Abstract
Purpose: There is little theory to explain how and why some people cope well despite chronic pain. This study proposes a mid-level theoretical explanation for those that cope well, shedding light on factors relevant to acceptance.
Method: Classical grounded theory methodology was closely followed to generate a theory grounded in data obtained from community-dwelling people self-identified as living well despite chronic pain.
Results: The main concern of people experiencing chronic pain is resolving the problem of disrupted self-coherence. Resolution involves re-occupying self by (1) making sense of pain using an idiographic model; (2) deciding to turn from patient to person, facilitated or hindered by interactions with clinicians and occupational drive; and (3) flexibly persisting, where occupational engaging and coping allow individuals to develop future plans.
Conclusions: This theory demonstrates the importance of engaging in occupation during rehabilitation by framing chronic pain adjustment within a process of renegotiating the self-concept. Occupations allow individuals to express values important to their sense of self. Coping strategies are used to enable occupation and are judged by their workability in this context. When developing goals and plans with people living with pain, rehabilitation professionals should consider an individual's position within the processes involved in learning to live well.
Implication for rehabilitation
Living well with chronic pain involves a process of making sense, deciding to move on with life, and flexibly persisting.
Diagnosis should be accompanied by messages about hurt and harm not being equivalent, and the need for a lifelong approach to managing a chronic problem.
An idiographic depiction or formulation of a person's pain and disability provides opportunities for making sense of symptoms and collaborating on treatment goals.
Remaining supportive, providing "small acts" demonstrating that the person is unique and being thought of, and encouraging engagement in valued occupations allows patients to experiment with, and start to engage in what is important in their lives.
Clinicians should help people extend their coping repertoire and encourage flexibility with how these are applied in the pursuit of valued occupations.
The positive motivation that comes from individuals identifying highly valued occupations is an aspect that all clinicians, but particularly occupational therapists, should recognize.