Believing the patient with chronic pain: a review of the literature

Clarke, Kathryn A.; Iphofen, Ron

doi:10.12968/bjon.2005.14.9.18073

Cited by 48 publications

(38 citation statements)

References 20 publications

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“…Because pain is invisible and immeasurable, its existence, quantity, and quality are difficult to detect (Jackson 2000;Melzack 2001Melzack , 2004Clarke & Iphofen 2005Turk & Winter 2010) thus; the only evidence of the existence of pain is based on the person's own report as a subjective experience (Lee & Tracey 2010). With the current instruments, it is challenging to examine pain directly, which is why indirect instruments are used, such as questionnaires, which refer to the consequences and effects of pain.…”

Section: Measuring Pain 31mentioning

confidence: 99%

“…The basic principle of pain is being invisible, immeasurable, and individual, comprising sensory, affective, cognitive, and evaluative aspects, and the fact that it is an experience (e.g. Sim & Waterfield 1997;Clarke & Iphofen 2005IASP 2012). It is questionable how pain can be categorized solidly, taking into account all the criteria of the experience of pain.…”

Section: Disability and Chronic Pain 33mentioning

confidence: 99%

“…Disbelief was based on lack of physical findings or other pathology -see also Thomas 2000;Lillrank 2003;Clarke & Iphofen 2005Pesut & McDonald 2007 -which caused delays in treatment or not being treated at all, resulting in increased distress and other additional psychological symptoms that were more difficult to understand and manage than physical pain. The disbelief by HCPs and spouse was considered unfair and unexpected, because the HCPs were expected to be professionals in pain and to provide the best management for pain without speculation of its existence.…”

Section: An Overview Of the Main Findings And Their Conclusion -102mentioning

confidence: 99%

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Revising the negative meaning of chronic pain – A phenomenological study

et al. 2014

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A Phenomenological StudyEsitetään Jyväskylän yliopiston liikuntatieteellisen tiedekunnan suostumuksella julkisesti tarkastettavaksi yliopiston Musica-rakennuksen salissa M103 helmikuun 21. päivänä 2015 kello 12.Academic dissertation to be publicly discussed, by permission of the Faculty of Sport and Health Sciences of the University of Jyväskylä, in building Musica, auditorium M103, on February 21, 2015 at 12 o'clock noon. UNIVERSITY OF JYVÄSKYLÄ JYVÄSKYLÄ 2015The Chronic pain is a complex combination of biopsychosocial symptoms affecting each other. In chronic pain, the patient's entire body may become a source of pain, and eventually the pain occupies the patient's mind and entire life. The purpose of this thesis was to search for a more profound understanding of the phenomenon of chronic pain from the perspective of persons with chronic pain and who have been treated for their chronic pain. Thirty-four participants with different types chronic pain were interviewed. The transcribed interviews were analysed using Giorgi's phenomenological method consisting of four phases: (1) reading the transcriptions several times, (2) discriminating meaning units, (3) collecting meaning units into groups, into meaning structures, (4) the synthesis, describing the phenomenon of chronic pain.The results indicate that chronic pain impaired the participants' life by controlling thoughts and making life itself painful. The strongest arguments made by the participants due to chronic pain were distress, loneliness, lost identity, and low quality of life. The participants stated that the key to managing their pain was to reconsider their meanings of pain. In the analysis, four essential themes of chronic pain emerged, namely: "Chronic pain affects the whole person", "Invisibility of chronic pain", "Negative meaning of chronic pain", and "Dominance of chronic pain".Chronic pain is a multidimensional illness which requires a multidisciplinary approach to understand the phenomenon of it. Accordingly, a multidisciplinary rehabilitation programme is required to manage it; unfortunately the opposite is true in clinical practice, adopting only a rhetoric approach. A potential source of psychosocial symptoms may be the personal responses to the experience of chronic pain based on individual meaning. Thus, the focus should be to identify and revise the meanings of pain in order to manage chronic pain and to restore positivity in personal life. The phenomenological framework provides a relevant new insight into the present understanding of chronic pain.

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Section: Measuring Pain 31mentioning

confidence: 99%

Section: Disability and Chronic Pain 33mentioning

confidence: 99%

Section: An Overview Of the Main Findings And Their Conclusion -102mentioning

confidence: 99%

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Revising the negative meaning of chronic pain – A phenomenological study

et al. 2014

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“…Många smärtdrabbade upplever svårighet att bli trodda, trots att man själv erfar sig så begränsad i livet (32)(33)(34). När Clark & Iphofen (34) intervjuade patienter om deras erfarenheter av att smärtan var osynlig, fick de redogörelser för hur andra ansåg att smärtan satt i huvudet, att den var psykiskt betingad.…”

Section: Att Leva Med Långvarig Smärtaunclassified

Att leva med en kropp som värker : samtal med fysioterapeuten

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2014

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Background and aim: Physiotherapists in primary care meet, assess and treat patients with long-standing benign musculoskeletal pain. As a clinical condition, long-standing pain is common but nonetheless it is quite complex. The aim of this thesis has been, from a bodily existential perspective, to investigate and conceptualise the experience of living with longstanding benign musculoskeletal pain, and from there, to work out a method for conversation and assessment within non-specialised physiotherapy. Methods: Our first study was an interview study where we applied a phenomenological approach and investigated the ways individuals suffering from long-standing pain experienced their body and their illness. Four aspects of body experience were described, and based on these aspects, four typologies of attitudes to pain were distinguished. In the second study, we made two group interviews with six physiotherapists about their experiences of using, in their clinical work, questions from the interview guide in study I that had given particularly rich responses. Transcripts were analysed using phenomenography. In the third study, patients’ verbal responses to the key questions, directed to them by physiotherapists in clinical situations, were investigated, and the four aspects of body experience from study I formed the concepts of a deductive analysis. In study IV, finally, the key questions and typologies were tried by a larger group (31), and their experiences and the possible applicability of the method were studied by qualitative content analysis combined with the counting of codes. Results: We created four typologies of attitudes to long-standing pain: “Surrendering to one’s fate”, “Accepting by an active process of change”, “Balancing between hope and resignation” and “Rejecting the body”. These typologies, in turn, were based on four aspects of body experience: “The body as an aspect of identity”. “Body reliance”, “Body awareness”, and “Ways of understanding pain”. In study II, by the aid of key questions, patient and physiotherapist managed to have a conversation on bodily existential matters. The physiotherapist learnt to know the patient as a person, a process appeared to be initiated in the patient, and their relation changed. The patient was willing to talk about her body in pain, and had the words to do this. In study III, the key questions opened ways to reflections on body, existence, and biography. The four aspects of body experience were central to the patients’ descriptions. In study IV, the participating physiotherapists reported by large positive experiences from applying key questions and typologies. The patients reflected, emotions were evoked, and the relation and the communication often improved. The typologies helped in giving a comprehensive perspective of the patient’s problem, and to grasp where in the process of rehabilitation the patient was to be found. Conclusions: The method, seven key questions combined with the tentative frame of interpretation of the answers, seemed to be easily appl...

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“…There is a wealth of evidence indicating that patients' verbal reports regarding their pain are disbelieved, or put into question through the assessment of other clues, by observers, including healthcare professionals (e.g., Saxey, 1986;Scott, 1992;Thorn, 1997;Solomon, 2001;Clarke & Iphofen, 2005;Clarke & Iphofen, 2008). In particular, a vast range of studies point to the fact that there is a discrepancy between patients' self evaluations and judgments expressed by observers, often resulting in a phenomenon of "pain underestimation" (e.g., MacLeod et al, 2001;Marquié et al, 2003;Kappesser et al, 2004;Kappesser et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Taking into account the observers’ uncertainty: a graduated approach to the credibility of the patient’s pain evaluation

et al. 2009

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1 AcknowledgementsAuthors wish to thank John Burns and three unknown referees for their pertinent comments and suggestions. We are also grateful to Marco Marelli for his suggestions on the analyses of the properties of the graduated approach used in Experiment 2. 1 AbstractThis article presents two experiments aiming to investigate the adoption of a graduated measure to describe credibility attribution by observers who evaluate patients' pain accounts. A total of 160 medical students were required to express a credibility judgment on the pain intensity level of hypothetical patients. We used 16 vignettes based on a factorial mixed-design. Withinparticipants factors were the reported pain, the presence of a physical sign, the patient's facial expression and the patient's gender, and between-groups factors were the patient's age and the geographical distribution of the patient's name. Results confirm the well-established tendency not to believe patients' self-reports and provide information regarding the evaluators' uncertainty. The findings suggest that a graduated measure is useful for assessing the degree of uncertainty of the observers and subtle effects of different factors upon the judgment of patient's pain.

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Believing the patient with chronic pain: a review of the literature

Cited by 48 publications

References 20 publications

Revising the negative meaning of chronic pain – A phenomenological study

Revising the negative meaning of chronic pain – A phenomenological study

Att leva med en kropp som värker : samtal med fysioterapeuten

Taking into account the observers’ uncertainty: a graduated approach to the credibility of the patient’s pain evaluation

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