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Living well with chronic pain: A classical grounded theory

Lennox Thompson, B., Gage, J. and Kirk, R., 2020. Living well with chronic pain: a classical grounded theory. Disability and rehabilitation, 42(8), pp.1141-1152. LINK >> HERE <<  Bronnie Lennox Thompson

Chronic pain affects millions of people worldwide, and it is a leading cause of disability. Much of the research has focused on identifying and treating the negative effects of chronic pain, but there is little written about those who manage to live well despite their pain. In a recent study, Thompson et al explored the themes which emerged from conversations around living well with pain to better understand this process.

The study utilised classical grounded theory methodology to generate a theory grounded in data obtained from community-dwelling people who self-identified as living well despite chronic pain. Researchers choose this approach when there is no existing theory or hypothesis to test.  Often, instead of having a specific question about human experiences, they may just have an area that want to explore and build of the results. So they might say something like: "What is the experience of those living well with pain?" and pull out themes from interviews to start map out areas of agreement and disagreement in the sample. this can then inform future research, which aims to be more specific and targeted with the data. For example, the researchers might go on to pull out one theme and develop a method of formulation or therapy specifically focused on facilitating change in that one area.  

Grounded Theory Research: You may not be too familiar with this approach to research because often therapists have been taught only to value positivist approaches to empirical data. Empiricism simply means gathering valid data through experience and observation, for example, the phenomena must be experienced and observed and documented through valid channels and by people considered capable to do so (the dominant method for this is through the university hierarchy system PhD, post-docs associate professor etc). Positivism is referring to the scientific method and many people within 'the sciences' consider the scientific method of doubt, variable control, comparison and repetition to the the only valid way to know anything about anything. The hierarch of evidence is based upon this idea with meta-analysis, systematic review and the RCT being at the top as they are seen to be the most reliable way of knowing anything about anything.  But, these approaches require us to be able to control variables, have a similar group for comparison and a specific action/variable to test. In lab based work where tissues are separated from bodies and single substances are added, this is a very reasonable and logical way of knowing about that disembodied tissue reacting to that substance.  However once the tissue is embodied and the substance introduced through the whole complex system (orally or intravenously) - the reliability and validity of the results becomes significantly less reliable.  The tendency here is to opt for large data sets to show there is enough repetition of the observed phenomena to demonstrate likelihood. So you can see that positivist approaches are valid for very specific questions. But when we want to learn about human phenomena/experiences, exploring valid systems of qualitative work can be very important. 

The researchers found that the main concern of people experiencing chronic pain is resolving the problem of disrupted self-coherence. Resolution involves re-occupying the self by:

(1) making sense of pain using an idiographic model; 

(2) deciding to turn from patient to person, facilitated or hindered by interactions with clinicians and occupational drive;

(3) flexibly persisting, where occupational engaging and coping allow individuals to develop future plans.

Occupation: refers to “the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do”

The study suggests that engaging in occupations during rehabilitation is important in framing chronic pain adjustment within a process of renegotiating the persons self-context, which allows individuals to express values important to their sense of self. The positive motivation that comes from individuals identifying highly valued occupations is an aspect that all clinicians, but particularly pain therapists, should recognise.

The findings of this study may have implications for rehabilitation professionals working with individuals living with chronic pain. Diagnosis should be accompanied by messages about hurt and harm not being equivalent, and the need for a lifelong approach to managing a chronic problem.

Remaining supportive, providing “small acts” demonstrating that the person is unique and being thought of, and encouraging engagement in valued occupations allows patients to experiment with, and start to engage in what is important in their lives. Clinicians could help people extend their coping repertoire and encourage flexibility with how these are applied in the pursuit of valued occupations.

I personally, love this paper and go back to it regularly to remind myself of the power of acceptance and flexibility in the long-term management of pain. It reminds me that people can live well with pain and that taking a personal approach, letting a persons values and interests be the guide for any kind of therapeutic approach is likely to support a feeling a self-coherence as well as motivation for movement and social connection. 

What does this paper say to you?

What were your thoughts on the research approach?

Could we have gathered information in a positivist way?

How does this paper support or facilitate change in your practice?

x Laura

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