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The Moral Experience of the Person with Chronic Pain

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Meanings of Pain

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Abstract

There is an ethical landscape associated with the understanding and management of the person with chronic pain, which spans a range of structural, policy, educational and clinical issues. This ethical landscape has normative (what one ought to do…) and non-normative (what one actually does…) terrains. Healthcare providers and patients alike encounter a moral tension between these normative and non-normative ethical terrains. This moral tension, if unrecognized and unresolved, can have damaging effects on a person’s sense of ‘self’, sense of agency and therefore their ability to effectively participate in actions and activities required towards better health. The Ethical Reasoning Bridge is an ethical reasoning model that conceptualizes how healthcare providers can negotiate this normative and non-normative ethical landscape in terms of their decision-making in clinical practice. The use of narrative reasoning can assist healthcare providers to support patients to develop narrative capabilities (speaking, acting, telling and imputing personal responsibility for actions). If healthcare providers can learn to negotiate the normative and non-normative ethical terrains which form the landscape of chronic pain ethics, we can assist persons with chronic pain to develop narrative capabilities, and also identify ‘a wider moral space’ (Kleinman in What really matters: living a moral life amidst uncertainty and danger. Oxford University Press, Oxford, 2006) in which they can begin to resolve the moral dilemma they face in having to comply with the normative expectations of others at the cost of denying their own lived experience.

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Notes

  1. 1.

    Intentionality here is a phenomenological term which does not refer to a practical intention to ‘do something’, but instead to the proposition that we have a conscious relationship with an object—externally or in mind or memory—which we interpret and develop meaning about (Larkin et al. 2011).

References

  • Barker P (1992) Regeneration. Penguin books, London

    Google Scholar 

  • Bok H (2001) Freedom and responsibility. Princeton University Press, US

    Google Scholar 

  • Brody H (2002) Stories of sickness. Oxford University Press, Cambridge

    Google Scholar 

  • Brooks D (2015) The moral injury. New York Times, 17 Feb 2015

    Google Scholar 

  • Carel H (2012) Nursing and medicine. In: Luft S, Overgaard S (eds) The routledge companion to phenomenology. Taylor and Francis Group, Routledge, pp 623–632

    Google Scholar 

  • Charon R (2006) Narrative medicine: honoring the stories of illness. Oxford University Press, Oxford

    Google Scholar 

  • Dauenhauer B, Pellauer D (2012) Paul Ricoeur, The Stanford Encyclopedia of Philosophy (Fall 2016 Edition), Edward N. Zalta (ed.), http://plato.stanford.edu/archives/fall2016/entries/ricoeur/.

  • Edwards I, Delany C (2008) Ethical reasoning. In: Higgs J, Jones M, Loftus S, Christensen N (eds) Clinical reasoning in the health professions, 3rd edn. Elsevier, Boston, pp 279–89

    Google Scholar 

  • Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM (2004) Clinical reasoning strategies in physical therapy. Phys Ther 84(4):312–330

    PubMed  Google Scholar 

  • Edwards I, Delany CM, Townsend AF, Swisher LL (2011) Moral agency as enacted justice: a clinical and ethical decision-making framework for responding to health inequities and social injustice. Phys Ther 91(11):1653–1663

    Article  PubMed  Google Scholar 

  • Edwards I, Jones MA, Thacker M, Swisher LL (2014) The moral experience of the patient with chronic pain: bridging the gap between first and third person ethics. Pain Med (15):364–378. doi: 10.1111/pme.12306

    Google Scholar 

  • Epstein RM, Borrell-Carrio F (2005) The biopsychosocial model: exploring six impossible things. Fam Syst Health 23(4):426

    Article  Google Scholar 

  • Fox RC (1994) The entry of U.S. bioethics into the 1990’s: a sociological analysis. In: Dubose ER, Hamel R, O’Connell LJ (eds) A matter of principles? Ferment in U.S. bioethics. Trinity Press International, Valley Forge, pp 21–71

    Google Scholar 

  • Frank AW (2004) The renewal of generosity. University of Chicago Press, Chicago

    Book  Google Scholar 

  • Gallagher L, McCauley J, Moseley GL (2013) A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. Clin J Pain 29(1): 20–5

    Google Scholar 

  • Gillett G (2009) Subjectivity and being somebody: human identity and neuroethics. Imprint Academic

    Google Scholar 

  • Greenhalgh T (2006) What seems to be the trouble?: stories in illness and healthcare: Radcliffe Publishing, Oxford

    Google Scholar 

  • Higgs J, Jones MA, Titchen A (2007) Knowledge, reasoning and evidence for practice. In: Higgs J, Jones M, Loftus S, Christensen N (eds) Clinical reasoning in the health professions, 3rd edn. Elsevier, Boston, pp 151–162

    Google Scholar 

  • Jones AH (1997) Literature and medicine: narrative ethics. Lancet 349:1243–1246

    Article  CAS  PubMed  Google Scholar 

  • Kahneman D (2011) Thinking, fast and slow, 1st edn. Farrar, Straus and Giroux, New York

    Google Scholar 

  • Karp JF (2012) Pain medicine fellows need explicit training in engaging patients in patient-centered pain management. Pain Med 13(8):985–986

    Article  PubMed  Google Scholar 

  • Kleinman A (2006) What really matters: living a moral life amidst uncertainty and danger: living a moral life amidst uncertainty and danger. Oxford University Press, Oxford

    Google Scholar 

  • Komesaroff P (2008) Experiments in love and death: medicine, postmernism, microethics and the body. Melbourne University Press, Melbourne

    Google Scholar 

  • Larkin M, Eatough V, Osborn M (2011) Interpretative phenomenological analysis and embodied, active, situated cognition. Theor Psychol 21(3):318–337

    Article  Google Scholar 

  • Lavie-Ajayi M, Almog N, Krumer-Nevo M (2012) Chronic pain as a narratological distress: a phenomenological study. Chronic Illn 8(3):192–200

    Article  PubMed  Google Scholar 

  • MacIntyre AC (2007) After virtue: a study in moral theory, 3rd edn. University of Notre Dame Press, Notre Dame

    Google Scholar 

  • Mattingly C (2010) The paradox of hope: journeys through a clinical borderland. University of California Press, Chicago

    Google Scholar 

  • McGee SJ, Kaylor BD, Emmott H, Christopher MJ (2011) Defining chronic pain ethics. Pain Med 12(9):1376–1384

    Article  PubMed  Google Scholar 

  • McParland JL, Eccleston C, Osborn M, Hezseltine L (2011) It’s not fair: an interpretative phenomenological analysis of discourses of justice and fairness in chronic pain. Health 15(5):459–474

    Article  PubMed  Google Scholar 

  • Merleau-Ponty M (1962) Phenomenology of perception. Routledge, London

    Google Scholar 

  • Morris DB, Wilson P (2008) The challenges of chronic pain and suffering. In: Wilson P, Watson P, Haythornwaite J, Troels J (eds) Clinical pain management, 2nd edn. CRC Press, Boca Raton, pp 86–98

    Google Scholar 

  • Moseley GL, Butler D (2015) Fifteen years of explaining pain: the past, present and future. J Pain. doi:10.1016/j.jpain.2015.05.005

    Google Scholar 

  • Nussbaum M (2006) Frontiers of justice: disability, nationality, species membership. The Belknap Press of Harvard University Press, Cambridge

    Google Scholar 

  • Osborn M, Smith JA (1998) The personal experience of chronic benign lower back pain: an interpretative phenomenological analysis. Br J Health Psychol 3(1):65–83

    Article  Google Scholar 

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

    Google Scholar 

  • Overmeer T, Boersma K (2016) What messages do patients remember? Relationship among patient perception of physical therapist’s messages, patient characteristics, satisfaction, and outcome. Phys Ther 96(3):275–283

    Article  PubMed  Google Scholar 

  • Relieving Pain in America (2011) A blueprint for transforming prevention, care, education, and research. The National Academies Collection: reports funded by National Institutes of Health, Washington (DC)

    Google Scholar 

  • Ricoeur P (1992) Oneself as another (trans Blamey K.) University of Chicago Press, Chicago

    Google Scholar 

  • Ricoeur P (2005) The course of recognition. Harvard University Press, Cambridge

    Google Scholar 

  • Ricoeur P (2006) Capabilities and rights. In: Nebel M, Sagovsky N (eds) Transforming unjust structures the capability approach. Springer, Dordrecht, pp 17–26

    Google Scholar 

  • Sherman N (2010) Soldiers’ moral wounds. The Chronicle Review. Available via http://www.chronicle.com/article/Soldiers-Moral-Wounds/64987/. Accessed 16 Jan 2017

  • Sherman N (2015) After war: healing the moral wounds of our soldiers. Oxford University Press, USA

    Google Scholar 

  • Singla M, Jones M, Edwards I, Kumar S (2015) Physiotherapists’ assessment of patients’ psychosocial status: are we standing on thin ice? A qualitative descriptive study. Manual Ther 20(2):328–334

    Article  Google Scholar 

  • Smith JA (2011) Evaluating the contribution of interpretative phenomenological analysis. Health Psychol Rev 5(1):9–27

    Article  Google Scholar 

  • Smith DJA, Osborn M (2007) Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Health 22(5):517–534

    Article  Google Scholar 

  • Snelgrove S, Liossi C (2009) An interpretative phenomenological analysis of living with chronic low back pain. Br J Health Psychol 14:735–749

    Article  PubMed  Google Scholar 

  • Snelgrove S, Edwards S, Liossi C (2013) A longitudinal study of patients’ experiences of chronic low back pain using interpretative phenomenological analysis: changes and consistencies. Psychol Health 28(2):121–138

    Article  PubMed  Google Scholar 

  • Vetter TR (2012) Paediatric chronic pain. In: Moore RJ (ed) Handbook of pain and palliative care: biobehavioural approaches for the life course. Springer, New York, pp 147–168

    Google Scholar 

  • Webster L (2014) Pain and suicide: the other side of the opioid story. Pain Med 15:345–346

    Article  PubMed  Google Scholar 

  • White M, Epston D (1990) Narrative means to therapeutic ends. W.W. Norton & Co, New York

    Google Scholar 

Download references

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Authors and Affiliations

  1. School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia

    Ian Edwards

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  1. Ian Edwards
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Correspondence to Ian Edwards .

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Editors and Affiliations

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

    Simon van Rysewyk

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Edwards, I. (2016). The Moral Experience of the Person with Chronic Pain. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-49022-9_12

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