Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain

Eaves, Emery R.; Nichter, Mark; Ritenbaugh, Cheryl

doi:10.1007/s11013-015-9465-4

Cited by 38 publications

(31 citation statements)

References 71 publications

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“…Although there are differences in how the term hope is understood in studies among patients, comprising terms such as expectations, aspirations, wants and desires, [ 28 , 29 ], informants in our study spoke about hope without making such differentiations. Nevertheless, hope has been pointed to as central in how people with pain assess new experiences and adjust their expectations towards treatments [ 39 ], and our findings support this.…”

Section: Discussionsupporting

confidence: 78%

Expectations towards participation in easily accessible pain management interventions: a qualitative study

Nøst

Steinsbekk

Riseth

et al. 2017

BMC Health Serv Res

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BackgroundPeople with chronic pain use a range of healthcare services, but they also report a high degree of dissatisfaction with treatments. One reason for dissatisfaction might be participants’ expectations towards treatments. The aim of this study was to explore expectations of people with chronic pain towards participation in easily accessible pain management interventions delivered in public primary care.MethodsA qualitative study using semi-structured individual face-to-face interviews with 21 informants. The informants were recruited among participants enrolled in a randomised controlled trial on the effect of an easily accessible self-management course for people with chronic pain. The data were analysed thematically using Systematic Text Condensation.ResultsHaving experienced pain for a long time, there was no specific expectation of a cure or a significant alleviation of the pain. The informants’ expectations mainly concerned a hope that participation could lead to a better everyday life. The informants said that hope was important as it motivated them to keep going and continue self-care activities. The hope acted as a driving force towards trying new interventions and maintaining motivation to do activities they experienced as beneficial. Both concrete aspects of the current intervention and an understanding of what interventions in general could offer contributed to the informants hope. The expectations centred about the interventions being something new, as they had not previously tried this service, an opportunity to gain and reinforce skills, to help them continue to grow as a person, to meet others in similar situations, and to access professional support in an easy manner. Participating in interventions provided by healthcare services was seen by some as an act of self-care, where they did something active to manage their health.ConclusionsExpectations towards the interventions were related to a hope for participation leading to a better everyday life. The role of hope for peoples’ motivation to self-care implies that service providers should be aware of and help to maintain hope for a better everyday life. The importance of social support as part of self-care should be acknowledged when developing interventions targeting chronic pain.Trial registrationClinicalTrials.gov: NCT02531282. Registered on August 21 2015.

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Section: Discussionsupporting

confidence: 78%

Expectations towards participation in easily accessible pain management interventions: a qualitative study

Nøst

Steinsbekk

Riseth

et al. 2017

BMC Health Serv Res

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show abstract

“…Participants in this study similarly avoided talk about pain, not wanting to “burden” others or allow pain to interfere with social and family life (Eaves et al 2015a; 2015b). Many chose not to talk about pain with significant others or even with their primary care physicians.…”

Section: Resultsmentioning

confidence: 99%

“Just Advil”: Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain

Eaves

2015

Social Science & Medicine

Self Cite

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Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medication as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as “just over-the-counter” or “not real pain medication,” sufferers engage in ideological harm reduction, distinguishing themselves from “those people who like taking pain medication” while still seeking relief. Justifying one’s use of OTC medication as minimal and “normal,” regardless of intake, avoids association with the addictive potential of prescription pain medications and aligns the identity of the chronic pain sufferer with a culturally sanctioned identity as stoic bearer of pain.

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“…A series of qualitative interviews embedded in RCTs in irritable bowel syndrome,69 chronic low back pain,56 and chronic temporomandibular disorder70 further disrupts a conscious expectation theory. In interviews performed by anthropologists, patients overwhelmingly denied positive expectations and instead described a history of repeated therapeutic failures 69.…”

Section: Evidence For Theories Of Placebo Effectsmentioning

confidence: 99%

Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice

Kaptchuk

Hemond

Miller

2020

BMJ

130

155

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Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights “predictive coding” and “bayesian brain” as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.

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Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain

Cited by 38 publications

References 71 publications

Expectations towards participation in easily accessible pain management interventions: a qualitative study

Expectations towards participation in easily accessible pain management interventions: a qualitative study

“Just Advil”: Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain

Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice

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