Pain Medicine Series

Sculpture by Fabio Viale

Pain Medicine Series: ‘Meaning in the Context of Pain’ (2021)

Traditionally, scientific research has had much to say about the physical nature of pain but much less about pain experience. It seems that a limitation in the ability of clinicians to treat pain or pain-related suffering is an incomplete appreciation of ‘pain experience’.

This special issue in Pain Medicine focuses on a pivotal aspect of this problem: how to understand the meaning of pain both for the patient and for the observing clinician.

Guest Editors
Dr Simon van Rysewyk (University of Tasmania)
Miss Melanie Galbraith (Life Ready Biosymm)
Dr John Quintner (Arthritis and Osteoporosis Western Australia)
Prof Milton Cohen (St Vincent’s Clinical School, University of New South Wales Medicine)


Editorial: Do we mean to ignore meaning in pain?
Simon van Rysewyk, Melanie Galbraith, John Quintner, Milton Cohen
Here.

How Do People Communicate about Knee Osteoarthritis? A Discourse Analysis
Samantha Bunzli, Nicholas Taylor, Penny O’Brien, Michelle Dowsey, Jason Wallis, Peter Choong, Nora Shields
Here.

Looking for Meaning in Labour Pain: Are Current Pain Measurement Tools Adequate?
Laura Whitburn, Lester Jones
Here.

A healing journey with chronic pain – a meta-ethnography synthesising 195 qualitative studies
Francine Toye, Joletta Belton, Erin Hannink, Kate Seers, Karen Barker
Here.

Spiritual Well-Being in People Living with Persistent Non-Cancer and Cancer-Related Pain
Melanie Lovell, Mandy Corbett, Skye Dong, Philip Siddall
Here.


Editorial: Do we mean to ignore meaning in pain?
Simon van Rysewyk, Melanie Galbraith, John Quintner, Milton Cohen

Abstract
Although Pain Medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatisfactory. The problem seems to be with meaning: some people with pain do not find meaning in clinical discussions of pain, and clinicians typically are not looking for it. For patients with pain, biomedical information can be perceived as lacking meaning in relation to their personal experience. By contrast, patient narratives and stories about pain, clinical encounters and therapies, cautionary tales, and common-sense experience seem to offer meaningful and actionable information. No biomedical explanation of pain, however useful it might be to a pain clinician, could describe the personal meaning or burden of pain to the individual.

Traditionally, scientific research has had much to say about the physical nature of pain but much less about pain experience. It seems that one limitation in the ability of clinicians to effectively treat pain or pain-related suffering is an incomplete appreciation of ‘pain experience.’ This special issue in Pain Medicine focuses on a pivotal aspect of this problem: how to understand the meaning of pain, for both the patient and the observing clinician.

Read the editorial.


Papers

How Do People Communicate about Knee Osteoarthritis? A Discourse Analysis
Samantha Bunzli, Nicholas Taylor, Penny O’Brien, Michelle Dowsey, Jason Wallis, Peter Choong, Nora Shields

Abstract
Objective

To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines.

Design
A qualitative synthesis using discourse analysis methods.

Methods
Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers and/or clinicians. Methodological quality was evaluated using the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analysed using inductive discourse analysis.

Results
A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1673 direct quotes) from people with knee osteoarthritis, carers and clinicians in 16 countries. Two overarching discourses were identified—impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore-down over time and required a doctor to repair. The overarching participatory discourse almost always co-existed alongside an impairment discourse. According to this discourse, a ′busy body′ was perceived as ′healthy′ and people could remain active despite knee osteoarthritis.

Conclusion
The prevailing impairment discourse may potentially discourage people from using knees that have passed their ′use-by-date′ and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating, which may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.

Read the paper.


A healing journey with chronic pain – a meta-ethnography synthesising 195 qualitative studies
Francine Toye, Joletta Belton, Erin Hannink, Kate Seers, Karen Barker

Abstract
Objective
There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery.

Design
A synthesis of qualitative research using meta-ethnography.

Methods
We used the seven stages of meta-ethnography. We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.Results

We screened 1,328 titles and included 195 studies. Our conceptual model indicates that validation and reconnection can empower a person with chronic pain to embark on a journey of healing. To embark on this journey requires commitment, energy, and support.

Conclusions
The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.

Read the paper.