Chronic pain as a narratological distress: a phenomenological study

The Pain-Invalidation Scale: Measuring Patient Perceptions of Invalidation Toward Chronic Pain

Increasing evidence reveals the damaging impact of having one's chronic pain symptoms invalidated through disbelief, discrediting, and critical judgement. In other instances, a caregiver's over-attentiveness to the daily tasks of individuals with pain can be problematic, potentially undermining rehabilitation. The aim of this study was to develop an instrument to measure different aspects of invalidation perceived by people with chronic pain. Item generation was informed through literature review and a thematic analysis of narratives from 431 peer-reviewed articles. The crowdsourcing platform Prolific was used to distribute survey items to participants. In Study 1A, Principal Component Analysis was performed on data from 302 respondents, giving rise to 4 subscales, including: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Invalidation by Over-attentive Others. Confirmatory Factor Analysis of data collected from aonther 308 individuals in Study 1B supported the 4-factor model of the Pain-Invalidation Scale (Pain-IS) and identified a best-fit model with 24 items. The Pain-IS was further validated in another 300 individuals in Study 2. The Pain-IS demonstrates sound psychometric properties and may serve as a valuable tool for use by clinicians in the detection of pain-invalidation issues, as a first step in patient pain management. Perspective. Links between pain-invalidation and pain levels, as well as functional detriment, highlight the importance of having one's chronic pain experience heard, believed and accepted. The Pain-Invalidation Scale is designed to identify domains where invalidation of the patient's pain should be addressed to promote emotional processing, treatment adherence and improved outcomes.

Portrait of My Father: Frida Kahlo's Intimate Relation to Epilepsy

The painting Portrait of My Father (1951) by the Mexican painter, Frida Kahlo, is discussed by the author within the context of epilepsy and biographical events in the lives of both Frida and her father, the German Mexican photographer Guillermo Kahlo. The biographical accounts of the photographer's seizures are suggestive of juvenile absence epilepsy but cannot discount the possibility of posttraumatic epilepsy of mesial frontal origin.

Invalidation of chronic pain: a thematic analysis of pain narratives

PURPOSE

Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain.

METHOD

A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain.

FINDINGS

Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation.

CONCLUSION

Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.

Restored Self: A Phenomenological Study of Pain Relief by Cannabis

Objective

To explore the subjective experience of pain relief by cannabis.

Design

Qualitative data were collected through in-depth semistructured interviews. Interview transcripts were analyzed using interpretative phenomenological analysis (IPA).

Subjects

Nineteen patients, aged 28 to 79, who were treated with medical cannabis under the supervision of a pain clinic in Israel.

Results

Three key themes that emerged from the analysis were explored: 1) the Sigh of Relief, describing the corporal sensation of using cannabis, including a sense of relaxation and reduction in pain; 2) the Return to Normality, describing the comprehensive effect of using cannabis, including an increased ability to sleep, focus, and function; and 3) the Side Effects of using cannabis.

Conclusions

We propose the term Restored Self to conceptualize the effect of medical cannabis. Restored Self is the experience of regaining one’s sense of self, sense of normality, and sense of control over one’s life.

A Canadian Survey of Self-Management Strategies and Satisfaction with Ability to Control Pain: Comparison of Community Dwelling Adults with Neuropathic Pain versus Adults with Non-neuropathic Chronic Pain

BACKGROUND

Individuals with chronic pain with neuropathic characteristics (CPNC) describe a different pain experience compared with those with chronic pain without neuropathic characteristics (CP).

AIMS

The aim of this study was to describe and compare pain, self-management strategies, and satisfaction with ability to control pain between adults with CPNC versus CP.

PARTICIPANTS

Seven hundred and ten community-dwelling adults with chronic pain participated in a cross-sectional survey.

METHODS

CPNC was defined as a score ≥12 on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Self-management and pain control was compared between participants with CPNC and CP using frequency, percent, relative risk (RR), odds ratios (ORs), and 95% confidence intervals (CIs).

RESULTS

Participants with CPNC (188/710) reported lower socioeconomic status, poorer general health, and more intense, frequent, and widespread pain. They were more likely to use prescription medications to manage pain (adjusted OR = 2.25, CI = 1.47-3.42). They were more likely to use potentially negative strategies to ease the emotional burden of living with chronic pain, including substance use (adjusted OR = 1.58, CI = 1.06-2.35), denial (adjusted OR = 2.21, CI = 1.49-3.28), and behavioral disengagement (adjusted OR = 1.68, CI = 1.16-2.45), and they were more likely to be completely dissatisfied with their ability to control pain (RR = 1.77, CI = 1.21-2.58).

CONCLUSIONS

Individuals with CPNC have distinct pain and self-management experiences compared with those with CP that may lead to negative coping strategies and dissatisfaction with ability to control pain. Therefore, self-management assessment and support should be tailored by pain condition.

Qualitative meta-synthesis: the experience of chronic pain across conditions

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.

The role of the Internet for people with chronic pain: examples from the DIPEx International Project

In this article we consider how people with chronic illness are using the internet, drawing on examples from published qualitative interview studies of experiences of chronic pain in the UK, Germany and Israel. Extracts from the interviews can be seen on the websites from the www.dipexinternational.org collaboration which publishes analyses and many thousands of video and audio interview clips on country specific web platforms. The UK branch of the collaboration has been operating for over a decade and currently includes broad based samples of qualitative interviews with patients about their experiences of over 80 health problems. The research has demonstrated that people living with chronic pain are increasingly using the web to find information, support and practical advice for self-management and also for reassurance, encouragement, to compare experiences of treatment and to offer advice and support to others. The internet is changing the way that people are experiencing illness, although access to relevant and reliable online material is not equally distributed. Those who do not speak one of the handful of dominant languages are less likely to find online experiences that resonate with their own.