Experiences of a non-clinical set of adolescents and young adults living with persistent pain: a qualitative metasynthesis

Coping in youth living with chronic pain: A systematic review of qualitative evidence

Background

Chronic pain is progressively receiving attention as a universal public health priority. It is anticipated that there will be an increase in the prevalence of chronic pain in the coming years, particularly among youth. Chronic pain can be stressful and have a significant impact on young people and their family.

Aims

The aim of this systematic review was to synthesize the best available qualitative evidence on the coping experiences of youth living with chronic pain and to note whether there were any differences in their coping experiences.

Methods

A multi-database search was conducted including child development and adolescent studies. CINAHL, MEDLINE, PsycINFO, Embase, and Scopus were searched for eligible English-language articles from inception to December 2023. Out of 1625 article titles and abstracts screened for eligibility, 280 articles underwent full-text screening, with 20 ultimately meeting all inclusion criteria. We conducted a thematic analysis of data extracted from the 20 reviewed articles.

Results

We arrived at two synthesized findings. A Different Way of Being considers the experience of being a youth with chronic pain. Learning to Get By looks at the coping strategies youth use to manage their chronic pain and involved youth using self-directed strategies, as well as relying on external supports.

Conclusions

It is apparent from these synthesized findings that youths' lives have been significantly impacted by chronic pain. Findings from this study can be used to support the care and well-being of youth living with chronic pain.

Exploring the emotional impact of pain on children and adolescents: A poetic meta-ethnography

Pain in early life can go unreported and untreated. We use poems to portray findings from a systematic review of qualitative research. The overall aim of the review was to distil essential experiences across pain conditions and contexts. This report, focusing on the emotional impact of pain, is one of a series of three analyses from one systematic review of qualitative research. We used meta-ethnography to synthesise research. We identified studies in English that explored acute and/or chronic child and/or adolescent pain experience. Findings were distilled into themes and poems co-created in English and Spanish. We included 189 reports (177 unique studies) incorporating 5875 people (at least 3484 reported as female). Most studies (93%) included participants aged 11-20 years (range 2-38). The studies explored acute (24% studies), chronic (75%), and acute/chronic (1%). We report seven themes: (1) Pain can be hard to bear; (2) Pain is scary; (3) Pain is constantly at the back of my mind: (4) Pain makes me feel like I am outside alone; (5) Pain makes school a hard fit; (6) Pain can hurt me deep inside; (7) Pain has changed me. Our themes highlight the emotional impact of pain across conditions and contexts. Art and science are both integral to leaps in understanding. The contribution of the Arts is their unique ability to reach audiences on an affective level, giving the potential to underpin compassionate care and policy. We invite readers to utilise these poems to start a conversation about young people's pain experiences. This systematic review was registered on the PROSPERO database (CRD42023429027). Ethical permissions are not required for an evidence synthesis. PERSPECTIVE: The voices of young people in pain are not always heard. This article presents themes, in poetic form, from a synthesis of 189 qualitative studies. Science and art are integral to leaps in understanding and inclusive arts-based research methods have the potential to underpin compassionate pain care for young people.

The presentation of self in everyday young lives with pain: a poetic meta-ethnography

BACKGROUND

Access to pain relief is a fundamental human right, yet child and adolescent pain can remain unheard and untreated . We aimed to understand and testify to young people's pain experiences.

METHODS

This is the first systematic review of qualitative research to present findings as poetry. We followed stages of meta-ethnography, using verbatim poetry to express the findings.

RESULTS

We included 189 studies incorporating 5875 young people with pain across a range of conditions and contexts. Our findings highlight the ambiguity of pain . This ambiguity is exacerbated by unpredictability, absence of diagnosis, and a tangle of bio-psycho-social factors.

CONCLUSIONS

Verbatim poetry can help us to imagine what it is like to live in someone else' shoes. Poetry can therefore contribute to compassionate and high-quality care. Future research might explore the role of poetry inmore inclusive research.

Understanding what it is like to experience pain as you grow up: a poetic meta-ethnography

ABSTRACT

A recent Lancet Commission raised concerns about the management of child and adolescent pain. We aimed to undertake a comprehensive review of qualitative research to understand children and adolescent pain experiences across contexts. We used the 7 stages of meta-ethnography to synthesise findings. We combined the strengths of arts-based methods, translating themes into poems in a range of languages. We screened 7471 titles, 464 abstracts, and 302 full texts, including 189 reports (177 unique samples) incorporating 5875 young people. Age range across studies was 2 to 38 years, with 93% including those between the age of 11 and 20 years old. Studies spanned 30 years (1993-2023) with 121 (64%) published in the last 10 years. Almost all (93%) were set-in high-income countries. We report 6 themes focusing on transition to adulthood: (1) I want to stay within the safety of home; (2) don't exclude me from my own care; (3) it might hurt but it's for my own good; (4) I rely on others but I want some independence; (5) I am no longer a child but I am not an adult yet; and (6) I wasn't prepared for the transfer to adult health care. Our findings focus on the complex transition into adulthood and the importance of creating a genuine healthcare partnership with young people by acknowledging their perspectives, creating a safe and supportive environment, and preparing them for the transition to adult pain care. Arts-based methods have the potential to make findings from qualitative evidence syntheses accessible and impactful for compassionate health care.

A breathing space: how young Norwegian women engaging psychomotor physiotherapy to address long-term health disorders narrate their experiences

INTRODUCTION

In Norway, as elsewhere, young people may experience psychological distress and long-lasting pain. Such health disorders can be complex, leading some young people to seek psychomotor physiotherapy treatment. Thus far, however, there has been little qualitative investigation of their experiences.

OBJECTIVE

The purpose of this study was to gain new knowledge about the illness experiences of young people with long-term health disorders engaging psychomotor physiotherapy.

METHOD

Qualitative interviews with ten Norwegian women aged 16-24 in psychomotor physiotherapy were analyzed within a narrative framework.

FINDINGS

The participants' treatment experiences take place in the context of a long history of pain, distress, and lack of understanding and support. Their stories tell of being threatened by illness and other difficult life events, and of being placed under further stress by a prolonged and disruptive quest for help within the healthcare system. For participants, psychomotor physiotherapy represents a breathing space where their illness experiences are acknowledged, enabling them to find rest and explore their bodily reactions and habits.

CONCLUSION

Long-term health disorders represent significant disruptions to the daily lives and relationships of young women. It is important to acknowledge the illness experiences of these young women and establish trustful therapeutic relationships. Psychomotor physiotherapy may offer significant potential as a means to help young people explore and make sense of their illness experiences.

How do we explain painful non-traumatic knee conditions to adolescents? A multiple-method study to develop credible explanations

BACKGROUND

Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand "what's wrong with me". Our aim is to develop credible explanations about the condition for adolescents suffering from non-traumatic knee pain.

METHODS

This multiple-method study integrated findings from two systematic literature searches of qualitative and quantitative studies, an Argumentative Delphi with international experts (n = 16) and think-aloud interviews with adolescents (n = 16). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents' needs; we analysed feedback using thematic analysis. The explanations were tailored based on the adolescent end-users' input.

RESULTS

We screened 3239 titles/abstracts and included 16 papers exploring diagnostic uncertainty from adolescents' and parents' perspectives. Five themes were generated: (1) understanding causes and contributors to the pain experience, (2) feeling stigmatized for having an invisible condition, (3) having a name for pain, (4) controllability of pain, and (5) worried about something being missed. The Argumentative Delphi identified the following themes: (1) multidimensional perspective, (2) tailored to adolescents, (3) validation and reassurance, and (4) careful wording. Merging findings from the systematic search and the Delphi developed three essential domains to address in credible explanations: "What is non-traumatic knee pain and what does it mean?", "What is causing my knee pain?" and "How do I manage my knee pain?"

CONCLUSIONS

Six credible explanations for the six most common diagnoses of non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain.

SIGNIFICANCE

This study provides credible explanations for the six most common diagnoses of non-traumatic knee pain. Additionally, we identified three key domains that may need to be addressed to reduce diagnostic uncertainty in adolescents suffering from pain complaints. Based on our findings, we believe that clinicians will benefit from exploring adolescents' own perceptions of why they experience pain and perceived management strategies, as this information might capture important clinical information when managing these young individuals.

Quality of life in adolescents with longstanding non-traumatic knee pain: An analysis of 316 adolescents with Patellofemoral Pain and Osgood-Schlatter Disease

OBJECTIVES

To describe the Quality of Life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) and investigate characteristics associated with QoL.

STUDY DESIGN

Cross-sectional.

PARTICIPANTS

316 adolescents with PFP or OSD.

MAIN OUTCOME MEASURES

QoL subscale of The Knee injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol 5-dimensions (EQ-5D).

RESULTS

The KOOS-QoL was 51 ± 18, and the total index score for the EQ5D was 0.67 ± 0.21. KOOS-QoL subscale showed that 60% reported being aware of their knee problems daily or constantly, 38% reported severe to extreme lack of confidence in their knees, 28% reported severe to extreme difficulty with their knees, and 20% reported severely or totally modifying their lifestyle to avoid potentially damaging activities to their knee. EQ-5D showed that 79% experienced problems with everyday activities, 48% reported mobility problems, 17% felt worried, sad, or unhappy, and 7% reported problems looking after themselves.

CONCLUSIONS

Many adolescents with longstanding non-traumatic knee pain experience low QoL. More than half were aware of their knee problems at least daily, one in three reported a severe lack of confidence in their knee, and one in six felt worried, sad, or unhappy.