What does coping mean to the worker with pain-related disability? A qualitative study

Purpose: Pain coping is important in health outcomes. In the current literature, pain coping usually means those goal-directed strategies to manage pain. The study goal was to explore what personal meaning “coping” has for work-disabled individuals in pain. Method: Qualitative, in depth interviews with follow-up verification interviews were conducted with 13 volunteers who were off work and in rehabilitation for chronic pain from a musculoskeletal injury. The two main questions were: (1) How did participants understand the term “coping with pain”; and (2) how did they come to this understanding of coping. The theoretical approach was social phenomenology and data were analyzed using thematic analysis. Results: The dominant theme was that pain coping is an intrinsic and life-defining attitude and belief. This understanding primarily arose through early modeling by parents and significant others. Secondary theme was that coping is practical strategies to manage or eliminate pain. This arose through more current interactions with health care providers and others in the social network. Conclusions: Researchers’ and clinicians’ view of coping may not always match the views held by individuals with chronic pain. This might impact on the effectiveness of interventions designed to modify coping behaviors, and alternative ways of intervening may be needed.

Implications for Rehabilitation

• Coping has an important impact on health recovery after musculoskeletal injuries but interventions to modify pain coping strategies in those with chronic pain have met with modest success.

• The dominant model for coping in the research literature defines coping as a behavioral and/or cognitive response to a stressful situation.

• A qualitative study to examine what personal meaning “coping” holds for work-disabled persons with chronic pain suggests that coping is primarily conceptualized as an intrinsic and life-defining attitude/belief learned early in life.

• The above incongruence between the dominant research model of coping and the views of workers with chronic pain might impact on the effectiveness of interventions designed to modify coping behaviors for this population, and alternative ways of intervening may be needed.

     

'Nobody likes a back bore'--exploring lay perspectives of chronic pain: revealing the hidden voices of nonservice users

Chronic pain is pain that persists beyond 12 weeks or that lasts beyond the expected duration of healing. The chronic pain sufferer also often experiences associated anxiety, depression and stress. An exploratory qualitative approach was adopted by the authors to explore what it is like to live with chronic pain from a sample of people who had not accessed secondary or tertiary health services. Semi-structured interviews were undertaken utilizing a 'snowball' sample of 12 participants. The complex issues presented by living with chronic pain that face sufferers in their personal and social worlds emerged from participant narratives. Three main themes which reflected individual variation in the ways that participants' had adapted to their pain were extracted from the data: dependence and social withdrawal; being 'normal' in comparison to others; and striving for self-management. Issues of coping and control were related to the theme of self-management. By capturing the voices of a previously unheard group our findings support and extend previous research by detailing the difficulties that need to be overcome by sufferers to finally accept the persistence of their pain. Moreover, it is this acceptance of, and adaptation to their pain, that may distinguish the participants in our sample from the majority of pain sufferers who engage and re-engage with secondary and tertiary healthcare facilities.     

The Impact of Preoperative Distress: A Qualitative analysis of the Perioperative Pain Self-Management Intervention

PurposePreoperatively distressed patients are at elevated risk for chronic postsurgical pain. Active psychological interventions show promise for mitigating chronic postsurgical pain. This study describes experiences of preoperatively distressed (elevated depressive symptom, anxious symptoms, or pain catastrophizing) and non-distressed participants who participated in the psychologically based Perioperative Pain Self-management (PePS) intervention.DesignThis is a qualitative study designed to capture participants’ perspectives and feedback about their experiences during the PePS intervention.MethodsInterviews were semi-structured, conducted by telephone, audio-recorded, transcribed, and audited for accuracy. Coded interviews were analyzed using a quote matrix to discern possible qualitative differences in what preoperatively distressed and non-distressed participants found most and least helpful about the intervention.ResultsTwenty-one participants completed interviews, 7 of whom were classified as distressed. Distressed participants identified learning how to reframe their pain as the most helpful part of the intervention. Non-distressed participants focused on the benefit of relaxation skill-building to manage post-surgical pain. Distressed and non-distressed participants both emphasized the importance of the social support aspects of PePS and- identified goal-setting as challenging.ConclusionsDistressed and non-distressed participants emphasized different preferences for pain management strategies offered by PePS. Most participants emphasized the importance of social support that PePS provided.Clinical ImplicationsOur results indicate that post-operative patients may benefit from interpersonal interaction with a trained interventionist. Our findings also suggest that distressed and non-distressed patients may benefit from varied intervention approaches. How to build flexibility into a manualized intervention or whether these subsets of patients would benefit more from different interventions is a direction for future research.     

Staying active despite pain: Pain beliefs and experiences with activity‐related pain in patients with chronic musculoskeletal pain

Scand J Caring Sci; 2011; 25; 108–116
Staying active despite pain: Pain beliefs and experiences with activity‐related pain in patients with chronic musculoskeletal pain Objective: Maintain a level of activity and exercise is advice often given to patients with chronic musculoskeletal pain, but many patients find physical activity painful and consequently hesitate to move. Disability seems to be associated with fear of pain and there is a need to enhance our understanding of patients’ beliefs and attitudes about how fear of pain affects physical activity and why some people are active despite their pain. The aim of this research was to understand thoughts and experiences about pain related to activity in patients with musculoskeletal disorders; the situations that promoted pain and if and how fear was expressed. Methods: Five women and five men, recruited from a larger survey on fear, pain and physical activity were interviewed. The interviews were analysed by qualitative methods for themes about participants’ pain and beliefs about pain. Results: By interpreting signals from the body, patients calculated and planned their daily life to stay active despite pain and participate in their social lives. Pain was a signal with diverse meanings which, with the influence of time, seemed to change from a sign of danger to a reminder to moderate their level of activity. By experimenting with different activities, patients learned how to gradually remain or become physically active. Conclusion: Patients strived to stay active despite pain. The interpretation of pain changed over time, from a threatening signal to a signal with diverse meanings. Practice implications: The findings provide insights that may improve the educational rehabilitation of patients with musculoskeletal pain.     

Patients’ experiences and actions when describing pain after surgery – A critical incident technique analysis

BackgroundPostoperative pain assessment remains a significant problem in clinical care despite patients wanting to describe their pain and be treated as unique individuals. Deeper knowledge about variations in patients’ experiences and actions could help healthcare professionals to improve pain management and could increase patients’ participation in pain assessments.ObjectiveThe aim of this study was, through an examination of critical incidents, to describe patients’ experiences and actions when needing to describe pain after surgery.MethodsAn explorative design involving the critical incident technique was used. Patients from one university and three county hospitals in both urban and rural areas were included. To ensure variation of patients a strategic sampling was made according to age, gender, education and surgery. A total of 25 patients who had undergone orthopaedic or general surgery was asked to participate in an interview, of whom three declined.FindingsPain experiences were described according to two main areas: “Patients’ resources when in need of pain assessment” and “Ward resources for performing pain assessments”. Patients were affected by their expectations and tolerance for pain. Ability to describe pain could be limited by a fear of coming into conflict with healthcare professionals or being perceived as whining. Furthermore, attitudes from healthcare professionals and their lack of adherence to procedures affected patients’ ability to describe pain. Two main areas regarding actions emerged: “Patients used active strategies when needing to describe pain” and “Patients used passive strategies when needing to describe pain”.Patients informed healthcare professionals about their pain and asked questions in order to make decisions about their pain situation. Selfcare was performed by distraction and avoiding pain or treating pain by themselves, while others were passive and endured pain or refrained from contact with healthcare professionals due to healthcare professionals’ large work load.     

Patient-Experienced Quality During Postoperative Pain Management - A Phenomenological-Hermeneutic Study

PurposeThe aim of this study was to describe an in-depth understanding of patients’ experiences and perspectives after use of the erector spinae plane block (ESP) in patients undergoing laparoscopic hemicolectomy due to malignant disease. Knowledge gained throughout the study aimed to ensure increased patient-experienced quality, patient safety and adequate post-surgery pain treatment.DesignA qualitative approach based on a phenomenological-hermeneutic framework inspired by Paul Ricoeur's perspectives was used.MethodsThe empirical material consisted of 11 semi-structured individual interviews with patients, who underwent laparoscopic hemicolectomy and received an ESP block as postoperative pain treatment.FindingsFour themes emerged during the analysis and represent the findings: (1)"The significance of the pain for everyday life", in which everyday life and social relations emerged as fundamental for patients' experience of pain and pain management; (2) "Joy and anxiety - two opposites" showed experiences of conflicting feelings causing uncertainty and insecurity (3); The theme "Painlessness - or not?" showed experiences of satisfaction with the ESP block and how patients considered the time perspective of having pain as an element of further insecurity; (4)"Losing control over one's own life" demonstrated how patients tried regaining control over their own lives during pain and after surgery.ConclusionsThe findings indicate that the majority of patients were happy with the ESP block because among other things, it reduced the need for rescue medicine including side-effects. Because of an acceptable pain intensity, patients paid more attention to other factors associated with their surgical intervention. Adequate pain management was described as of great importance for their experience of well-being and increased quality of life.     

Barriers to Effective Pain Management in Cancer Patients From the Perspective of Patients and Family Caregivers: A Qualitative Study

BackgroundPain is one of the most common and undesired symptoms in cancer patients, affecting patients’ physical and psychological well-being. Barriers to effective pain management in cancer patients need to be identified and addressed by clinicians.AimsThe purpose of this study was to explore the barriers to effective cancer pain management from the perspective of cancer patients and their family members.MethodsA qualitative research design was employed. Semistructured interviews were conducted with 10 patients and 10 family caregivers to elucidate their perspectives regarding the barriers to effective cancer pain management in Jordan.ResultsRegulatory factors, knowledge deficit, and the use of religious and cultural strategies to cope with pain were major barriers to effective cancer pain management. Although effective cancer pain management is highly recommended, the participants’ cultural beliefs deeply appreciated pain tolerance and discouraged effective treatment of cancer pain.ConclusionTailoring culturally appropriate educational programs regarding effective cancer pain management could facilitate pain management among patients with cancer.     

A qualitative investigation of factors that matter to individuals in the pain management process

Objective: Chronic musculoskeletal pain is a complex condition to manage with widespread consequences including physical disability, psychosocial effects and increased use of healthcare. Previous research has found patients’ experiences within health care can be influenced by factors such as expectations, therapist characteristics and treatment process. This study used patient interviews to identify the key factors that influence individuals’ experiences in the management of chronic pain.

Design: Qualitative study using semi-structured interviews in either a home or hospital setting.

Methods: Semi-structured interviews were conducted on eight participants attending hospital-based pain management. Participants were asked about their experiences of pain management and living with a chronic pain condition. Interviews were transcribed and analysed thematically.

Results: Three main themes were identified; impact of their condition on daily life, clinical interactions and the pain management process. Understanding the condition was a key factor for the patients, in particular, explanation by the clinician. The temporality of their pain meant timing of appointments was critical. Patients reported factors such as family days and follow-up sessions would improve their treatment experience.

Conclusions: This study highlighted important factors for healthcare professionals and patients in the management of chronic pain. Participants indicated a desire to understand their condition and learn strategies for self-management to allow them to cope better. As patients found benefit from being involved in the management process, discussions around the options for treatment may enhance management and rehabilitation. It is important we continue to research factors important to individuals with musculoskeletal pain to find an effective, evidence-based framework for understanding and managing this condition.

• Implications for rehabilitation

• This study highlights the importance to patients of being given information to help them understand their pain condition and to learn strategies for self-management to cope better.

• Where information was not provided and inadequate time allowed for questioning and discussion, patients tended to desire more frequent access to the care services. More effective communication may result in reduced demand and more efficient management.

• Patients suggested that ongoing peer support may offer an alternative to clinician-led services.

     

Physiotherapists’ experiences of activity pacing with people with chronic musculoskeletal pain: an interpretative phenomenological analysis

Abstract

Purpose: Activity pacing is a strategy used by physiotherapists treating people with chronic pain. Questions as to the usefulness of activity pacing with people with chronic pain have been raised clinically and in research. This study explores physiotherapists’ experiences of using activity pacing with people with chronic musculoskeletal pain. Method: We interviewed six physiotherapists and used the methods of Interpretative Phenomenological Analysis (IPA) to explore the meaning of pacing. Results: We identified three master themes. First, activity pacing was perceived as part of a process whereby patients came to realize that change is possible, and that life could be different. Second, in order to use activity pacing effectively the physiotherapist needs to shift from a “fix it” to a “sit with” approach to the treatment. Third physiotherapists described how they used many combined therapeutic approaches in managing chronic pain. Conclusions: This study increases our understanding of activity pacing and will help to make the best use of activity pacing in clinical practice, and optimize outcomes for the patients. These findings suggest that physiotherapists need to develop reflective listening skills, and use an experiential learning approach to facilitate activity pacing.     

A case of mistaken identity? The role of injury representations in chronic musculoskeletal pain

Abstract

Purpose: To explore how patients construe bodily injury, examine how injury representations change over the course of a rehabilitation program and how injury representations influence adaptation and recovery trajectories.

Methods: A case study method was used with qualitative interviews as the primary data source. Qualitative semi-structured interviews were conducted three times over the course of a 12-week intensive interdisciplinary occupational rehabilitation program with one interview 1 month following discharge. To capture changes in rehabilitation trajectories, data analysis employed a narrative approach informed by Bury (progression, regression, and stability) and Frank’s (chaos, restitution, and quest) approaches.

Results: Sixteen patients (10 men and 6 women) were disabled as a result of persistent pain and impairment from a variety of work injuries participated. Progression/restitution narratives were characterized by the transformation of bone and nerve problems to include soft tissue elements. These participants expanded their scope of injury representations and appraisal to include neurobiological aspects of chronic pain and dimensions of psychosocial well-being, and linked diagnostic representations to self-management strategies in a functional manner.

Conclusion: Body representations of injury morphology and pain mechanisms are important objects of fear and acceptance for injury recovery. Active strategies that encourage a “hands on” understanding of diagnosis may prove most effective in treating persistent pain.

• Implications for Rehabilitation

• Patient representations of pain and body injury are windows into the personal experience of individuals with chronic musculoskeletal pain.

• When patients enter programs, practitioners need to assess what the patient believes is wrong with their body and what will be helpful in rectifying the problem.

• Based on their initial assessment, practitioners need to direct education and activity toward shifting patient beliefs to include elements of soft tissue and a broader scope of pain sensitization and psychological impact. Activity-based intervention is essential for creating coherence between injury and pain representations and coping action.

• During rehabilitation, practitioners need to monitor patient beliefs about their injury. Shifting beliefs are signs that the patient is adopting a more adaptive cognitive stance toward their injury. Lack of movement indicates that the message is not getting through and the approach needs to be modified.

• When working with patients to transform beliefs, a collaborative approach might be best to increase trust and reduce reactance.

     

Pain Experiences and Coping Strategies in Rural Older Adults With Chronic Musculoskeletal Pain in Mountainous Areas of Taiwan

BackgroundAlthough rural communities are home to a higher proportion of older residents, they provide fewer healthcare services than do urban core communities. Chronic musculoskeletal (MSK) pain is often associated with reduced daily activity and quality of life in older adults, particularly those in rural areas.AimsThis study investigated the pain experiences and coping strategies in rural older adults with MSK pain in Taiwan.MethodsA structured questionnaire was used to collect data from rural older adults with chronic MSK pain in mountainous areas of Taiwan.ResultsIn total, 55 rural older adults were enrolled in this study. The most common pain sites were the low back and knees. The main cause of pain was osteoarthritis. Three quarters of the participants suffered from moderate to severe chronic MSK pain on average. The results revealed that behavioral strategies were used more often than cognitive strategies. Regarding behavioral strategies, the most common non-pharmacologic and pharmacologic pain coping strategies were to rest and to take Chinese medicine, respectively. The most common cognitive strategy for pain coping was to talk to others.ConclusionsThe findings suggested that pain management for chronic MSK pain in rural older adults was inadequate in mountainous areas of Taiwan. Most rural older adults used multiple coping strategies to deal with their pain, and behavioral strategies were favored over cognitive strategies.     

A lonely life—A qualitative study of immigrant women on long-term sick leave in Norway

BackgroundThis study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants’ special needs.ObjectiveThe objective of the study was to explore how immigrant women on long-term sick leave in Norway due to chronic pain experience their illness and their relationships at work and in the family.DesignThis article has a qualitative design, using participant observation and in-depth interviews.MethodsParticipant observations were carried out in an outpatient clinic and qualitative interviews were conducted after the rehabilitation period. A hermeneutic approach was used to understand the meaning of the narrated text. All the authors participated in the discussion of the findings, and consensus was obtained for each identified theme.SettingsThe research was conducted at an outpatient clinic at a rehabilitation hospital in the southern part of Norway. The clinic offers wide-ranging, specialized, multidisciplinary patient evaluations that last between 24 and 48 h, followed by advice and/or treatment either individually or in a group, i.e. in a rehabilitation course.ParticipantsParticipants (immigrant women) who had been referred to the outpatient clinic and to a rehabilitation course were recruited. Fourteen African and Asian women were observed in two rehabilitation courses, and eleven of them agreed to be interviewed once or twice (3).ResultsThe interpretation revealed the following two main themes: ‘Shut inside the home’ and ‘Rejected at the workplace’. Based on the women's experiences, a new understanding emerged of how being excluded or not feeling sufficiently needed, wanted or valued by colleagues, employers or even by family members rendered their daily lives humiliating and lonely.ConclusionsThe immigrant women on long-term sick leave live in triple jeopardy: being ill and being lonesome both at home and at the workplace. This can be described as a vicious circle where the humiliating domestic and workplace-rejection might reinforce both the women's experience of shame and avoidance of telling anybody about their illness/symptoms, which then results in more days on sick leave during which they are again isolated and lonesome. There is a need for more research on multidisciplinary rehabilitation approaches designed to cater for immigrants’ special needs.     

Chronic pain affects the whole person – a phenomenological study

Abstract

Purpose: The aim of this qualitative study was to explore participants’ perspectives on the effects of chronic pain on the psychophysical unity. Methods: Thirty-four chronic pain outpatients were interviewed, and the transcribed interviews were analysed with Giorgi’s four-phase phenomenological method. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the pain duration was more than 5 years, and most had degenerative spinal pain. Results: The results of this whole research project indicated that the phenomenon chronic pain consisted of four essential themes: Pain affects the whole person, invisibility, negativity, and dominance of pain. This study concentrates only on one theme “Chronic pain affects the whole person”, in which were found eight subthemes in the interviews. The strongest argument made by the participants was not the physical pain itself but the psychosocial consequences, such as distress, loneliness, lost identity, and low quality of life which were their main problems. Conclusions: In multidisciplinary holistic rehabilitation, it is essential to take care of the patient’s psychological distress. A potential source of psychosocial symptoms may be the subjective responses to experience of chronic pain due to the subjective meanings of pain.

• Implications for Rehabilitation

• About chronic pain

• Pain is an experience, not only an aversive sensation. Intensity of pain describes only the sensation, not the experience of pain.

• In chronic pain, the main complaint may be not the physical pain, but the distress. In rehabilitation, the patient needs to be taken as a whole person.

• Multidisciplinary rehabilitation, including patient counselling should be the fundamental part of treatment.

• In rehabilitation, the individual meaning of chronic pain needs to be disclosed.

     

Leveraging Parent Pain Perspectives to Improve Pain Practices for Children with Medical Complexity

PurposeChildren with medical complexity (MC) must rely on others to notice and address pain. Parents are aware of child pain behaviors and can serve as reliable proxy reporters. Thus, there is a critical need to understand parent perspectives to improve pain practices.DesignIndividual interviews were used as a data collection method in this qualitative study.MethodsParticipants were recruited via mail and social media postings. Interviews were audio-recorded and transcribed verbatim. Transcribed documents were imported to NVIVO for qualitative analysis. Conventional and directed approaches to qualitative content analysis were used.ResultsFrom the data analysis, major themes included: pain experiences, confidence in caregivers, parents are partners, proactive communication, and a spontaneous theme, “they can hear us.” Emotional pain and challenges identifying the source pain were identified as sub-themes of pain experiences.ConclusionsParents in this study shared methods helpful to identifying pain in their children, as well as suggestions for discussing pain with caregivers. Priorities for future research include identifying methods for sharing pain information that are thorough, but do not burden parents or providers. Researchers should also determine how parents and caregivers can partner to identify and address pain in children with MC. Going forward, conversations about pain should be a key part of any admission assessment or first encounter. As pain episodes among children with MC can be complex and may not always be re-created in front of a provider, nurses may advise parents to take photos or videos to share with caregivers.     

Conquering the great divide: Rural mothers of children with chronic health conditions accessing specialist medical care for their children

BackgroundGlobally, the number of children with chronic health conditions (CHCs) is increasing and mothers are mostly responsible for their care.AimFew studies have focused on rural mothers and their experiences of sourcing health care for their children who have CHCs. The purpose of this study was to explore these experiences.MethodUsing a phenomenological approach, semi-structured interviews were conducted in early 2018. The Consolidated criteria for Reporting Qualitative research (COREQ) guidelines were followed. Sixteen rural mothers were interviewed regarding their experiences of accessing health care to provide optimal management of their children’s CHC.FindingsThematic analysis of resulting data revealed the overarching theme ‘Conquering the great divide’. From this overarching theme, four themes emerged. This paper focuses on the first theme, ‘Heading to the big smoke: access’.DiscussionRural mothers felt challenged accessing health care for their children in the major cities whilst also maintaining routine family life back home.ConclusionUnderstanding these rural women’s experiences could assist health care professionals to develop strategies to facilitate rural mothers accessing services for their children with a CHC.