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“Pain Takes Over Everything”: The Experience of Pain and Strategies for Management

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Meanings of Pain

Abstract

This chapter explores the personal experience of pain from its biological underpinnings to strategies people identified for managing this experience. The somatic experience of chronic pain describes the biological processes involved in pain and how this can become a chronic experience with psychological and social implications. The personal experience of pain is explored through a systematic review of research of qualitative experiences. We found that the experience of pain was similar despite its etiological underpinnings—whatever the biological cause there were similarities in the personal experience. Participants in the studies identified five themes that described these personal experiences: (1) body as obstacle; (2) disrupted sense of self; (3) invisible but real; (4) unpredictability; and (5) keeping going. This section of the chapter is followed by the findings of a systematic review of how older people learn to manage their pain experiences: “adjusting to the inevitable,” “doing it my way without medication” and “the importance of support in managing the struggle.” The chapter concludes by discussing some of the strategies that can be used to manage the self in pain: support for self-management, medication, exercise and psychological interventions (mindfulness and cognitive behavioural therapy).

Clinical Implications: Many people manage their chronic pain by actively balancing the competing forces of hope and despair. There are similarities in this experience of chronic pain across a range of conditions which has implications for the development of pain management strategies and interventions that address the pain experience and not just the biological condition. Learning to manage the self in pain involves acceptance of pain as on-going and a part of who they are; keeping connected with others; keeping occupied through meaningful activities; getting meaningful support; and developing new meaning in life. Clinical interventions need to a focus on the person’s sense of self, strategies for maintaining hope, strategies that provide relief for the distress associated with pain; and providing people with a sense of control over their experiences both with the pain itself and in their encounters with the medical profession and the use of medication.

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References

  1. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807–13.

    Article  PubMed  Google Scholar 

  2. Baliki MN, Apkarian AV. Nociception, pain, negative moods, and behavior selection. Neuron. 2015;87(3):474–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Ballantyne JC, Sullivan MD. Intensity of chronic pain—the wrong metric? N Engl J Med. 2015;373(22):2098–9.

    Article  CAS  PubMed  Google Scholar 

  4. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895–926.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Scascighini L, Sprott H. Chronic nonmalignant pain: a challenge for patients and clinicians. Nat Clin Pract Rheumatol. 2008;4(2):74–81.

    Article  PubMed  Google Scholar 

  6. Monsivais DB, Engebretson JC. Cultural cues: review of qualitative evidence of patient-centered care in patients with nonmalignant chronic pain. Rehabil Nurs. 2011;36(4):166–71.

    Article  PubMed  Google Scholar 

  7. Maly MR, Krupa T. Personal experience of living with knee osteoarthritis among older adults. Disabil Rehabil. 2007;29:1423–33.

    Article  PubMed  Google Scholar 

  8. Currie S, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107(1–2):54–60.

    Article  PubMed  Google Scholar 

  9. Arnow B, Blasey C, Lee J, Fireman B, Hunkeler E, Dea R, et al. Relationships among depression, chronic pain, chronic disabling pain and medical conditions. Psychiatr Serv. 2009;60:344–50.

    Article  PubMed  Google Scholar 

  10. Blair MJ, Robinson RL, Katon WJ, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433–45.

    Article  Google Scholar 

  11. Walker AK, Kavelaars A, Heijnen CJ, Dantzer R. Neuroinflammation and comorbidity of pain and depression. Pharmacol Rev. 2013;66:80–101.

    Article  PubMed  Google Scholar 

  12. Campbell LC, Clauw DJ, Keefe FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry. 2003;54(3):399–409.

    Article  PubMed  Google Scholar 

  13. Gambassi G. Pain and depression: the egg and the chicken story revisited. Arch Gerontol Geriatr. 2009;49:103–12.

    Article  PubMed  Google Scholar 

  14. Cohen M, Quintner J, Buchanan D, Nielsen M, Guy L. Stigmatization of patients with chronic pain: the extinction of empathy. Pain Med. 2011;12(11):1637–43.

    Article  PubMed  Google Scholar 

  15. Jackson JE. Stigma, liminality, and chronic pain—mind-body borderlands. Am Ethnol. 2005;32(3):332–53.

    Article  Google Scholar 

  16. Crowe M, Whitehead L, Seaton P, Jordan J, McCall C, Maskill V, et al. Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs. 2017;73(5):1004–16.

    Article  PubMed  Google Scholar 

  17. Osborn M, Smith JA. Living with a body separate from the self. The experience of the body in chronic benign low back pain: an interpretative phenomenological analysis. Scand J Caring Sci. 2006;20(2):216–22.

    Article  PubMed  Google Scholar 

  18. Campbell C, Cramb G. ‘Nobody likes a back bore’—exploring lay perspectives of chronic pain: revealing the hidden voices of nonservice users. Scand J Caring Sci. 2008;22(3):383–90.

    Article  PubMed  Google Scholar 

  19. Williams S. Chronic illess as biographical disruption or biographical disruption as chronic illness? Sociol Health Illn. 2000;22:241–57.

    Google Scholar 

  20. Eccleston C, Williams C, Rogers W. Patients’ and professionals understandings of the causes of chronic pain: blame, responsibility and identity protection. Soc Sci Med. 1997;45:699–709.

    Article  CAS  PubMed  Google Scholar 

  21. Crowe M, Whitehead L, Gagan MJ, Baxter GD, Pankhurst A, Valledor V. Listening to the body and talking to myself—the impact of chronic lower back pain: a qualitative study. Int J Nurs Stud. 2010;47(5):586–92.

    Article  PubMed  Google Scholar 

  22. Rhodes L, McPhillips-Tangum C, Marham C, Klenk R. The power of the visible: the meaning of diagnostic tests in chronic back pain. Soc Sci Med. 1999;48:1189–203.

    Article  CAS  PubMed  Google Scholar 

  23. Corbett M, Foster N, Ong B. Living with low back pain. Soc Sci Med. 2007;65(8):1584–94.

    Article  PubMed  Google Scholar 

  24. British Geriatrics Society. Guidance on the management of pain in older people. Age Ageing. 2013;42:i1–i57.

    Article  Google Scholar 

  25. Keefe FJ, Porter L, Somers T, Shelby R, Wren AV. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth. 2013;111(1):89–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Jakobsson U, Hallberg IR, Westergren A. Overall and health related quality of life among the oldest old in pain. Qual Life Res. 2004;13(1):125–36.

    Article  PubMed  Google Scholar 

  27. Wu M, Brazier JE, Kearns B, Relton C, Smith C, Cooper CL. Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample. Eur J Health Econ. 2015;16(2):141–51.

    Article  PubMed  Google Scholar 

  28. Eggermont LH, Leveille SG, Shi L, Kiely DK, Shmerling RH, Jones RN, et al. Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the elderly Boston study. J Am Geriatr Soc. 2014;62(6):1007–16.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Silva AG, Queiros A, Cerqueira M, Rocha NP. Pain intensity is associated with both performance-based disability and self-reported disability in a sample of older adults attending primary health care centers. Disabil Health J. 2014;7(4):457–65.

    Article  PubMed  Google Scholar 

  30. Mackichan F, Adamson J, Gooberman-Hill R. ‘Living within your limits’: activity restriction in older people experiencing chronic pain. Age Ageing. 2013;42(6):702–8.

    Article  PubMed  Google Scholar 

  31. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111(1):13–8.

    Article  Google Scholar 

  32. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. Eur J Pain. 2010;14(4):380–6.

    Article  PubMed  Google Scholar 

  33. Bernfort L, Gerdle B, Rahmqvist M, Husberg M, Levin LA. Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life. Pain. 2015;156(3):521–7.

    Article  PubMed  Google Scholar 

  34. Crowe M, Gillon D, Jordan J, McCall C. Older peoples’ strategies for coping with chronic non-malignant pain: a qualitative meta-synthesis. Int J Nurs Stud. 2017;68:40–50.

    Article  PubMed  Google Scholar 

  35. Lansbury G. Chronic pain management: a qualitative study of elderly people’s preferred coping strategies and barriers to management. Disabil Rehabil. 2000;22(1–2):2–14.

    Article  CAS  PubMed  Google Scholar 

  36. Howarth M, Warne T, Haigh C. Pain from the inside: understanding the theoretical underpinning of person-centered care delivered by pain teams. Pain Manag Nurs. 2014;15(1):340–8.

    Article  PubMed  Google Scholar 

  37. Clarke KA, Iphofen R. Believing the patient with chronic pain: a review of the literature. Br J Nurs. 2005;14(9):490–3.

    Article  PubMed  Google Scholar 

  38. Turk DC, Okifuji A. Pain terms and taxonomies. In: Loeser D, Butler SH, Chapman JJ, Turk DC, editors. Bonica’s management of pain. 3rd ed. London: Lippincott Williams & Wilkins; 2001. p. 18–25.

    Google Scholar 

  39. Crowe M, Whitehead L, Gagan M-J, Baxter D, Panckhurst A. Self-management and chronic low back pain: a qualitative study. J Adv Nurs. 2010;66(7):1478–86.

    Article  PubMed  Google Scholar 

  40. Holm S. Justifying patient self-management – evidence based medicine or the primacy of the first person perspective. Med Health Care Phil. 2005;8:159–64.

    Article  Google Scholar 

  41. Ross M, Carswell A, Hing M, Hollingworth G, Dalziel W. Seniors’ decision making about pain management. J Adv Nurs. 2001;35:442–51.

    Article  CAS  PubMed  Google Scholar 

  42. Schofield P. The assessment of pain in older people: UK national guidelines. Age Ageing. 2018;47(1):i1–i22.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, et al. Guideline for opioid therapy and chronic noncancer pain. Can Med Assoc J. 2017;189(18):E659–E66.

    Article  Google Scholar 

  44. George J, Elliott RA, Stewart DC. A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging. 2008;25(4):307–24.

    Article  PubMed  Google Scholar 

  45. Topinkova E, Baeyens JP, Michel JP, Lang PO. Evidence-based strategies for the optimization of pharmacotherapy in older people. Drugs Aging. 2012;29(6):477–94.

    Article  PubMed  Google Scholar 

  46. Gaskell H, Derry S, Moore RA. Treating chronic non-cancer pain in older people—more questions than answers? Maturitas. 2014;79(1):34–40.

    Article  PubMed  Google Scholar 

  47. Marcum ZA, Hanlon JT, Murray MD. Improving medication adherence and health outcomes in older adults: an evidence-based review of randomized controlled trials. Drugs Aging. 2017;34(3):191–201.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Park J, Lavin R, Couturier B. Choice of nonpharmacological pain therapies by ethnically diverse older adults. Pain Manag. 2014;4:389–406.

    Article  PubMed  Google Scholar 

  49. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;4:CD011279.

    PubMed  Google Scholar 

  50. Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38(3):427–49.

    Article  PubMed  Google Scholar 

  51. Martinez-Gomez D, Guallar-Castillon P, Garcia-Esquinas E, Bandinelli S, Rodriguez-Artalejo F. Physical activity and the effect of multimorbidity on all-cause mortality in older adults. Mayo Clin Proc. 2017;92(3):376–82.

    Article  PubMed  Google Scholar 

  52. Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hubscher M. Exercise for chronic musculoskeletal pain: a biopsychosocial approach. Musculoskel Care. 2017;15(4):413–21.

    Article  Google Scholar 

  53. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11:CD007407.

    PubMed  Google Scholar 

  54. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med. 2017;51(2):199–213.

    Article  PubMed  Google Scholar 

  55. Kabat-Zinn J. Full catastrophe living: using the wisdom of the body and mind to face stress, pain and illness. New York: Dell; 1990. 722 p.

    Google Scholar 

  56. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;300:1350–2.

    Article  CAS  PubMed  Google Scholar 

  57. Kabat-Zinn J. Mindfulness-based interventions in context: past, present and future. Clin Psychol Sci Pract. 2003;10:144–56.

    Article  Google Scholar 

  58. Crowe M, Jordan J, Burrell B, Jones V, Gillon D, Harris S. Mindfulness-based stress reduction for long-term physical conditions: a systematic review. Aust NZ J Psychiat. 2016;50(1):21–32.

    Article  Google Scholar 

  59. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169–83.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539–44.

    Article  PubMed  Google Scholar 

  61. Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. Mindfulness based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013;33:763–71.

    Article  PubMed  Google Scholar 

  62. Fordyce WE. Behavioral-science and chronic pain. Postgrad Med J. 1984;60(710):865–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.

    Article  PubMed  Google Scholar 

  64. Wilson IR. Management of chronic pain through pain management programmes. Br Med Bull. 2017;124(1):55–64.

    CAS  PubMed  Google Scholar 

  65. Turk DC, Wilson HD, Cahana A. Treatment of chronic non-cancer pain. Lancet. 2011;377(9784):2226–35.

    Article  CAS  PubMed  Google Scholar 

  66. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. Clin J Pain. 2017;33(6):552–68.

    Article  PubMed  Google Scholar 

  67. Lunde M, Nordhus IH. Combining acceptance and commitment therapy and cognitive behavioral therapy for the treatment of chronic pain in older adults. Clin Case Stud. 2009;10:125–43.

    Google Scholar 

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Authors and Affiliations

  1. Centre for Postgraduate Nursing Studies, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

    Marie Crowe, Deb Gillon, Cate McCall & Jennifer Jordan

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  1. Marie Crowe
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  2. Deb Gillon
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  3. Cate McCall
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  4. Jennifer Jordan
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Correspondence to Marie Crowe .

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  1. School of Humanities, Department of Philosophy and Gender Studies, University of Tasmania, Hobart, TAS, Australia

    Simon van Rysewyk

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Crowe, M., Gillon, D., McCall, C., Jordan, J. (2019). “Pain Takes Over Everything”: The Experience of Pain and Strategies for Management. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-24154-4_4

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