Advertisement

Making Sense: Regaining Self-Coherence

  • Bronwyn Lennox ThompsonEmail author
Chapter

Abstract

Chronic pain is a perplexing and confusing experience for both the individual and the clinician. As meaning-making beings, people struggle to make sense of an experience that disrupts the sense of coherence and assumptions about who they are and what they can do. Individuals who successfully make sense of their pain, and can integrate this new reality into their self-concept are able to move forward in life. Findings from a classical grounded theory are used in this chapter to show the importance of making sense of pain as part of a process of regaining self-coherence. The overall process shows that a critical aspect of accepting chronic pain is learning to re-occupy a self-concept that integrates the impact of chronic pain while allowing the individual to express important values through activities in daily life. Clinicians are encouraged to place emphasis on creating a space where being present, listening and explaining can occur so that people living with pain can begin to feel that the world, and their place in it, makes sense.

Keywords

Chronic Pain Chronic Fatigue Syndrome Persistent Pain Illness Representation Diagnostic Label 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abrahams T (2008) Occupation, identity and choice: a dynamic interaction. J Occup Sci 15(3):186–189CrossRefGoogle Scholar
  2. Abraido-Lanza AF (2004) Social support and psychological adjustment among latinas with arthritis: a test of a theoretical model. Ann Behav Med 27(3):162–171. doi: 10.1207/s15324796abm2703_4 CrossRefPubMedPubMedCentralGoogle Scholar
  3. Aldrich S, Eccleston C (2000) Making sense of everyday pain. Soc Sci Med 50(11):1631–1641. doi: 10.1016/S0277-9536(99)00391-3 CrossRefPubMedGoogle Scholar
  4. Allen C, Vassilev I, Kennedy A, Rogers A (2016) Reaching the parts offline support can’t: long-term condition illness work in online communities: a meta-synthesis of qualitative studies. J Med Internet Res 18(3):1–17. doi: 10.2196/jmir.5260
  5. Andrews NE, Strong J, Meredith PJ (2016) The relationship between approach to activity engagement, specific aspects of physical function, and pain duration in chronic pain. Clin J Pain 32(1):20–31CrossRefPubMedGoogle Scholar
  6. Antonovsky A (1996) The salutogenic model as a theory to guide health promotion. Health Promot Int 11(1):11–18. doi: 10.1093/heapro/11.1.11 CrossRefGoogle Scholar
  7. Armentrout DP (1979) The impact of chronic pain on the self-concept. J Clin Psychol 35(3):517–521. doi: 10.1002/1097-4679(197907)35:3%3C517:aid-jclp2270350309%3E3.0.co;2-6 CrossRefPubMedGoogle Scholar
  8. Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, Martin SA (2008) Patient perspectives on the impact of fibromyalgia. Patient Educ Couns 73(1):114–120. doi: 10.1016/j.pec.2008.06.005 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Ashby S, Fitzgerald M, Raine S (2012) The impact of chronic low back pain on leisure participation: implications for occupational therapy. Br J Occup Ther 75(11):503–508. doi: 10.4276/030802212X13522194759897 CrossRefGoogle Scholar
  10. Audulv A, Asplund K, Norbergh KG (2012) The integration of chronic illness self-management. Qual Health Res 22(3):332–345. doi: 10.1177/1049732311430497
  11. Baird AJ, Haslam RA (2013) Exploring differences in pain beliefs within and between a large nonclinical (workplace) population and a clinical (chronic low back pain) population using the pain beliefs questionnaire. Phys Ther. doi: 10.2522/ptj.20120429 PubMedGoogle Scholar
  12. Balague F, Cedraschi C (2006) Radiological examination in low back pain patients: anxiety of the patient? Anxiety of the therapist? Joint Bone Spine: Revue du Rhumatisme 73(5):508–513. doi: 10.1016/j.jbspin.2006.01.005 CrossRefGoogle Scholar
  13. Baumeister RF (1997) Identity, self-concept, and self-esteem: the self lost and found. In: Hogan R, Johnson JA, Briggs SR (eds) Handbook of personality psychology. Academic Press, San Diego, pp 681–710CrossRefGoogle Scholar
  14. Branstetter-Rost A, Cushing C, Douleh T (2009) Personal values and pain tolerance: Does a values intervention add to acceptance? J Pain 10(8):887–892. doi: 10.1016/j.jpain.2009.01.001 CrossRefPubMedGoogle Scholar
  15. Bury M (1982) Chronic illness as biographical disruption. Sociol Health Illn 4(2):167–182. doi: 10.1111/1467-9566.ep11339939 CrossRefPubMedGoogle Scholar
  16. Busch H (2005) Appraisal and coping processes among chronic low back pain patients. Scand J Caring Sci 19(4):396–402CrossRefPubMedGoogle Scholar
  17. Carlisle ACS, John AMH, Fife-Schaw C, Lloyd M (2005) The self-regulatory model in women with rheumatoid arthritis: relationships between illness representations, coping strategies, and illness outcome. Br J Health Psychol 10(4):571–587. doi: 10.1348/135910705X52309 CrossRefPubMedGoogle Scholar
  18. Charmaz K (1995) The body, identity, and self: adapting to impairment. Sociol Q 36(4):657–680. doi: 10.2307/4121346 CrossRefGoogle Scholar
  19. Chisholm A, Nelson PA, Pearce CJ, Keyworth C, Griffiths CE, Cordingley L, Bundy C (2016) The role of personal models in clinical management: exploring health care providers’ beliefs about psoriasis. Br J Health Psychol 21(1):114–134CrossRefPubMedGoogle Scholar
  20. Dahl J (2015) Valuing in ACT. Curr Opin Psychol 2:43–46. doi: 10.1016/j.copsyc.2015.03.001 CrossRefGoogle Scholar
  21. Darlow B, Dowell A, Baxter GD, Mathieson F, Perry M, Dean S (2013) The enduring impact of what clinicians say to people with low back pain. Ann Fam Med 11(6):527–534. doi: 10.1370/afm.1518 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Darlow B, Dean S, Perry M, Mathieson F, Baxter GD, Dowell A (2015) Easy to harm, hard to heal: patient views about the back. Spine 40(11):842–850CrossRefPubMedGoogle Scholar
  23. Diefenbach MA, Leventhal H (1996) The common-sense model of illness representation: theoretical and practical considerations. J Soc Distress Homeless 5(1):11–38. doi: 10.1007/BF02090456 CrossRefGoogle Scholar
  24. Diehl M, Hay EL (2010) Risk and resilience factors in coping with daily stress in adulthood: the role of age, self-concept incoherence, and personal control. Dev Psychol 46(5):1132–1146. doi: 10.1037/a0019937 CrossRefPubMedPubMedCentralGoogle Scholar
  25. Dow CM, Roche PA, Ziebland S (2012) Talk of frustration in the narratives of people with chronic pain. Chronic Illn 8(3):176–191. doi: 10.1177/1742395312443692 CrossRefPubMedGoogle Scholar
  26. Eccleston C, Crombez G (2007) Worry and chronic pain: a misdirected problem solving model. Pain 132(3):233–236. doi: 10.1016/j.pain.2007.09.014 CrossRefPubMedGoogle Scholar
  27. Eriksen TE, Kerry R, Mumford S, Lie SAN, Anjum RL (2013) At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms. Philos Ethics Humanit Med 8(1):11CrossRefPubMedPubMedCentralGoogle Scholar
  28. Fahy E, Hardikar R, Fox A, Mackay S (2013) Quality of patient health information on the internet: reviewing a complex and evolving landscape. Australas Med J 7(1):24–28CrossRefGoogle Scholar
  29. Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ (2010) Factors defining care-seeking in low back pain: a meta-analysis of population based surveys. Eur J Pain 14(7):e1–e7. doi: 10.1016/j.ejpain.2009.11.005 CrossRefGoogle Scholar
  30. Flink IK, Boersma K, MacDonald S, Linton SJ (2012) Understanding catastrophizing from a misdirected problem-solving perspective. Br J Health Psychol 17(2):408–419CrossRefPubMedGoogle Scholar
  31. Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, Underwood M (2014) A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord 15:50CrossRefPubMedPubMedCentralGoogle Scholar
  32. Gauntlett-Gilbert J, Connell H, Clinch J, McCracken LM (2013) Acceptance and values-based treatment of adolescents with chronic pain: outcomes and their relationship to acceptance. J Pediatr Psychol 38(1):72–81CrossRefPubMedGoogle Scholar
  33. Glattacker M, Heyduck K, Meffert C (2012) Illness beliefs, treatment beliefs and information needs as starting points for patient information: evaluation of an intervention for patients with chronic back pain. Patient Educ Couns 86(3):378–389. doi: 10.1016/j.pec.2011.05.028 CrossRefPubMedGoogle Scholar
  34. Graves H, Scott DL, Lempp H, Weinman J (2009) Illness beliefs predict disability in rheumatoid arthritis. J Psychosom Res 67(5):417–423CrossRefPubMedGoogle Scholar
  35. Gray SE, Rutter D (2007) Illness representations in young people with chronic fatigue syndrome. Psychol Health 22(2):159–174CrossRefGoogle Scholar
  36. Hagger MS, Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychol Health 18(2):141–184. doi: 10.1080/088704403100081321 CrossRefGoogle Scholar
  37. Hanley A, Garland E, Canto A, Warner A, Hanley R, Dehili V, Proctor A (2015) Dispositional mindfulness and bias in self-theories. Mindfulness 6(2):202–207CrossRefGoogle Scholar
  38. Hansson KS, Fridlund B, Brunt D, Hansson B, Rask M (2011) The meaning of the experiences of persons with chronic pain in their encounters with the health service. Scand J Caring Sci 25(3):444–450. doi: 10.1111/j.1471-6712.2010.00847.x CrossRefPubMedGoogle Scholar
  39. Harding G, Parsons S, Rahman A, Underwood M (2005) “It struck me that they didn’t understand pain”: the specialist pain clinic experience of patients with chronic musculoskeletal pain. Arthritis & Rheumatism: Arthritis Care & Research, 53(5):691–696. doi: 10.1002/art.214515
  40. Hellstrom C (2001) Temporal dimensions of the self-concept: entrapped and possible selves in chronic pain. Psychol Health 16(1):111–124. doi: 10.1080/08870440108405493 CrossRefGoogle Scholar
  41. Jackson PL, Meltzoff AN, Decety J (2005) How do we perceive the pain of others? A window into the neural processes involved in empathy. Neuroimage 24(3):771–779CrossRefPubMedGoogle Scholar
  42. Jakobsen K, Lillefjell M (2014) Factors promoting a successful return to work: from an employer and employee perspective. Scand J Occup Ther 21(1):48–57. doi: 10.3109/11038128.2013.857717 PubMedGoogle Scholar
  43. Jensen LF, Hvidberg L, Pedersen AF, Aro AR, Vedsted P (2015) Time from first symptom experience to help seeking for colorectal cancer patients: associations with cognitive and emotional symptom representations. Patient Educ Couns 99(5):807–813. doi: 10.1016/j.pec.2015.11.013
  44. Jutel A (2009) Sociology of diagnosis: a preliminary review. Sociol Health Illn 31(2):278–299CrossRefPubMedGoogle Scholar
  45. Kanaan RA, Armstrong D, Wessely SC (2012) The function of ‘functional’: a mixed methods investigation. J Neurol Neurosurg Psychiatry 83(3):248–250. doi: 10.1136/jnnp-2011-300992 CrossRefPubMedPubMedCentralGoogle Scholar
  46. Kindermans HP, Goossens ME, Roelofs J, Huijnen IP, Verbunt JA, Morley S, Vlaeyen JW (2010) A content analysis of ideal, ought, and feared selves in patients with chronic low back pain. Eur J Pain 14(6):648–653. doi: 10.1016/j.ejpain.2009.10.012 CrossRefPubMedGoogle Scholar
  47. Kindermans HP, Huijnen IP, Goossens ME, Roelofs J, Verbunt JA, Vlaeyen JW (2011) “Being” in pain: the role of self-discrepancies in the emotional experience and activity patterns of patients with chronic low back pain. Pain 152(2):403–409. doi: 10.1016/j.pain.2010.11.009 CrossRefPubMedGoogle Scholar
  48. Kitchens B, Harle CA, Li S (2014) Quality of health-related online search results. Decis Support Syst 57:454–462. doi: 10.1016/j.dss.2012.10.050 CrossRefGoogle Scholar
  49. Kothari DJ, Davis MC, Yeung EW, Tennen HA (2015) Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia. Pain 156(3):540–546CrossRefPubMedGoogle Scholar
  50. Lachapelle DL, Lavoie S, Boudreau A (2008) The meaning and process of pain acceptance. Perceptions of women living with arthritis and fibromyalgia. Pain Res Manag 13(3):201–210CrossRefPubMedPubMedCentralGoogle Scholar
  51. Large R, Strong J (1997) The personal constructs of coping with chronic low back pain: is coping a necessary evil? Pain 73(2):245–252. doi: 10.1016/S0304-3959(97)00100-0 CrossRefPubMedGoogle Scholar
  52. Larsen EL, Nielsen CV, Jensen C (2013) Getting the pain right: how low back pain patients manage and express their pain experiences. Disabil Rehabil Int Multidiscip J 35(10):819–827CrossRefGoogle Scholar
  53. Lee BO, Chaboyer W, Wallis M (2010) Illness representations in patients with traumatic injury: a longitudinal study. J Clin Nurs 19(3–4):556–563Google Scholar
  54. Lempp H, Scott D, Kingsley G (2006) The personal impact of rheumatoid arthritis on patients’ identity: a qualitative study. Chronic Illn 2(2):109–120. doi: 10.1177/17423953060020020601 CrossRefPubMedGoogle Scholar
  55. Lempp HK, Hatch SL, Carville SF, Choy EH (2009) Patients’ experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study. BMC Musculoskelet Disord 10:124CrossRefPubMedPubMedCentralGoogle Scholar
  56. Leos C, Khan CM, Rini C (2016) Understanding self-management behaviors in symptomatic adults with uncertain etiology using an illness perceptions framework. J Behav Med 39(2):310–319CrossRefPubMedGoogle Scholar
  57. Leventhal H, Diefenbach M, Leventhal EA (1992) Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res 16(2):143–163. doi: 10.1007/BF01173486 CrossRefGoogle Scholar
  58. Lillrank A (2003) Back pain and the resolution of diagnostic uncertainty in illness narratives. Soc Sci Med 57(6):1045–1054. doi: 10.1016/S0277-9536%2802%2900479-3 CrossRefPubMedGoogle Scholar
  59. Löfvander MB, Engström AW (2004) “Unable and useless” or “able and useful”? A before and after study in the primary care of self-rated inability to work in young immigrants having long-standing pain. J Back Musculoskelet Rehabil 17(3–4):91–100CrossRefGoogle Scholar
  60. Maly MR, Krupa T (2007) Personal experience of living with knee osteoarthritis among older adults. Disabil Rehabil Int Multidiscip J 29(18):1423–1433. doi: 10.1080/09638280601029985 CrossRefGoogle Scholar
  61. McCracken LM (2010) Toward understanding acceptance and psychological flexibility in chronic pain. Pain 149(3):420–421. doi: 10.1016/j.pain.2010.02.036 CrossRefPubMedGoogle Scholar
  62. McCracken LM, Jones R (2012) Treatment for chronic pain for adults in the seventh and eighth decades of life: a preliminary study of acceptance and commitment therapy (ACT). Pain Med 13(7):860–867. doi: 10.1111/j.1526-4637.2012.01407.x CrossRefPubMedGoogle Scholar
  63. McCracken LM, Keogh E (2009) Acceptance, mindfulness, and values-based action may counteract fear and avoidance of emotions in chronic pain: an analysis of anxiety sensitivity. J Pain 10(4):408–415. doi: 10.1016/j.jpain.2008.09.015 CrossRefPubMedGoogle Scholar
  64. McCracken LM, Velleman SC (2010) Psychological flexibility in adults with chronic pain: a study of acceptance, mindfulness, and values-based action in primary care. Pain 148(1):141–147. doi: 10.1016/j.pain.2009.10.034 CrossRefPubMedGoogle Scholar
  65. McCracken LM, Vowles KE (2014) Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol 69(2):178–187. doi: 10.1037/a0035623 CrossRefPubMedGoogle Scholar
  66. McCracken LM, Yang SY (2006) The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain 123(1–2):137–145. doi: 10.1016/j.pain.2006.02.021
  67. McPherson KM, Brander P, Taylor WJ, McNaughton HK (2004) Consequences of stroke, arthritis and chronic pain—are there important similarities? Disabil Rehabil 26(16):988–999CrossRefPubMedGoogle Scholar
  68. Mengshoel AM, Heggen K (2004) Recovery from fibromyalgia—previous patients’ own experiences. Disabil Rehabil 26(1):46–53CrossRefPubMedGoogle Scholar
  69. Morley S, Davies C, Barton S (2005) Possible selves in chronic pain: self-pain enmeshment, adjustment and acceptance. Pain 115(1–2):84–94. doi: 10.1016/j.pain.2005.02.021 CrossRefPubMedGoogle Scholar
  70. Newton BJ, Southall JL, Raphael JH, Ashford RL, LeMarchand K (2013) A narrative review of the impact of disbelief in chronic pain. 14(3):161–171. doi: 10.1016/j.pmn.2010.09.001
  71. Paez-Blarrina M, Luciano C, Gutierrez-Martinez O, Valdivia S, Rodriguez-Valverde M, Ortega J (2008) Coping with pain in the motivational context of values: comparison between an acceptance-based and a cognitive control–based protocol. Behav Modif 32(3):403–422. doi: 10.1177/0145445507309029 CrossRefPubMedGoogle Scholar
  72. Persson D, Andersson IH, Eklund M (2011) Defying aches and revaluating daily doing: occupational perspectives on adjusting to chronic pain. Scand J Occup Ther 18(3):188–197. doi: 10.3109/11038128.2010.509810 CrossRefPubMedGoogle Scholar
  73. Pickett S, Allen W, Franklin M, Peters RM (2014) Illness beliefs in African Americans with hypertension. West J Nurs Res 36(2):152–170CrossRefPubMedGoogle Scholar
  74. Poulsen A, Johnson H, Ziviani J (2011) Participation, self-concept and motor performance of boys with developmental, coordination disorder: a classification and regression tree analysis approach. Aust Occup Ther J 58(2):95–102CrossRefPubMedGoogle Scholar
  75. Ressler PK, Bradshaw YS, Gualtieri L, Chui KKH (2012) Communicating the experience of chronic pain and illness through blogging. J Med Internet Res 14(5):249–262CrossRefGoogle Scholar
  76. Rogers A, Allison T (2004) What if my back breaks?: Making sense of musculoskeletal pain among South Asian and African-Caribbean people in the North West of England. J Psychosom Res 57(1):79–87. doi: 10.1016/S0022-3999(03)00570-1 CrossRefPubMedGoogle Scholar
  77. Salvadorini G, Bandinelli F, Delle Sedie A, Riente L, Candelieri A, Generini S, Matucci-Cerinic M (2012) Ankylosing spondylitis: how diagnostic and therapeutic delay have changed over the last six decades. Clin Exp Rheumatol 30(4):561–565PubMedGoogle Scholar
  78. Scollan-Koliopoulos M, Walker EA, Rapp KJ (2011) Self-regulation theory and the multigenerational legacy of diabetes. Diabetes Educ 37(5):669–679CrossRefPubMedPubMedCentralGoogle Scholar
  79. Seear K (2009) The etiquette of endometriosis: stigmatisation, menstrual concealment and the diagnostic delay. Soc Sci Med 69(8):1220–1227CrossRefPubMedGoogle Scholar
  80. Sheridan NF, Kenealy TW, Kidd JD, Schmidt-Busby JIG, Hand JE, Raphael DL, Rea HH (2015) Patients’ engagement in primary care: powerlessness and compounding jeopardy. A qualitative study. Health Expect 18(1):32–43. doi: 10.1111/hex.12006 CrossRefPubMedGoogle Scholar
  81. Siddall PJ, Cousins MJ (2004) Persistent pain as a disease entity: implications for clinical management. Anesth Analg 99(2):510–520. doi: 10.1213/01.ane.0000133383.17666.3a CrossRefPubMedGoogle Scholar
  82. Skinner M, Wilson HD, Turk DC (2012) Cognitive-behavioral perspective and cognitive-behavioral therapy for people with chronic pain: distinctions, outcomes, and innovations. J Cogn Psychother 26(2):93–113. doi: 10.1891/0889-8391.26.2.93 CrossRefGoogle Scholar
  83. Smedley R, Coulson N, Gavin J, Rodham K, Watts L (2015) Online social support for complex regional pain syndrome: a content analysis of support exchanges within a newly launched discussion forum. Comput Hum Behav 51:53–63CrossRefGoogle Scholar
  84. Strong J, Large R (1995) Coping with chronic low back pain: an idiographic exploration through focus groups. Int J Psychiatry Med 25(4):371–387. doi: 10.2190/H4P9-U5NB-2KJU-4TBN CrossRefPubMedGoogle Scholar
  85. Sutherland R, Morley S (2008) Self-pain enmeshment: Future possible selves, sociotropy, autonomy and adjustment to chronic pain. Pain 137(2):366–377. doi: 10.1016/j.pain.2007.09.023 CrossRefPubMedGoogle Scholar
  86. Thacker MA, Moseley GL (2012) First-person neuroscience and the understanding of pain. Med J Aust 196(6):410–411CrossRefPubMedGoogle Scholar
  87. Thompson BL (2015) Living well with chronic pain (Ph.D.). University of Canterbury, ChristchurchGoogle Scholar
  88. Van Damme S, Crombez G, Eccleston C (2008) Coping with pain: a motivational perspective. Pain 139(1):1–4. doi: 10.1016/j.pain.2008.07.022 CrossRefPubMedGoogle Scholar
  89. Vowles KE, McCracken LM, O’Brien JZ (2011) Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther 49(11):748–755. doi: 10.1016/j.brat.2011.08.002 CrossRefPubMedGoogle Scholar
  90. Werner A, Malterud K (2003) It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med 57(8):1409–1419. doi: 10.1016/S0277-6536(02)00520-8 CrossRefPubMedGoogle Scholar
  91. WFOT (2010, 2011) Definition “occupation”. Retrieved from http://www.wfot.org/aboutus/aboutoccupationaltherapy/definitionofoccupationaltherapy.aspx
  92. White AK, Johnson M (2000) Men making sense of their chest pain–niggles, doubts and denials. J Clin Nurs 9(4):534–541. doi: 10.1046/j.1365-2702.2000.00413.x CrossRefPubMedGoogle Scholar
  93. Wong EC, Kennedy D, Marshall GN, Gaillot S (2011) Making sense of posttraumatic stress disorder: illness perceptions among traumatic injury survivors. Psychol Trauma Theory Res Pract Policy 3(1):67–76CrossRefGoogle Scholar
  94. Ziebland S, Lavie-Ajayi M, Lucius-Hoene G (2014) The role of the Internet for people with chronic pain: examples from the DIPEx international project. Br J Pain 9(1):62–64. doi: 10.1177/2049463714555438

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and Musculoskeletal MedicineUniversity of OtagoChristchurchNew Zealand

Personalised recommendations