A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain – Nov 2013 – PubMed Health full-text review
The study helps us to understand the experience of people with chronic musculoskeletal pain as a constant adversarial struggle, which may distinguish it from other types of pain, and it opens up possibilities for therapies that aim to help a person to move forward alongside pain.
One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved.
However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain.
A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain.
Specifically, it would help us understand peoples’ experience of health care with the aim of improving it.
Our findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain.
- the struggle to affirm self and construct self over time;
- find an explanation for pain;
- negotiate the health-care system while feeling compelled to stay in it;
- be valued and believed; and
- find the right balance between sick/well and hiding/showing pain.
In spite of this struggle, our model showed that some people were able to move forward alongside their pain by
- listening to their body rather than fighting it;
- letting go of the old self and finding a new self;
- becoming part of a community and not feeling like the only one;
- telling others about pain and redefining relationships;
- realising that pain is here to stay rather than focusing on diagnosis and cure; and
- becoming the expert and making choices.
We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.
Our model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain.
This study opens up possibilities for therapies that aim to help a person to move forward alongside pain.
Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure.
Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain.
Not feeling believed can have an impact on a person’s participation in everyday life.
The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice.
Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain.
Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it.
Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience.
Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain.
Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.
This publication is based on a study I posted earlier: Patients’ experiences of life with chronic pain
- Getting started
- Deciding what is relevant
- Reading the studies
- Determining how studies are related to each other
- Translating studies into each other
- Synthesising translations
- Expressing the synthesis
- Deciding what is relevant
- Determining how studies are related
- Translating studies into each other: developing the conceptual categories
- Synthesising translations: line of argument
- Integrating my body
- Accepting pain and redefining my self
- Redefining self in space and time
- Patient as subject not object
- Towards a culturally embodied model of pain
- The performative aspects of pain experience
- Qualitative syntheses in musculoskeletal pain
- Methodological issues
- Clinical application