The Moral Experience of the Person with Chronic Pain

  • Ian EdwardsEmail author


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.


Chronic Pain Healthcare Provider Moral Dilemma Normative Expectation Healthcare Practitioner 
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  1. Barker P (1992) Regeneration. Penguin books, LondonGoogle Scholar
  2. Bok H (2001) Freedom and responsibility. Princeton University Press, USGoogle Scholar
  3. Brody H (2002) Stories of sickness. Oxford University Press, CambridgeGoogle Scholar
  4. Brooks D (2015) The moral injury. New York Times, 17 Feb 2015Google Scholar
  5. Carel H (2012) Nursing and medicine. In: Luft S, Overgaard S (eds) The routledge companion to phenomenology. Taylor and Francis Group, Routledge, pp 623–632Google Scholar
  6. Charon R (2006) Narrative medicine: honoring the stories of illness. Oxford University Press, OxfordGoogle Scholar
  7. Dauenhauer B, Pellauer D (2012) Paul Ricoeur, The Stanford Encyclopedia of Philosophy (Fall 2016 Edition), Edward N. Zalta (ed.),
  8. 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 279–89Google Scholar
  9. Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen GM (2004) Clinical reasoning strategies in physical therapy. Phys Ther 84(4):312–330PubMedGoogle Scholar
  10. 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):1653–1663CrossRefPubMedGoogle Scholar
  11. 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
  12. Epstein RM, Borrell-Carrio F (2005) The biopsychosocial model: exploring six impossible things. Fam Syst Health 23(4):426CrossRefGoogle Scholar
  13. 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 21–71Google Scholar
  14. Frank AW (2004) The renewal of generosity. University of Chicago Press, ChicagoCrossRefGoogle Scholar
  15. 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): 20–5Google Scholar
  16. Gillett G (2009) Subjectivity and being somebody: human identity and neuroethics. Imprint AcademicGoogle Scholar
  17. Greenhalgh T (2006) What seems to be the trouble?: stories in illness and healthcare: Radcliffe Publishing, OxfordGoogle Scholar
  18. 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 151–162Google Scholar
  19. Jones AH (1997) Literature and medicine: narrative ethics. Lancet 349:1243–1246CrossRefPubMedGoogle Scholar
  20. Kahneman D (2011) Thinking, fast and slow, 1st edn. Farrar, Straus and Giroux, New YorkGoogle Scholar
  21. Karp JF (2012) Pain medicine fellows need explicit training in engaging patients in patient-centered pain management. Pain Med 13(8):985–986CrossRefPubMedGoogle Scholar
  22. 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, OxfordGoogle Scholar
  23. Komesaroff P (2008) Experiments in love and death: medicine, postmernism, microethics and the body. Melbourne University Press, MelbourneGoogle Scholar
  24. Larkin M, Eatough V, Osborn M (2011) Interpretative phenomenological analysis and embodied, active, situated cognition. Theor Psychol 21(3):318–337CrossRefGoogle Scholar
  25. Lavie-Ajayi M, Almog N, Krumer-Nevo M (2012) Chronic pain as a narratological distress: a phenomenological study. Chronic Illn 8(3):192–200CrossRefPubMedGoogle Scholar
  26. MacIntyre AC (2007) After virtue: a study in moral theory, 3rd edn. University of Notre Dame Press, Notre DameGoogle Scholar
  27. Mattingly C (2010) The paradox of hope: journeys through a clinical borderland. University of California Press, ChicagoGoogle Scholar
  28. McGee SJ, Kaylor BD, Emmott H, Christopher MJ (2011) Defining chronic pain ethics. Pain Med 12(9):1376–1384CrossRefPubMedGoogle Scholar
  29. 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):459–474CrossRefPubMedGoogle Scholar
  30. Merleau-Ponty M (1962) Phenomenology of perception. Routledge, LondonGoogle Scholar
  31. 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 86–98Google Scholar
  32. 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
  33. Nussbaum M (2006) Frontiers of justice: disability, nationality, species membership. The Belknap Press of Harvard University Press, CambridgeGoogle Scholar
  34. Osborn M, Smith JA (1998) The personal experience of chronic benign lower back pain: an interpretative phenomenological analysis. Br J Health Psychol 3(1):65–83CrossRefGoogle Scholar
  35. 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):216–22Google Scholar
  36. 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):275–283CrossRefPubMedGoogle Scholar
  37. 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
  38. Ricoeur P (1992) Oneself as another (trans Blamey K.) University of Chicago Press, ChicagoGoogle Scholar
  39. Ricoeur P (2005) The course of recognition. Harvard University Press, CambridgeGoogle Scholar
  40. Ricoeur P (2006) Capabilities and rights. In: Nebel M, Sagovsky N (eds) Transforming unjust structures the capability approach. Springer, Dordrecht, pp 17–26Google Scholar
  41. Sherman N (2010) Soldiers’ moral wounds. The Chronicle Review. Available via Accessed 16 Jan 2017
  42. Sherman N (2015) After war: healing the moral wounds of our soldiers. Oxford University Press, USAGoogle Scholar
  43. 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):328–334CrossRefGoogle Scholar
  44. Smith JA (2011) Evaluating the contribution of interpretative phenomenological analysis. Health Psychol Rev 5(1):9–27CrossRefGoogle Scholar
  45. 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):517–534CrossRefGoogle Scholar
  46. Snelgrove S, Liossi C (2009) An interpretative phenomenological analysis of living with chronic low back pain. Br J Health Psychol 14:735–749CrossRefPubMedGoogle Scholar
  47. 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):121–138CrossRefPubMedGoogle Scholar
  48. 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 147–168Google Scholar
  49. Webster L (2014) Pain and suicide: the other side of the opioid story. Pain Med 15:345–346CrossRefPubMedGoogle Scholar
  50. White M, Epston D (1990) Narrative means to therapeutic ends. W.W. Norton & Co, New YorkGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.School of Health SciencesUniversity of South AustraliaAdelaideAustralia

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