The Meanings of Chronic Pain: Chronic Pain as a 'Biographical Disruption'

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Short, Stephanie

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Erben, Rosmarie

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Understanding the meaning that the patient makes of their pain is critical to the effective management of chronic pain. Not only do individual patients with chronic pain have difficulty coping with changes to their bodies and to their way of living, in many cases they also face a future of uncertainty and increasing disability. Over time, having chronic unrelenting pain can bring about a loss of self-identity and self-esteem, with threats to future vocational or career prospects. This has the potential to disrupt previous biographical plans and aspirations, to create a 'biographical disruption', in sociological terms. Full appreciation of the biological, the psychological and social influences on the patient, the biopsychosocial perspective, is important, therefore, to the successful management of those with chronic pain. In current times, when an aging workforce and increasing numbers of disabled adults are placing increased burden on social structures and insurance schemes, successful management of chronic pain is becoming even more important. This study set out to investigate these factors amongst patients and professionals dealing with this condition. Analysis of data from in-depth interviews with treating practitioners and patients in relation to their perceptions of 'success' in pain management, and 'barriers to success' supported the emergence of three distinct patient groups. Patient outcomes were defined in the form of a patient typology, described as: 'Disempowered': those who were disempowered, depressed and remaining dependent upon social benefits and ongoing health care, with a 'disappearing biography'; 'Empowered': patients who were socially mobile, able to become empowered and 'reclaiming a biography'; and 'Seeking revenge': those seeking validation of their injury, remaining angry and intent on revenge, seeking to regain their 'stolen biography'. These interpretations were a product of interactions with others, which included treating practitioners, insurance company and rehabilitation personnel. The findings of this qualitative study provide original and significant application and elaboration of the concept of 'biographical disruption' to chronic pain management. Findings from this research suggest that social factors have previously been underestimated as determinants of successful outcomes in relation to pain management. Rather than biological and psychological factors, social factors were identified as playing a major role in the development and maintenance of disability, pain and dysfunction in this population.

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Thesis (PhD Doctorate)

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Doctor of Philosophy (PhD)


School of Public Health

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Chronic pain patients

disempowered patients

empowered patients

seeking revenge patients

pain management

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