The Meaning Making Model Applied to Community-Dwelling Adults with Chronic Pain

Abstract

Purpose Chronic pain is a multidimensional experience that is influenced by biological, psychological, social, and spiritual factors. The Meaning Making Model is a recent cognitive behavioral model that has been developed to understand how psychosocial factors influence adjustment to stressful events, such as having a chronic illness. This qualitative study aims to understand the potential utility of this model for understanding the role of meaning making in adjustment to chronic pain. Materials and Methods Eighteen community-dwelling adults with chronic low back pain or chronic pain due to osteoarthritis participated in four focus groups. Participants were asked open-ended questions about their pain experience, pain-related beliefs, meaning of pain, and the perceived association between pain and their meaning in life and sense of purpose. Data were submitted to thematic analysis and the identified themes were considered in light of the Meaning Making Model. Results Three overarching themes emerged, each of which included two themes. The first overarching theme – “appraised meaning of pain” – included the themes “causal attributions” and “primary appraisals.” The second – “meaning making processes” – included the themes “assimilation” and “accommodation.” The third – “meanings made” – included the themes “pain as an opportunity” and “acceptance.” Conclusion The key themes that emerged as individuals with chronic pain discussed pain and its impact are consistent with those that would be hypothesized as important from the Meaning Making Model, providing preliminary support for the utility of this model in the context of chronic pain. People with chronic pain appear to appraise pain in terms of its cause, controllability, threat, loss, or challenge. When a discrepancy between the appraised meaning of pain and one’s global meaning emerged, participants engaged in meaning making processes (accommodation and assimilation), resulting in meanings made, such as a reappraised meaning of pain, perceptions of growth, and acceptance.

Impact of Spiritual Wellbeing on Health Promoting Lifestyles in Coronary Heart Disease Patients: Mediating Role of Perceived Health Status

“…The role of spirituality in health promoting behaviors which stimulate people's own understanding of the reality in terms of complex, intelligible, and biological processes, has been studied worldwide. 21,22 Specifically, A Saudi Arabian and Pakistani study also revealed that perceived positive health states are closely related to increased exercises, spiritual growth, and the interpersonal relations for health improving lifestyles. 8,23 In fact, the present study is an interesting representation of ties of all dimensions of spirituality and health promoting style.…”

Introducing the integrated model of co-occurring chronic pain and posttraumatic stress disorder: Adding meaning-making and existential concepts to current theory.

“…In one example, Park and colleagues showed that when global meanings are violated due to a stressful event, these violations are associated with more PTSD symptoms through negative views of the world and self (Park et al, 2012), highlighting how potentially traumatic events may disrupt meaning-making processes related to the self and the world. Similarly, for chronic pain, Ferreira-Valente et al (2021) validated portions of Park’s meaning-making model, showing how patients with chronic pain may appraise pain as harm/threat, loss, uncontrollable, and/or a challenge. The meaning-making model posits that meaning-making processes (i.e., situational meaning) lead to meanings made that may include acceptance, changes in global beliefs, changes in global goals, alterations of identity, and changes in one’s subjective sense of meaning.…”

“…In turn, this results in a feedback loop that then influences one’s global meaning. In Ferreira-Valente et al’s (2021) work, they found that patients used accommodation during meaning-making, wherein they altered their goals and endorsed a renewed sense of meaning in life. Just as individuals who experienced a traumatic event may need to reconcile their assumptions of a just-world with the fact they have experienced an apparently unjust trauma (Janoff-Bulman, 1992), individuals with pain also may believe they experienced an injustice from the emergence of their chronic pain (M.…”

Reconsidering Fordyce's classic article, “Pain and suffering: what is the unit?” to help make our model of chronic pain truly biopsychosocial

“…24 Personal and interpersonal processes of meaning-making involving the relation between patients' identity, agency, and social status and their suffering do not receive as much attention. 27 Both the biomedical model and the dominant version of the BPS model focus on the former mechanistic questions about “how” pain is produced and modulated rather than the latter meaning-focused “why” questions about personal reasons for pain and suffering. 84 Our contemporary interpretation of Fordyce's model challenges this separation of mechanisms and meanings and these distinct approaches to pain vs suffering.…”