Chronic Pain and the Struggle with a “New Self”

Accepting a “new self” – one unable to function in the same way as the former pain-free self was found to be a major challenge for adults living with chronic non-malignant muskoskeletal (MSK) pain.

Funded by the Health Services and Delivery Research programme (HS&DR), the study found that adults with MSK chronic pain can have an altered relationship with their sense of self and can feel ‘homeless’ in their own body.

The study is the first of its kind to collate the findings of research on non-malignant chronic pain to create a central resource. Chronic pain is common and increasing. According to the report:

  • 5 million people develop chronic pain each year
  • 25% of adults around the world suffer with moderate or severe pain
    (for between 6% and 14% of those adults, the pain is severe and disabling)
  • 49% of patients with chronic pain experience depression
  • 25% lose their jobs
  • 16% feel that their chronic pain is so bad that they sometimes want to die.

Despite the prevalence of adults with chronic pain, the health care system continues to struggle to treat people. Francine Toye, Research Lead at Nuffield Orthopaedic Centre NHS Trust in the UK, comments:

The alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing.”

Researchers collated qualitative studies from six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012.

The full texts of 321 potentially relevant studies were screened and  77 were deemed appropriate and included in the meta-ethnography – a systematic analysis and synthesis of qualitative research.

Forty-nine papers explored the experience of chronic MSK pain and 28 papers explored the experience of fibromyalgia.

The limitations of living with unpredictable pain was found to restrict activities, the ability to make future plans and people struggled in relating to a new body which they felt, at times, unable to control, relate to, or understand.

Many adults reported feeling like a “shuttlecock” as they were referred to various professionals and departments. A short film, “Struggling to Be Me” highlights the main findings of the study into patients’ experience of chronic muskoskeletal pain.

Five themes were found to be prevalent within the collated research:

  • a constant daily struggle to affirm their self
  • construction of time altered: unpredictable now and future
  • struggling to construct an explanation of suffering
  • struggling to negotiate the health-care system
  • struggling to prove legitimacy

Methods of moving on from pain included working towards an integrated relationship with the painful body, redefining a positive sense of self now and in the future, regaining a sense of reciprocity and social participation, recognizing the limits of the medical model and being empowered to experiment and change things without the sanction of health-care professionals.

The results hope to inform health services on how to improve treatment for people who seek help from the health-care service for MSK problems in future.

Notes:
Full report: A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain:
http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0005/93632/FullReport-hsdr01120.pdf

Warwick Press Release: http://www2.warwick.ac.uk/newsandevents/pressreleases/living_with_chronic/

A short film based on the meta-ethnography of patients’ experience of chronic musculoskeletal pain:
Struggling to Be Me

Image credit: with thanks to Hanspeter Klasser of RGB Free Stock

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