Living well with chronic pain: a classical grounded theory

Journal Biomedical and Biopharmaceutical Research, 2013

Chronic pain (CP) is a complex phenomenon that affects the lives of individuals at the level of well-being, family relationships and social and professional life, causing biological and psychosocial changes, and in most cases, suffering. CP is associated with physical, professional and social limitations, and compromises quality of life (QOL) provoking insecurity which results in considerable social and material losses. In this context a multidimensional pain assessment is fundamental in order to find a swift and appropriate response to the needs of each individual. The evaluation should take into account psychological and social factors in addition to physical factors. pain (CP) is a complex phenomenon that affects the lives of individuals at the level of well-being, family relationships and social and professional life, causing biological and psychosocial changes, and in most cases, suffering. CP is associated with physical, professional and social limitations, and compromises quality of life (QOL) provoking insecurity which results in considerable social and material losses. In this context a multidimensional pain assessment is fundamental in order to find a swift and appropriate response to the needs of each individual. The evaluation should take into account psychological and social factors in addition to physical factors.

Journal of Pain Research

Chronic pain is nowadays used as an umbrella term referring to a wide range of clinical conditions, such as fibromyalgia, migraine, or long-standing pain states without actual known causes. However, labeling a patient's clinical condition with the term "chronic pain", when dealing with pain lasting longer than 3 months, might be misleading. This paper aims at analyzing the possible pitfalls related to the use of the term "chronic pain" in the clinical field. It appears, indeed, that the term "chronic pain" shows a semantic inaccuracy on the basis of emerging scientific evidences on the pathogenesis of different long-standing pain states. The major pitfalls in using this label emerge in clinical settings, especially with patients having a biomedical perspective on pain or from different cultures, or with healthcare providers of other medical specialties or different disciplines. A label solely emphasizing temporal features does not help to discern the multifaceted complexity of long-standing pain states, whose onset, maintenance and exacerbation are influenced by a complex and interdependent set of bio-psycho-social factors. Thus, finding a more meaningful name might be important. We call upon the necessity of bringing awareness and implementing educational activities for healthcare providers, as well as for the public, on the biopsychosocial approach to assess, prevent and care of chronic pain. Further research on the etiopathogenetic processes of chronic pain states is also required, together with examinative diagnostic methods, to individuate the most appropriate label(s) representing the complex longstanding pain states and to avoid adopting the term "chronic pain" inappropriately.

Pain Forum, 1995

T he Focus article noted theoretical gaps that needed further development before formally specified models of the most prominent, comprehensive theories of chronic pain are ready for empirical testing. These gaps include measurement and structural issues. The thought-provoking commentaries by Drs. Chapman, Donaldson, Fordyce, and Jerome expand on and also note other issues that require attention. In particular, Drs. Chapman and Donaldson echo our concern about the insufficient parameter specification of operant-behavioral and cognitive-behavioral theories. Their other concerns are about the compatibility of theory and the primary motive behind chronic pain research, the comparability of the different theories, and the utility of studying chronic pain populations rather than people. Dr. Fordyce's concerns are about attention to the dynamic quality of pain and also to the linkage between chronic pain and reinforcement contingencies or other environmental influences. Dr. Jerome is most favorable to proceed with empirical tests of theoretical models. We now respond to these concerns. In addition, guidance from the experience in other fields is offered to broaden the perspective for proceeding with tests of theoretical models in chronic pain. A procedural plan that can be implemented with necessary caution also follows.

The virtual mentor : VM, 2013

Treating or alleviating pain is a primary role of medicine. What actually constitutes pain is subjective, value-laden, and difficult to define objectively and empirically, relying as the definition does on bodily signs and language, both of which are culturally embedded and subject to multiple interpretations. Biomedical theories of pain concentrate upon its neurophysiological aspects in both diagnosis and treatment. Hence, scientific medicine reduces the experience of pain to an elaborate broadcasting system of nerve signals, rather than seeing it as molded and shaped by the person who is experiencing it and his or her particular sociocultural context. The biomedical concept of pain is unsophisticated and oversimplified, often resulting in physicians' doubting the veracity of patients' reports of pain and the marginalization of such patients. We must incorporate engagement with the social and emotional context into medical understanding and treatments of pain to fully encompass its complex nature. The long-dominant conceptualization of pain has focused upon sensation, with the subsequent inference that it is able to be rationally and objectively measured. Biomedical practice traditionally assessed the nociceptive-"sensing harmful stimuli"-aspects of pain and employed the acute-chronic differentiation which did not necessarily take emotional aspects of pain into account. The observable links between test-confirmed physical disorders and expressions of pain are more obvious. On the other hand, one of the most complex and difficult types of pain to treat is idiopathic pain-that is, pain for which there is no observable or confirmable physical pathology. Often termed chronic pain syndrome and subsumed under the label of medically unexplained symptoms (MUS), these are illnesses or syndromes that cannot be defined in terms of organic pathology and are given low clinical importance. Frustrated by the seemingly intractable nature of idiopathic pain, practitioners often describe sufferers as "frequent fliers" or "heartsink" patients, further adding to their marginalization . As well as being a medical "problem," pain is not solely a creation of our anatomy and physiology but, in lay terms, is an everyday experience, emerging at "the intersection of bodies, minds and cultures" [2]. Moreover, defining pain is a semantic problem; in any language there may be wide variations in interpretation and meanings. Dictionary definitions of pain refer to any or all of the following: PAIN [from the Latin poena, meaning penalty or punishment]

Musculoskeletal Care, 2014

Background. Chronic pain is not only a physical disorder, but also a complex combination of biopsychosocial symptoms affecting each other. When in chronic pain, the patient's entire body becomes a source of pain, and eventually the pain occupies the patient's mind and entire life. The aim of the present study was to examine the life experience and management of chronic pain from the patient's perspective. Methods. Thirty-four participants with chronic pain were interviewed. For 21 of the participants, the duration of pain was more than five years. Most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi's four-phase phenomenological method. Results. The results indicated that chronic pain impaired the participant's psychosocial well-being by controlling thoughts and making life itself painful. When life is filled with pain, the entire life is seen through pain. Continuity, unpredictability and the fear of the pain decreased quality of life. As a result of the interviews, the following subthemes were identified, based on the essential theme of 'the dominance of chronic pain': namely: 'pain is the master', 'life is not worth living', 'contextual pain' and 'waiting and hoping'. Conclusions. Chronic pain may decrease the quality of the patient's life to such an extent that it may be regarded as not worth living. Multidisciplinary management of chronic pain may lead to a better health status and diminish the adverse consequences of chronic pain.

Electronic Journal of General Medicine, 2019

Background and Objective: The concept of chronic pain is a significant nursing notion for which there are various definitions and patterns mentioned in texts. Thus, this survey was carried out to analyze the concept of chronic pain with respect to more clarifications on this concept in nursing with an evolutional approach. Materials and Methods: In the present study, Rodgers evolutional method for concept analysis was used. The sources where the required data for analysis was obtained were Nursing Index, ProQuest, and Ovid databases. The criteria for entering these databases were English texts published from 1995 to 2016 years. The keywords used for searching in titles were acute pain, interact abele, trauma pain, non-cancer pain. Results: In this study, the features of chronic pain were identified as being long, killing, and having visceral nervous roots. The symptoms for this pain are characterized as hurting, acute pain, and passing the acute pain. Its aftermaths consist of physical and psychological disorders, economic problems and lack of appropriate welfare in life. Conclusion: According to the findings of the present study, it is possible to present a theoretical definition for chronic pain concept. The results may help other researchers in developing a model and theory related to this topic by illuminating the chronic pain concept and regarding the fact that theories are building blocks for formulating theories.

PubMed, 1979

T he impact of chronic pain on patients, the health care system, and society at large is huge. An estimated 50 million to 100 million adults in the United States suffer from chronic pain. 1,2 Chronic pain affects a greater proportion of Americans than heart disease, cancer, and diabetes combined. 3-5 The economic cost is staggering, with more than $100 billion per year in lost productivity and increased health care utilization. 6 The problem is so widespread that The Joint Commission has recommended that physicians consider pain as "the fifth vital sign." 7 The Crisis in the Care of Patients With Chronic Pain Despite the prevalence and seriousness of the problem, patients with chronic pain often remain inadequately treated. One study found that approximately 95% of patients with chronic pain report continued moderate or severe pain after a year of treatment with pain medications. 8 Another study

Sociology of Health and Illness, 1992

Chronic pain is a problematic reality at least for two reasons. First, pain is a person's private experience, to which no one else has direct access. Second, chronic pain is lasting proof of a failure that questions the validity of actions and explanations, both past and future, of all involved. Because pain is a private sensation that cannot be reduced by objectification, it cannot, ultimately, be stablised as an unquestionable fact that can serve as the basis of medical practice and thus organise relations between professional and lay persons. This fragile factuality increases the work a physician has to do to decipher a patient's pain. The aim of this paper is to examine how physicians specialising in pain medicine work at this deciphering. Because of these characteristics of pain, physicians are forced to work on the elusive information provided by patients so as to bring into being something called chronic pain. When doing this they tap various, nearly incompatible, resources. I shall study the way these multiple resources are put to use by physicians as they form judgements about cases. By using as a field experiment two pain centres with opposite conceptions and practices, it can be shown how physicians in each centre determine patients' pain situations and formulate advice to them, how the characteristics of this work involve physicians in specific systems of relations with patients, and how these systems are related to dimensions of this work: either to a justification of physicians' actions or else to a confirmation, or realignment, of the initial doctor-patient agreement.

Psychological Bulletin, 1995

The authors compare theoretical perspectives of chronic pain using a restrictive comprehensive categorization. Four of the perspectives (mind-body dualism, psychological, radical operant-behavioral, and radical cognitive) are categorized as restrictive. The other 4 perspectives (International Association for the Study of Pain, gate control, nonradical operant-behavioral, and cognitivebehavioral) that incorporate multiple facets are categorized as comprehensive. On the basis of empirical support, practical application, and issues concerning potential research design problems, the restrictive perspectives could be rejected for not providing a model in which chronic pain can be thoroughly investigated. The comprehensive perspectives, however, demonstrate greater potential for serving that role. Nonetheless, the need for additional theory development by the comprehensive perspectives is noted. Over the past 25 years, a revolution has been occurring in the understanding of chronic pain. There has been a growing consensus from a variety of theoretical views (e.g.