sveinsdóttir H, Holden JE, Björnsdóttir A. Breaking the vicious circle: Experiences of people in chronic pain on the pain rehabilitation journey. Nurs Open 2020; 7:1412-1423. [PMID: 32802361 PMCID: PMC7424485 DOI: 10.1002/nop2.512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
Aim To explore the lived experience of individuals' in chronic pain of participating in a pain rehabilitation programme in Iceland. Design Phenomenological research. Method The Vancouver School of Doing Phenomenology. Eleven participants were interviewed. Results The overarching theme was as follows: "the journey of breaking the vicious circle of chronic pain." Before the programme, the participants felt they were in survival mode, trying to survive each day; they were stuck in a vicious circle of chronic pain, simultaneously trying to ease and conceal the pain. Reaching out for professional help was a turning point. While attending the programme, participants began deconstructing their old ways of dealing with chronic pain. After completing the programme, they were still reconstructing their daily lives. In conclusion, pain rehabilitation programmes can be the first step towards breaking the vicious circle of chronic pain.
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Affiliation(s)
- Hafdís Skúladóttir
- Faculty of NursingSchool of Health SciencesUniversity of AkureyriAkureyriIceland
| | | | | | - Herdís Sveinsdóttir
- Faculty of NursingSchool of Health SciencesUniversity of IcelandReykjavikIceland
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14
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McKillop AB, Carroll LJ, Dick BD, Battié MC. What Motivates Engagement in Work and Other Valued Social Roles Despite Persistent Back Pain? JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:466-474. [PMID: 32016648 DOI: 10.1007/s10926-020-09875-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The prognosis of persistent back pain is variable, with some individuals adjusting poorly and others continuing to actively engage in work and other valued social roles. The aim of this study was to better understand why some individuals, despite persistent back pain, continue to actively engage in work and other valued social roles. Methods Individuals with persistent back pain, who were participating in their regular duties as a full-time employee, homemaker, student or any combination of these, were recruited from a multidisciplinary pain centre and orthopedic physical therapy clinics in Alberta, Canada. A qualitative study was conducted using semi-structured interviews of 15 participants and a thematic analysis to analyze the data. Results There were two motivators identified for participating in the work role: (1) participation formed part of the participant's self-schema (a cognitive framework that includes one's beliefs about oneself) and (2) participation made it possible to achieve a valued outcome. Conclusions Further understanding of important motivators for maintaining engagement in work and other valued social roles despite persistent back pain can help inform the development of more successful disability and pain management programs.
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Affiliation(s)
- Ashley B McKillop
- Faculty of Rehabilitation Medicine, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Linda J Carroll
- School of Public Health, University of Alberta, 4075 Research Transition Facility, Edmonton, AB, T6G 2E1, Canada
| | - Bruce D Dick
- Faculty of Medicine & Dentistry, Department of Anesthesiology & Pain Medicine, University of Alberta, 2-150 Clinical Sciences, Edmonton, AB, T6G 2G3, Canada
| | - Michele C Battié
- School of Physical Therapy & Western Bone and Joint Institute, Western University, Elborn College Room 1445, London, ON, N6G 1H1, Canada
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15
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Mbarga J, Foley RA, Pichonnaz C, Ancey C. Trajectoires de personnes souffrant de lombalgie chronique : ruptures et reconstructions après un programme de rééducation. SANTE PUBLIQUE 2020; Vol. 32:19-28. [PMID: 32706223 DOI: 10.3917/spub.201.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose of research: The objective of this article is to investigate, from the perspective of patients, the disruptions of the biographical trajectories induced by chronic low back pain and the impact of a multidisciplinary rehabilitation program on their reconstruction. METHODS Based on an interdisciplinary qualitative research, we investigated the experience of 20 participants with chronic low back pain following a three-week rehabilitation program at the hospital. Semi-directive interviews were conducted before and after inclusion in the program. RESULTS Although affecting each person in a singular way, chronic low back pain induces biographical linearity disruptions related to the apparition of pain, and the disruption of daily and professional activities. For the majority of participants, the rehabilitation program provided a repairative space to restore continuity between past, present and future life. Whether or not there is a significant improvement in pain, most participants report benefits that give them the feeling of getting back to normality. Nevertheless, they identify those more for the domestic, family, and social spheres than at the professional level, effects remaining moderate to mitigated in that area. CONCLUSIONS The rehabilitation program influences the dynamics of biographical trajectories and promotes a return to what is perceived as normality. By providing individuals with theoretical and practical tools and increasing their functional capacities, it promotes autonomous pain and problem management. Immediate effects are seen as restorative for domestic, family and social activities, but remain limited on the professional level.
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16
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Munday I, Newton-John T, Kneebone I. 'Barbed wire wrapped around my feet': Metaphor use in chronic pain. Br J Health Psychol 2020; 25:814-830. [PMID: 32452109 PMCID: PMC7496857 DOI: 10.1111/bjhp.12432] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/03/2020] [Indexed: 11/29/2022]
Abstract
Objectives As there is no objective test for pain, sufferers rely on language to communicate their pain experience. Pain description frequently takes the form of metaphor; however, there has been limited research in this area. This study thus sought to extend previous findings on metaphor use in specific pain subgroups to a larger, heterogeneous chronic pain sample, utilizing a systematic method of metaphor analysis. Design Conceptual metaphor theory was utilized to explore the metaphors used by those with chronic pain via qualitative methodology. Methods An anonymous online survey was conducted which asked for the descriptions and metaphors people use to describe their pain. Systematic metaphor analysis was used to classify and analyse the metaphors used into specific metaphor source domains. Results Participants who reported chronic pain completed the survey (N = 247, age 19–78, M = 43.69). Seven overarching metaphor source domains were found. These were coded as Causes of Physical Damage, Common Pain Experiences, Electricity, Insects, Rigidity, Bodily Misperception, and Death and Mortality. Conclusions Participants utilized a wide variety of metaphors to describe their pain. The most common descriptions couched chronic pain in terms of physical damage. A better understanding of pain metaphors may have implications for improved health care communication and provide targets for clinical interventions.
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Affiliation(s)
- Imogene Munday
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, New South Wales, Australia
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17
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Santos WJD, Giacomin KC, Firmo JOA. [Alterity of the body of the elderly: estrangement and pain in Public Health]. CIENCIA & SAUDE COLETIVA 2019; 24:4275-4284. [PMID: 31664399 DOI: 10.1590/1413-812320182411.26342017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 04/06/2018] [Indexed: 11/22/2022] Open
Abstract
In old age, the ailing patient's body becomes estranged and reveals an awareness of alterity. This paper investigates how the body of the elderly addresses the estrangement as a subject, producing its own actions in the experience of disease and practice of public health. The research, developed using the qualitative approach of an anthropological nature, is based on the assumptions of ethnography. Individual interviews with a semi-structured script in the universe of 57 elderly people were conducted. The methodology of Signs, Meanings and Actions oriented the data collection and analysis enabling the investigation of representations and concrete behaviors associated with the otherness of the body. There was the sense of production of otherness in relation to two analytical categories associated with aging and disease. A split between the active body of the memory and another experienced with limitations in the present is detected, reflecting the confrontation of self-care and adherence to treatment. The body of the elderly individual is heir to a body image that remodels constantly, depriving the elderly of their place as contemporary owners of their bodies, as they become other persons.
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Affiliation(s)
- Wagner Jorge Dos Santos
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou/Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte, MG, Brasil.
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18
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Yamashita H, Nishigami T, Mibu A, Tanaka K, Manfuku M, Fukuhara H, Yoshino K, Seto Y, Wand BM. Perceived Body Distortion Rather Than Actual Body Distortion Is Associated With Chronic Low Back Pain in Adults With Cerebral Palsy: A Preliminary Investigation. Pain Pract 2019; 19:826-835. [DOI: 10.1111/papr.12815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Affiliation(s)
| | - Tomohiko Nishigami
- Department of Nursing and Physical Therapy Konan Women's University Kobe Japan
| | - Akira Mibu
- Department of Rehabilitation Tanabe Orthopaedics Osaka Japan
| | | | | | - Hikaru Fukuhara
- Day‐care and Rehabilitation Center for Disabled Children “Asashioen” Osaka Japan
| | - Koichi Yoshino
- Department of Orthopaedic Surgery SKY Orthopaedics Clinic Ibaraki Japan
| | - Yoichi Seto
- Department of Orthopaedic Surgery SKY Orthopaedics Clinic Ibaraki Japan
| | - Benedict M. Wand
- The School of Physiotherapy The University of Notre Dame Australia Fremantle Western Australia Australia
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19
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Honoré Grauslund AM, Solmunde Michelsen J, Esbensen BA. Everyday life with chronic back pain: a qualitative study among Turkish immigrants in Denmark. Disabil Rehabil 2019; 43:1162-1170. [PMID: 31524527 DOI: 10.1080/09638288.2019.1661034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chronic back pain has a major physical and psycho-social impact. There have been few subjective assessments of everyday life in relation to migration and ethnicity. Through a descriptive and qualitative cross-cultural design, the aim was to develop an in-depth understanding of how Turkish immigrants experience living with back pain. METHODS We conducted a qualitative study based on interviews with Turkish immigrants suffering from CBP recruited from a rheumatology outpatient clinic. The analysis was based on Giorgi's phenomenological analysis. RESULTS Eleven Turkish participants with chronic back pain (mean age 47.6) were recruited. Three essences resulted from the analysis: "Overwhelming and prevailing pain" - reflecting pain taking control of everyday life, "Being distressed in community life" - encompassing how pain causes changes in social roles, and "Looking for a way out of pain" - referring to feeling lost when being treated in the healthcare system, finding pain-management strategies and returning to Turkey for assistance. CONCLUSION Chronic back pain has a significant influence on daily life. Pain changes the feeling of identity relating to close relationships and in the Labor market. Most participants' proficiency in Danish language skills posed a challenge for the existing treatment paradigm, in which information is crucial for successful rehabilitation.IMPLICATIONS FOR REHABILITATIONTo improve access to both info on chronic back pain and its treatment, it is crucial that rehabilitation be offered in a range of languages.Proficiency in Danish varies greatly among immigrants, despite years of stay in Denmark. Engaging a professional interpreter early on in the rehabilitation program might improve patient compliance to the preferred treatment regimen.Including a peer-to-peer educational approach in parts of the rehabilitation program might be beneficial, as some immigrants remain skeptical towards the health care system in Denmark.
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Affiliation(s)
- Anne-Mette Honoré Grauslund
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Glostrup, Denmark
| | - Jannie Solmunde Michelsen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Glostrup, Denmark
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Allvin R, Fjordkvist E, Blomberg K. Struggling to be seen and understood as a person - Chronic back pain patients' experiences of encounters in health care: An interview study. Nurs Open 2019; 6:1047-1054. [PMID: 31367430 PMCID: PMC6650668 DOI: 10.1002/nop2.290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to describe how patients with chronic back pain experience encounters with health care. Persons with chronic back pain are a stigmatized group often treated based on stereotypes, which may lead to misunderstandings and create frustrated patients and healthcare personnel. Few studies have examined the generic aspects of quality of care in this context. DESIGN A descriptive design with a qualitative approach was used. METHODS Nine individual interviews were conducted with chronic back pain patients after admission to an orthopaedic hospital ward. Data were analysed using content analysis. RESULTS The patients' experiences of healthcare encounters can be described by the theme "Struggling to be seen and understood as a person," comprising the categories "Lack of access and trust to care," "A desire to be taken care of and listened to" and "Own strength to handle healthcare situations."
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Affiliation(s)
- Renée Allvin
- Clinical Skills CenterÖrebro University HospitalÖrebroSweden
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | - Erika Fjordkvist
- Departments of OrthopedicsÖrebro University HospitalÖrebroSweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
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Abstract
OBJECTIVE Pain is a universal phenomenon, but is also inherently private and subjective - there's no objective test for its existence. Sufferers rely on language to describe their pain experience. The McGill Pain Questionnaire paved the way for incorporating language into pain assessment and recent research has explored aspects of pain language such as metaphors and grammatical patterns. This study investigated how chronic pain sufferers use language to describe their pain experience. DESIGN Three focus groups were conducted (N = 16, age 22-74 years, M = 46.6 years) with participants attending an outpatient chronic pain management program in Sydney, Australia. Participants were asked to describe aspects of their pain experience. MAIN OUTCOME MEASURE The language which participants utilized to talk about their pain experience. RESULTS Thematic analysis identified five superordinate themes: Isolation, Physical Sensations of Pain, Pain Personified, Pain as Overwhelming, and Coping with Pain. Across themes, participants relied on metaphorical language, which reflects the complex, multidimensional aspects of pain as well as the desire to effectively communicate it to others. CONCLUSIONS This study underscores research indicating the complexity of pain experience and hence pain language, and suggests that single word adjectival measures are inadequate to completely capture its complexity. IMPLICATIONS FOR REHABILITATION Chronic pain is now considered a disease in and of itself, with patient's pain language being an important study area due to the lack of objective tests for pain. In both assessment and rehabilitation, patients rely on metaphorical pain language in order to facilitate understanding and garner support from others. Pain metaphors may provide a useful target for interventions such as Acceptance and Commitment Therapy and Cognitive Behavioural Therapy, particularly when addressing catastrophic thinking patterns.
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Affiliation(s)
- Imogene Munday
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Broadway, Australia
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22
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Sanders T, Winter D, Payne H. Personal Constructs of Mind-Body Identity in People Who Experience Medically Unexplained Symptoms. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2018. [DOI: 10.1080/10720537.2018.1515047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tom Sanders
- University of Hertfordshire, Hatfield, United Kingdom
| | - David Winter
- University of Hertfordshire, Hatfield, United Kingdom
| | - Helen Payne
- University of Hertfordshire, Hatfield, United Kingdom
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23
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Kılınç S, Campbell C, Guy A, van Wersch A. Epilepsy, identity, and the experience of the body. Epilepsy Behav 2018; 89:42-47. [PMID: 30384098 DOI: 10.1016/j.yebeh.2018.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Abstract
Living with a chronic condition can challenge a person's identity, yet there is a paucity of research exploring this experience for people with epilepsy and particularly for those diagnosed in adulthood. Consequently, through an interpretative phenomenological approach, the current study aimed to explore what the experience of adult-onset epilepsy meant for a person's identity. Thirty-nine people with adult-onset epilepsy from across the UK took part in up to two semi-structured interviews. A modified form of interpretative phenomenological analysis was conducted and identified three themes: 1) disarming the impact of seizures considered strategies used to control seizure occurrence and regain a sense of control over the body; 2) distinguishing the self from the body highlighted participants' attempts to separate their sense of self from the unpredictability of their bodies; 3) separating epilepsy from themselves demonstrated how participants externalized epilepsy from themselves in order to reject it as part of their identity. The findings highlighted that living with adult-onset epilepsy can challenge a person's sense of self and trust in their body, resulting in the adoption of various strategies to manage the threat to their identity. As such, practitioners must pay attention to the impact that adult-onset epilepsy can have on a person's identity and faith in their body.
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Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK.
| | | | - Alison Guy
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK
| | - Anna van Wersch
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK
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24
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Jordan A, Noel M, Caes L, Connell H, Gauntlett-Gilbert J. A developmental arrest? Interruption and identity in adolescent chronic pain. Pain Rep 2018; 3:e678. [PMID: 30324170 PMCID: PMC6172819 DOI: 10.1097/pr9.0000000000000678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/19/2018] [Accepted: 07/15/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although the pediatric pain literature has explored the role of developmental factors in young children's acute pain, relatively less is known about specific developmental challenges in adolescents with chronic pain. OBJECTIVES To meet this knowledge gap, this study sought to adopt an idiographic phenomenological approach to examine how adolescents make sense of their own development in the context of living with chronic pain. METHODS Semistructured interviews were conducted with ten adolescents (12-17 years; 7 females) recruited from a tertiary care pain treatment programme. Interview data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. RESULTS Study findings identified 2 themes: "An externally imposed lens on identity" and "Paradoxes of developmental progress." The first theme highlighted an understanding of how adolescent identity is perceived. Some adolescents perceived identity as distinct from pain, whereas others perceived identity as part of their chronic pain condition. This theme also detailed how identity was negotiated by adolescents and others through engagement with valued activities. The second theme represented an understanding of how chronic pain disrupts and alters adolescent developmental trajectories at an individual level, suggesting possibilities of enhanced and delayed trajectories. Enhanced trajectories were associated with increased management of emotionally difficult situations and resulted in mastery of complex interpersonal skills. CONCLUSION Findings provided a nuanced understanding of developmental progress in the context of adolescent chronic pain and suggested challenges with drawing normative comparisons. Future research could extend findings by adopting a longitudinal approach to studying adolescent development and eliciting accounts from broader social groups.
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Affiliation(s)
- Abbie Jordan
- Department of Psychology, Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Line Caes
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Hannah Connell
- Bath Centre for Pain Services, Royal United Hospitals NHS Trust, Bath, United Kingdom
| | - Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals NHS Trust, Bath, United Kingdom
- Faculty for Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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25
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Martínez E, Aira Z, Buesa I, Aizpurua I, Rada D, Azkue JJ. Embodied pain in fibromyalgia: Disturbed somatorepresentations and increased plasticity of the body schema. PLoS One 2018; 13:e0194534. [PMID: 29624596 PMCID: PMC5889164 DOI: 10.1371/journal.pone.0194534] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 03/05/2018] [Indexed: 11/22/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.
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Affiliation(s)
- Endika Martínez
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Zigor Aira
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Itsaso Buesa
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
- * E-mail:
| | - Ibane Aizpurua
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
| | - Diego Rada
- Preventive Medicine and Public Health Department, School of Pharmacy University of the Basque Country, UPV/EHU Paseo de la Universidad, Vitoria-Gasteiz, Araba, Spain
| | - Jon Jatsu Azkue
- Department of Neurosciences, School of Medicine and Nursery, University of the Basque Country, UPV/EHU Barrio Sarriena s/n, Leioa, Bizkaia, Spain
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26
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Stensland ML, Sanders S. "It has changed my whole life": The systemic implications of chronic low back pain among older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:129-150. [PMID: 29336694 DOI: 10.1080/01634372.2018.1427169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic low back pain (CLBP) is the most common pain complaint among older adults. Despite its prevalence, very little research has qualitatively examined the diverse consequences of living with CLBP in later life. As part of a larger study aiming to understand the experience of CLBP among older adults, the objective of this manuscript is to understand how older adults experience CLBP and its impacts on the functioning of older adults. Guided by van Manen's phenomenological method, 23 semi-structured interviews with 21 pain clinic patients aged 66-83 were conducted. Through an iterative process assisted by NVivo 11 software, researchers used line-by-line thematic coding to identify main impacts of CLBP. Under the main theme "It has changed my whole life," results are reflected in six subthemes: (a) Pain damages sense of self; (b) trapped in a body that doesn't work anymore; (c) me, my partner, and my pain; (d) pain complicates family relationships; (e) painfully employed; and (f) feeling socially and recreationally repressed. This study improves our understanding of older pain clinic patients' experience of living with debilitating CLBP and offers direction for social work intervention in the context of multidisciplinary pain management.
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Affiliation(s)
| | - Sara Sanders
- a School of Social Work , University of Iowa , IA , USA
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Hughes M, Burton AE, Dempsey RC. 'I am free in my wheelchair but pain does have a say in it though': The meaning and experience of quality of life when living with paraplegia and chronic pain. J Health Psychol 2017; 24:1356-1367. [PMID: 29284303 DOI: 10.1177/1359105317750254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study investigated how wheelchair-using individuals with paraplegia and chronic pain make sense of the factors associated with quality of life based on interviews using photo-elicitation and interpretative phenomenological analysis. Three superordinate themes emerged in the analysis: experiencing quality of life through the perception of self and identity, interpersonal relationships as facilitators and barriers to quality of life and life in a wheelchair: pain experience and management. Quality of life for those living with paraplegia and chronic pain is experienced as a complex interaction across several life domains. The use of photographs may improve the communication of pain-related experiences and understanding by healthcare staff.
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Mohebbi Z, Sharif F, Peyrovi H, Rakhshan M, Naini MA, Zarshenas L. Self-Perception of Iranian Patients during their life with Irritable Bowel Syndrome: A Qualitative Study. Electron Physician 2017; 9:5885-5893. [PMID: 29560138 PMCID: PMC5843412 DOI: 10.19082/5885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background Irritable bowel syndrome (IBS), as a chronic digestive disorder, impacts extensively on the quality of life, emotional well-being and self-identity. Chronic illness disrupts taken-for-granted notions about self. No qualitative study was found regarding patients’ experience of life with irritable bowel syndrome (IBS) in Iran. Objective To explore the self-perception of lived experience of IBS patients. Methods A qualitative study with hermeneutic phenomenological approach was conducted on 12 IBS patients who had been referred to three central clinics (2 governmental and 1 private) affiliated to Shiraz University of Medical Sciences. The data were collected through in-depth semi-structured interviews from July 2015 to September 2016 by purposeful sampling. Thematic analysis was carried out using Van Manen’s six-step methodological framework as a guide. In addition, MAXQDA software was used for data management. Results In this study, two main themes “the threatened self” and “deep self-knowledge”, emerged during the life of patients with IBS, indicating the meaning of self-perception of such patients. The theme of “the threatened self” consisted of two subthemes of “fear from stigmatization” and “bad sense of self”. The subthemes of “body knowledge”, “self-acceptance” and “personal growth” were related to deep self-knowledge. Conclusion The results of the present study could be applied in designing and implementation effective and holistic care of IBS patients.
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Affiliation(s)
- Zinat Mohebbi
- Ph.D. Candidate of Nursing, Faculty Member, Student Research Committee, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- Ph.D. of Psychiatric Nursing, Professor, Community Based Psychiatric Care Research Center, Shiraz Geriatric Research Center, Department of Mental Health and Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Peyrovi
- Ph.D. of Nursing, Professor, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Rakhshan
- Ph.D. of Nursing, Assistant Professor, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahvash Alizade Naini
- Gastroenterologist, Associate Professor, Gastroenterology and Hepatology Research Center, Department of Gastroenterology and Hepatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Zarshenas
- Ph.D. of Nursing, Assistant Professor, Community Based Psychiatric Care Research Center, Department of Mental Health and Psychiatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Rooney C, Hadjri K, Faith V, Rooney M, McAllister K, Craig C. Living Independently: Exploring the Experiences of Visually Impaired People Living in Age-Related and Lifetime Housing Through Qualitative Synthesis. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 11:56-71. [PMID: 29233012 DOI: 10.1177/1937586717696699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study is to gain a deeper understanding of the experiences of visually impaired older people living independently at home. BACKGROUND As populations are aging globally, there is now an increase in the prevalence of visual impairment. That means for ongoing and future aging-in-place strategies that seek to enable older people to remain independent for longer, more attention needs to be given to the needs of those with visual impairment. As people develop visual impairment, they use adaptive strategies including modifying long-term homes or relocating to more suitable accommodation. In the United Kingdom, aging-in-place strategies include employing statutory lifetime home standards (LTHS) in the home or relocating to sheltered housing to live independently with support available if required. METHODS To get a better understanding of the needs of the visually impaired in the home, 12 interviews with six visually impaired occupants of LTHS homes and six from sheltered accommodation were analyzed separately using interpretative phenomenological analysis. Secondly, qualitative synthesis was used to further analyze themes generated from both samples before interview results were conceptualized in two superordinate concepts, namely, "negotiating priorities" and "understanding visual impairment." RESULTS Participants from both groups had similar needs and were willing to compromise by living with some negative features. Those who coped well with moving utilized various resources. CONCLUSIONS These findings will shed more understanding on providing good quality housing for those with visual impairment wanting to live either independently or within healthcare home environments.
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Affiliation(s)
- Clíona Rooney
- 1 School of Planning Architecture and Civil Engineering, Queen's University Belfast, Belfast, UK.,2 Current address: Maynooth University Social Science Institute (MUSSI), Maynooth University, Kildare, Ireland
| | - Karim Hadjri
- 3 School of Architecture, The University of Sheffield, Sheffield, United Kingdom
| | - Verity Faith
- 4 School of Natural and Built Environment, Queen's University Belfast, Belfast, United Kingdom
| | - Máirin Rooney
- 5 Department of Education, St. Angela's College Sligo (National University of Ireland, Galway), Sligo, Ireland
| | - Keith McAllister
- 4 School of Natural and Built Environment, Queen's University Belfast, Belfast, United Kingdom
| | - Cathy Craig
- 6 School of Psychology, Queen's University Belfast, Belfast, United Kingdom
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Wand BM, Elliott RL, Sawyer AE, Spence R, Beales DJ, O'Sullivan PB, Smith AJ, Gibson W. Disrupted body-image and pregnancy-related lumbopelvic pain. A preliminary investigation. Musculoskelet Sci Pract 2017; 30:49-55. [PMID: 28531793 DOI: 10.1016/j.msksp.2017.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/24/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent investigations have suggested that disrupted body-image may contribute to the lumbopelvic pain experience. The changes in body shape and size associated with pregnancy suggest that pregnancy-related lumbopelvic pain might be a problem in which alterations in body-image are particularly relevant. OBJECTIVES To investigate if self-reported body-image is related to lumbopelvic pain status in women during pregnancy and explore the factors that might contribute to changes in body-image in women experiencing pregnancy-related lumbopelvic pain. DESIGN Cross-sectional cohort study. METHOD Forty-two women in the third trimester of pregnancy were recruited regardless of clinical status. Pain intensity and disability were measured to estimate clinical severity. The Fremantle Back Awareness Questionnaire was used to assess body-image. Participants also completed a series of questionnaires and physical tests to explore factors that might be associated with altered body-image. RESULTS The median Fremantle Back Awareness Questionnaire score for the pain free women was 1 (IQR 0-1.5) and the median score for those in pain was 3.5 (IQR 2-8). This difference was statistically significant (p = 0.005). The questionnaire score was significantly correlated with pain intensity but not with disability. Of the measured variables only pain catastrophisation was significantly associated with disrupted body-image. CONCLUSIONS Self-reported disruption of body-image was significantly greater in pregnant women who were experiencing lumbopelvic pain than those who weren't and the extent of body-image disruption was associated with pain intensity. Only pain related catastrophisation was related to disrupted body-image.
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Affiliation(s)
- Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, Fremantle, WA, 6959, Australia.
| | - Rhianne L Elliott
- Central West Health and Rehabilitation, Urch St, Geraldton, WA, 6530, Australia
| | - Abbey E Sawyer
- Physiotherapy Department, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA, 6009, Australia
| | - Rory Spence
- RediMed Total Health Solutions, 1 Frederick Street, Belmont, WA, 6104, Australia
| | - Darren J Beales
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - Peter B O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - Anne J Smith
- School of Physiotherapy and Exercise Science, Curtin University, PO Box U1987, Perth, WA, 6845, Australia
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat St, Fremantle, WA, 6959, Australia
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Rooney C, Hadjri K, Mcallister K, Rooney M, Faith V, Craig C. Experiencing visual impairment in a lifetime home: an interpretative phenomenological inquiry. JOURNAL OF HOUSING AND THE BUILT ENVIRONMENT : HBE 2017; 33:45-67. [PMID: 29498379 PMCID: PMC5818547 DOI: 10.1007/s10901-017-9553-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 05/02/2017] [Indexed: 06/08/2023]
Abstract
Lifetime home standards (LTHS) are a set of standards aimed at making homes more accessible. Previous research, however, indicates that LTHS do not adequately meet the needs of those with sensory impairments. Now, with visual impairment set to increase globally and acknowledging the recognised link between quality of dwelling and wellbeing, this article aims to examine the experiences of visually impaired people living in lifetime homes. The objectives are to investigate existing lifetime homes and to identify whether LTHS meet occupants' needs. Qualitative semi-structured interviews were carried out with six visually impaired people living in homes designed to LTHS in Northern Ireland. Collected data was analysed using interpretative phenomenological analysis identifying three super-ordinate themes: (1) living with visual impairment; (2) design considerations and (3) coping strategies. A core theme of balance between psychological and physical needs emerged through interconnection of super-ordinate themes. Although there are benefits to living in lifetime homes, negative aspects are also apparent with occupants employing several coping strategies to overcome difficulties. Whilst residents experience negative emotions following visual impairment diagnoses, results suggest that occupants still regard their homes as key places of security and comfort in addition to then highlighting the need for greater consideration of specific individual needs within general guidelines.
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Affiliation(s)
- Clíona Rooney
- School of Planning, Architecture and Civil Engineering, Queen’s University Belfast, David Keir Building, Stranmillis Road, Belfast, UKBT9 5AG UK
- Present Address: MUSSI, Iontas Building, Maynooth University, Co. Kildare, Ireland
| | - Karim Hadjri
- Sheffield School of Architecture, The University of Sheffield, Arts Tower, Western Bank, Sheffield, S10 2TN UK
| | - Keith Mcallister
- School of Natural and Built Environment, Queen’s University Belfast, David Keir Building, Stranmillis Road, Belfast, UKBT9 5AG UK
| | - Máirín Rooney
- St. Angela’s College (National University of Ireland Galway), Lough Gill, Sligo, Ireland
| | - Verity Faith
- School of Planning, Architecture and Civil Engineering, Queen’s University Belfast, David Keir Building, Stranmillis Road, Belfast, UKBT9 5AG UK
| | - Cathy Craig
- School of Psychology, Queen’s University Belfast, David Keir Building, Stranmillis Road, Belfast, BT7 1NN UK
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Bourvis N, Vion-Dury J. Phénoménologie expérientielle de l’algie vasculaire de la face (AVF). ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lindenmeyer A, Greenfield SM, Greenfield C, Jolly K. How Do People With COPD Value Different Activities? An Adapted Meta-Ethnography of Qualitative Research. QUALITATIVE HEALTH RESEARCH 2017; 27:37-50. [PMID: 27117959 DOI: 10.1177/1049732316644430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition where activities of daily living (ADLs) may be very restricted; people with COPD need to prioritize what is important to them. We conducted a meta-ethnography to understand which ADLs are valued and why, systematically searching for articles including experiences of ADLs and organizing themes from the articles into five linked concepts: (a) caring for the body, (b) caring for the personal environment, (c) moving between spaces, (d) interacting with others, and (e) selfhood across time. In addition, we identified three key aspects of personal integrity: effectiveness, connectedness, and control. We found that ADLs were valued if they increased integrity; however, this process was also informed by gendered roles and social values. People whose sense of control depended on effectiveness often found accepting help very difficult to bear; therefore, redefining control as situational and relational may help enjoyment of activities that are possible.
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Affiliation(s)
| | | | | | - Kate Jolly
- University of Birmingham, Birmingham, United Kingdom
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Crowe M, Whitehead L, Seaton P, Jordan J, Mccall C, Maskill V, Trip H. Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs 2016; 73:1004-1016. [PMID: 27679971 DOI: 10.1111/jan.13174] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Abstract
AIM To synthesize qualitative descriptions of the experience of chronic pain across conditions. BACKGROUND Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches. DESIGN Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research (CERQual) developed by Grading of Recommendations Assessment Development and Evaluation (GRADE) working group to evaluate the strength of the evidence. DATA SOURCES PubMed and Ovid Medline from 2000-2015. REVIEW METHODS Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. RESULTS Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'. CONCLUSIONS The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions.
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Affiliation(s)
- Marie Crowe
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Philippa Seaton
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Catherine Mccall
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Virginia Maskill
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Henrietta Trip
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
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Hermann HC, Grimm A, Klapp BF, Neuhaus R, Papachristou C. Body Experience After Liver Transplantation: A Body Grid Examination. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1227736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. C. Hermann
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - A. Grimm
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - B. F. Klapp
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
| | - R. Neuhaus
- Department of General, Visceral, and Transplantation Surgery, Charité University Medicine Berlin, Germany
| | - C. Papachristou
- Clinic for Internal Medicine and Psychosomatics, Charité University Medicine Berlin, Germany
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Andermo S, Hök J, Sundberg T, Arman M. Practitioners’ use of shared concepts in anthroposophic pain rehabilitation. Disabil Rehabil 2016; 39:2413-2419. [PMID: 27737568 DOI: 10.1080/09638288.2016.1231843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Susanne Andermo
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
| | - Johanna Hök
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
| | - Tobias Sundberg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
| | - Maria Arman
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
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Roddis JK, Holloway I, Bond C, Galvin KT. Living with a long-term condition: Understanding well-being for individuals with thrombophilia or asthma. Int J Qual Stud Health Well-being 2016; 11:31530. [PMID: 27534945 PMCID: PMC4989274 DOI: 10.3402/qhw.v11.31530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/14/2022] Open
Abstract
A range of literature has explored the experience of living with a long-term condition (LTC), and frequently treats such experiences and conditions as problematic. In contrast, other research has demonstrated that it may be possible to adapt and achieve well-being, even when living with such a condition. This tends to focus on meaning and the qualitative experience of living with an LTC, and offers alternative perspectives, often of the same or similar conditions. As a result of these conflicting views, this study chose to consider two conditions which, though they may lead to life-threatening illness on occasion, do not appear to impact significantly the lives of all those affected on a daily basis. The aim of this research was to explore and explain how people make sense of two long-term, potentially life-threatening health conditions, namely, thrombophilia and asthma. In doing so, it specifically considered the contribution made by information about the condition. A constructivist grounded theory approach was adopted; this enabled the generation of a theory regarding how people make sense of their LTC, whilst acknowledging the social circumstances in which this was situated. Semi-structured interviews were conducted with 16 participants who had given consent to take part in the research. The findings demonstrate that participants undergo a two-stage process—gaining knowledge and living with a long-term condition. The theory based on these findings indicates that those who are knowledgeable about their condition, making informed decisions in relation to it, and accept their condition are able to live with it, whilst those who do not accept their condition do not fully adapt to it or integrate it into their lives.
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Affiliation(s)
- Jennifer K Roddis
- Faculty of Health and Social Sciences at Bournemouth University, Bournemouth, UK;
| | - Immy Holloway
- Faculty of Health and Social Sciences at Bournemouth University, Bournemouth, UK
| | - Carol Bond
- Faculty of Health and Social Sciences at Bournemouth University, Bournemouth, UK
| | - Kathleen T Galvin
- College of Life, Health and Physical Sciences, University of Brighton, UK
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Calsius J, De Bie J, Hertogen R, Meesen R. 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. Front Psychol 2016; 7:253. [PMID: 26973560 PMCID: PMC4770185 DOI: 10.3389/fpsyg.2016.00253] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Joeri Calsius
- Rehabilitation Research Center - Biomedical Research Center, Faculty of Medicine and Life Sciences, University of Hasselt Hasselt, Belgium
| | - Jozef De Bie
- Department of Psychiatry, Ziekenhuis Oost-Limburg Genk, Belgium
| | | | - Raf Meesen
- Rehabilitation Research Center - Biomedical Research Center, Faculty of Medicine and Life Sciences, University of Hasselt Hasselt, Belgium
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Moorley C, Cahill S, Corcoran N. Stroke among African-Caribbean women: lay beliefs of risks and causes. J Clin Nurs 2016; 25:403-11. [DOI: 10.1111/jocn.13061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Calvin Moorley
- School of Health & Social Care; London South Bank University; London UK
| | - Sharon Cahill
- School of Psychology; University of East London; London UK
| | - Nova Corcoran
- School of Life Sciences and Education; University of South Wales; Cardiff UK
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Bailly F, Foltz V, Rozenberg S, Fautrel B, Gossec L. The impact of chronic low back pain is partly related to loss of social role: A qualitative study. Joint Bone Spine 2015; 82:437-41. [DOI: 10.1016/j.jbspin.2015.02.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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Biguet G, Nilsson Wikmar L, Bullington J, Flink B, Löfgren M. Meanings of "acceptance" for patients with long-term pain when starting rehabilitation. Disabil Rehabil 2015; 38:1257-67. [PMID: 26305503 DOI: 10.3109/09638288.2015.1076529] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Gabriele Biguet
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Lena Nilsson Wikmar
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Jennifer Bullington
- b Department of Health Care Sciences, Ersta Sköndal University College , Stockholm , Sweden , and
| | - Berit Flink
- a Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Karolinska Institutet , Stockholm , Sweden
| | - Monika Löfgren
- c Department of Clinical Sciences , Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden
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Ojala T, Häkkinen A, Karppinen J, Sipilä K, Suutama T, Piirainen A. Revising the negative meaning of chronic pain - A phenomenological study. Chronic Illn 2015; 11:156-67. [PMID: 25330917 DOI: 10.1177/1742395314555236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Tapio Ojala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Jaro Karppinen
- Medical Research Center, Oulu, Finland Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland Oral and Maxillofacial Department, Kuopio University Hospital, Kuopio, Finland Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu, Oulu, Finland Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland
| | - Timo Suutama
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Piirainen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Turner-Cobb JM, Michalaki M, Osborn M. Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report. Psychol Health 2015; 30:495-501. [DOI: 10.1080/08870446.2014.991735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Although unseen, chronic pain is real-A phenomenological study. Scand J Pain 2015; 6:33-40. [PMID: 29911591 DOI: 10.1016/j.sjpain.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/28/2014] [Indexed: 11/22/2022]
Abstract
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.
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Living with difference: exploring the social self of adolescents with chronic pain. Pain Res Manag 2014; 18:e115-23. [PMID: 24308027 DOI: 10.1155/2013/120632] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic pain negatively affects an adolescent's life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent's sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support. OBJECTIVES To better understand the challenges adolescents with chronic pain face with regard to their friendships. METHODS An interpretative phenomenological study using individual interviews was conducted. RESULTS Two themes emerged. 'Rethinking the self with pain' describes the intrusive nature of chronic pain, challenging the participants to rethink the way they view themselves and their place within their social network. 'Rethinking friendships' describes the interpretation of their friends' reactions to their chronic pain condition, which led to these adolescents spending more time by themselves, and feeling misunderstood and unsupported. CONCLUSIONS The impact of chronic pain on the adolescent as an individual as well as the responses of close friends and others within their social network resulted in the development of new friendship needs. However, the adolescents were not always able to secure these new friendship needs. Their experiences suggest factors within friendships that may be ameliorated by interventions, thus maintaining and strengthening their close friendships.
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Edwards I, Jones M, Thacker M, Swisher LL. The Moral Experience of the Patient with Chronic Pain: Bridging the Gap Between First and Third Person Ethics. PAIN MEDICINE 2014; 15:364-78. [DOI: 10.1111/pme.12306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, Fossum C, Underwood M. A systematic review and meta-synthesis of the impact of low back pain on people's lives. BMC Musculoskelet Disord 2014; 15:50. [PMID: 24559519 PMCID: PMC3932512 DOI: 10.1186/1471-2474-15-50] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background Low back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people’s lives. Methods Two reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people’s experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach. Results We included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly. Conclusions The social component of the biopsychosocial model is not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients’ experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.
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Affiliation(s)
- Robert Froud
- Warwick Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK.
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Gibbins J, Bhatia R, Forbes K, Reid CM. What do patients with advanced incurable cancer want from the management of their pain? A qualitative study. Palliat Med 2014; 28:71-8. [PMID: 23670721 DOI: 10.1177/0269216313486310] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain is one of the most frequent symptoms among patients with metastatic cancer, yet little is known about what patients with advanced cancer want from the management of their pain. Measuring the effectiveness of the management of pain is challenging as it is a subjective phenomenon and a multifaceted process. Determining how we currently define whether a patient with pain due to advanced cancer has controlled pain (or not) is important, particularly from the patient's perspective. AIM To explore how patients with advanced cancer describe the control of pain and what they want from management of this pain. DESIGN Qualitative study using face-to-face interviews. Data were analysed using a constant comparison approach. SETTING/PARTICIPANTS Purposive sample of patients with advanced cancer known to palliative care services. RESULTS Twelve interviews took place until saturation of data was achieved. Four themes emerged: maintaining role, self and independence; compromising/modifying expectations; role of healthcare professionals; and meaning of pain in context of advanced cancer. CONCLUSION Patients determined whether their pain was 'controlled' by whether or not they were able to perform activities or tasks and maintain relationships with family or friends, which determined themselves as individuals. Numerical rating scales did not appear to be useful for patients in measuring whether they are able to perform these activities or maintain a sense of control and independence. Individualised goal/task/role/activity setting for patients with advanced cancer pain may be useful to allow patients themselves to determine what they want from the 'management' of their pain.
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Affiliation(s)
- Jane Gibbins
- 1St Julia's Hospice, Cornwall Hospice Care, Hayle, Cornwall, UK
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