Citation: Blackburn, Alison (2011) Living with Pain or Living in Pain

291 Pages·2016·1.07 MB·English

Citation: Blackburn, Alison (2011) Living with Pain or Living in Pain : Narrative Journeys with
Low Back Pain. Doctoral thesis, Northumbria University.
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Living with Pain or Living in Pain:
Narrative Journeys with Low Back Pain.

Alison N Blackburn

PhD
2010
Abstract

This study used a qualitative method to focus on the perspectives, beliefs and
expectations of low back pain sufferers. The research was undertaken within a hospital
based pain clinic.

In recent years low back pain research has proliferated, and the epidemiological evidence
suggests that back pain is an increasing problem. Much attention has been paid to the
impact of low back pain on the population, and to the increasing cost in economic and
health terms. Biomedical and psychological evidence abounds to shape acute and chronic
management of low back pain, but there is a dearth of information about the viewpoint of
those suffering pain. This study attempted to bring the understanding of the back pain
sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain
on their lifestyle were explored, along with the influence of contextual factors in relation
to how back pain sufferers perceived themselves and how others perceived them.

A narrative method was utilized to illuminate the journey with pain. Nine interviews
were conducted, and the interpretation and presentation of the narratives generated was
influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that
doctorability, agency, control, separation or acceptance of the pain and the concept of
future life were key features within the narratives. The analysis highlighted that for the
majority in this study pain arrived uninvited following a traumatic accident or incident,
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and back pain became a chronic condition. It was always unwanted and initially it was
unexpected as the usual script for pain is one of a transient incapacity followed by
recovery. It was precisely this deviation from the norm that resulted in difficulties for the
people suffering the pain. Biographical differences did not appear to be identifiable in the
themes discerned in the stories, nor in the overall structure.

The narratives showed the complexity of establishing a life with pain, rather than a life in
pain. The participants entered previously unknown territory, and consequently adopted
diverse strategies to maintain relationships, work and interests from their former life as
well as developing new activities and management options. The narratives indicated that
some were more successful than others, and constructed a life with pain. Some were less
successful, and the people lived within severe limits and led very restricted lives, as such
a life in pain. Three central status claims emerged through the narratives: searching for a
cure; resignation; and acceptance, and the research built a conceptual model of different
ways of living with or in pain with reference to these claims.

In conclusion, it is the individuals understanding of their relationship with pain that
shapes that persons life. People differ in their aspirations, backgrounds and experiences,
and the individual stories indicated such differences. ‘Struggles discourse’ provided a
vehicle by which meaningful identity could be rescued from unfavourable circumstances.
This discursive strategy resonated with the idea of identity as a dynamic concept,
illustrated by those with chronic pain when they compared their former healthy self with
their ill self. It is proposed that being encouraged to relinquish aspects of the self that are
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no longer meaningful and incorporate pain related changes to form a new self moves
people from separating from and fighting the pain to resigning to the pain, and ultimately
it is hoped that acceptance to a life with pain can be achieved.

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Acknowledgements

Completing this study would not have been possible without the support and
encouragement of family, friends and colleagues. I am grateful to the many people who
assisted in the completion of this thesis. I am indebted to those who kindly agreed to be
interviewed and gave up their time to do so. Thanks also to the hospital for giving access
to their resources. Thanks to my work colleagues who have provided valuable insights
and encouragement, and generally made working life easier.

I am particularly grateful to my family for their continued support and belief in me. My
husband and children tolerated absences from family life over many years, and through
their understanding and patience a thesis was completed. I would also like to thank my
supervisors Dr Pamela Dawson, Dr Michael Hill, and Dr Colin Chandler who have given
their constant support and guidance, and encouraged me to finish this thesis.

Declaration

I declare that the work contained in this thesis has not been submitted for any other
award and that it is all my own work.
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Table of Contents
Content Page
Abstract 1
Acknowledgements 4
List of tables 12
List of figures 12
List of appendices 13

Chapter 1
Introduction to the study 14 - 23
Background rationale 14
A brief epidemiological review of low back pain 15
The challenge of low back pain 20
Aims of the study 21

Chapter 2
Literature Review 24 – 74
Overview 24
Pain: A Short History of Ideas 25
Pre-scientific models 25
Positivist models (Clinical-Medical) 26
Interpretivist model 28
Scientific-Realist model 30
Operationalising Concepts of Pain 33
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Low Back Pain: A History of Medical Ideas 36
Early thoughts on low back pain 36
Current thoughts on low back pain 38
Epidemiology and treatment of low back pain 38
Living with Low Back Pain 41
Physiological and behavioural effects 42
Anxiety, depression and anger 43
Sense of loss 45
Impact of pain on the sense of self 47
Social Meaning of Low Back Pain 49
Cultural influences 49
Social influences 50
Beliefs about pain 51
Fear of pain 53
Lay v professional views of illness 56
Biomedical expectations and private experiences of pain 58
The importance of legitimacy 59
Causality and diagnosis 62
Narratives of normalisation 64
The concept of transition 65
Illness narratives 67
Disruption of self 68
In summary 72
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Chapter 3
Methodology 75 -114
Overview 75
Philosophical framework 76
An Interpretivist epistemology 76
Narrative 78
Why narrative? 78
Definition and meaning 80
Truthfulness and narrative- the problem of versions 83
Sampling 84
The sample 84
Purposive sampling 84
Ethical issues 89
Privacy, anonymity and confidentiality 90
Data generation 93
Narrative interviews 94
Conceptual framework 96
Interview guide 97
Recording and transcription 98
Truthfulness and respondent validation 100
Narrative analysis 103
Interpretive theory 106
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Appropriation & distanciation 107
Ricoeur’s three phases of analysis 108
Rigour 111

Chapter 4
Recurrent Features of the Stories 115 - 163
Chapter overview 115
Doctorability – the quest to establish medical legitimacy 118
Doctorability and legitimacy 118
Diagnosis and authenticity 122
The importance of diagnosis 124
Agency – Who’s making decisions? 127
Passivity and the medical journey 130
Agency, legitimacy and causation 132
Control / dominance – the pain or me? 135
Bad days 136
Good days 140
Fighting an ongoing battle 144
Paying the consequences 147
Anticipating Futures – where do we go from here? 148
The idea of time 148
Looking for a cure 150
Resignation to the pain 151
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