Meaning out of chaos: a way to understand chronic pain

Bullington, Jennifer; Nordemar, Rolf; Nordemar, Kristina; Sjöström-Flanagan, Charlotte

doi:10.1046/j.0283-9318.2003.00244.x

Cited by 71 publications

(84 citation statements)

References 16 publications

(13 reference statements)

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“…Upplevelsen underordnas ett symptomtänkande och hur patienten innerst inne har det och tänker om sin situation kommer ofta inte fram. Denna problematik har under de senaste cirka tjugo åren uppmärksammats, diskuterats och utvecklats vetenskapligt av fysioterapeuter med förankring framför allt i helhetsinriktade traditioner och psykiatrisk fysioterapi (50,(55)(56)(57)(58)(59)(60)(61)(62)(63)(64). Gemensamt för dessa forskare är också att de anlägger ett existentiellt perspektiv på kroppen, ibland inom en fenomenologisk referensram.…”

Section: Teoretisk Ram Ett Förhållningssätt För Fysioterapeuter I Förunclassified

“…Bullington et al fann på liknande sätt i en studie på en smärtklinik att grunden för att uppnå en god fysioterapeut -patientrelation var ett jämbördigt 'jag-du-möte'. Bullington beskriver också att det är fruktbart att inta inställningen att man inte ska förändra den andre det vill säga patienten (55).…”

Section: Interaktionen I Det Fysioterapeutiska Mötetunclassified

“…Andra forskare beskriver processen som mer lagbunden. Bullington et al (138) kallar den en väg från "kaos till ordning". Gullacksen (74) kallar stadierna "skeenden" och de innehåller alla ett då, ett nu och ett sedan.…”

Section: Accepterandets Väg -En Processunclassified

“…Att vara lyhörd för kroppens röst och därmed komma förbi främlingskapet till kroppen stärker jaget (142). Man blir hel, trots smärta och funktionsnedsättning (138). Många med långvarig smärta har också beskrivit hur de upplevt sig försummade eller misstrodda av vårdpersonal (36,143) vilket också kan leda till att de i sin tur misstror sina egna sinnen och sin förmåga att bedöma kroppens signaler och vad han eller hon tål.…”

Section: Kroppstillit Och Kroppsmedvetenhet Gör Det Lättare Att Integunclassified

“…Fysioterapeuter har efterfrågat anpassade behandlingsformer för patientgruppen (55,170). Vi hoppas att resultaten som presenteras här kan bidra till att fysioterapeuter kan utveckla sin relation till patienten genom att de tillsammans undersöker innebörden och konsekvenserna av att leva med smärta.…”

Section: Konklusionunclassified

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Att leva med en kropp som värker : samtal med fysioterapeuten

Afrell¹

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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Section: Teoretisk Ram Ett Förhållningssätt För Fysioterapeuter I Förunclassified

Section: Interaktionen I Det Fysioterapeutiska Mötetunclassified

Section: Accepterandets Väg -En Processunclassified

Section: Kroppstillit Och Kroppsmedvetenhet Gör Det Lättare Att Integunclassified

Section: Konklusionunclassified

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Att leva med en kropp som värker : samtal med fysioterapeuten

Afrell¹

2014

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Self-Organization in Chronic Pain: A Concept Analysis

Monsivais¹

2005

Rehabilitation Nursing

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The purpose of this article is to examine the concept of self-organization in chronic pain using Rodgers' (2000) evolutionary approach. This article describes the antecedents, attributes, and consequences of self-organization in chronic pain. Self-organization in chronic pain may be achieved through the attributes of being believed, accessing credible resources, and taking action and responsibility. Self-organization occurs when the patient with pain develops a transformed identity, new insights, and is an active, in-control participant in care. Chronic pain is a common and costly problem, and recognition of the key attributes of self-organization in this condition is an important step in promoting positive health outcomes. Rehabilitation nurses play a key role in providing credible resources and working with the patient to take action and responsibility.

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A revised model for coping with advanced cancer. Mapping concepts from a longitudinal qualitative study of patients and carers coping with advanced cancer onto Folkman and Greer's theoretical model of appraisal and coping

et al. 2017

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Objective: To explore whether the Folkman and Greer theoretical model of appraisal and coping reflects the processes used by people living with advanced cancer.Methods: Interview data from a longitudinal qualitative study with people with advanced (stage 3 or 4) cancer (n = 26) were mapped onto the concepts of the Folkman and Greer theoretical model. Qualitative interviews conducted in home settings, 4-12 weeks apart (n = 45) examined coping strategies, why people thought they were effective, and in what circumstances.Interviews were coded and analysed using techniques of constant comparison.Results: Mapping coping strategies clearly onto the problem-or emotion-focused elements of the model proved problematic. Fluctuating symptoms, deterioration over time, and uncertain timescales in advanced cancer produce multiple events simultaneously or in quick succession.This demands not only coping with a single event but also frequent repositioning, often to an earlier point in the coping process. In addition, there is substantial ongoing potential for some degree of distress rather than purely "positive emotion" as the final stage in the process is death with several points of permanent loss of capability in the interim. Conclusions:The Folkman and Greer theoretical model is helpful in deconstructing the discrete "problem-focused" or "emotion-focused" coping mechanisms participants describe, but its formulation as a linear process with a single, positive, outcome is insufficiently flexible to capture the evolution of coping for people with advanced cancer.

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Meaning out of chaos: a way to understand chronic pain

Cited by 71 publications

References 16 publications

Att leva med en kropp som värker : samtal med fysioterapeuten

Att leva med en kropp som värker : samtal med fysioterapeuten

Self-Organization in Chronic Pain: A Concept Analysis

A revised model for coping with advanced cancer. Mapping concepts from a longitudinal qualitative study of patients and carers coping with advanced cancer onto Folkman and Greer's theoretical model of appraisal and coping

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