A qualitative exploration of experiences of communication for people living with chronic pain using interpretative phenomenological analysis (IPA)

1. COMMUNICATING CHRONIC PAIN
K A T E R I N A P A P A D O P O U L O U S U P E R V I S E D B Y D R S U S A N E U S T A C E
D O C T O R A T E I N C O U N S E L L I N G P S Y C H O L O G Y T R I N I T Y C O L L E G E D U B L I N 2 0 1 8
A Q U A L I T A T I V E E X P L O R A T I O N O F E X P E R I E N C E S O F C O M M U N I C A T I O N F O R P E O P L E
L I V I N G W I T H C H R O N I C P A I N , U S I N G I N T E R P R E T A T I V E P H E N O M E N O L O G I C A L A N A L Y S I S
( I P A )

2. WHERE THE CURRENT RESEARCH FALLS IN THE CONTEXT OF
LITERATURE REVIEW
Deficit in the identification, measurement, description and communication of chronic pain ( paradox)
Pain: sensation, emotion, cognition, action tendency
The biopsychosocial perspective of chronic pain
In a psychological framework rehabilitation and pain management can be seen as a dyadic emotion regulation process of communication
Inability to predict what actually constitutes successful communication of chronic pain. In different instances communication of chronic
pain can be perceived as “pain talk” or “emotional disclosure”, “functional communication” or “an organic, implicit process”.

3. WHERE THE CURRENT RESEARCH FALLS IN THE CONTEXT OF
LITERATURE REVIEW
Aim: Prioritize the phenomenological uniqueness of each of the participants who are going to contribute with their
everyday truth to the truth about chronic pain. Beyond theoretical structures of communication models :
o The developmental and evolutionary perspective (Berg & Upchurch, 2007). - The operant model (Fordyce, 1976),
o Pain Empathy Model (Goubert, Vervoort, & Craig, 2013)
o The Communication Model of Pain (biopsychosocial perception of pain (Hadjistavropoulos et al., 2011).
An open call for a discipline like counselling psychology which values the idiosyncratic, dyadic, cultural and social
understanding of human phenomena. Focus on wellbeing instead of “cure”.

4. RESEARCH QUESTION
The interviews attempted to explore the experience of people with chronic pain in relation to the everyday understanding of
contact – to touch, to meet, to communicate with another person
I feel that the literature review culminates in the domain of communication of chronic pain, by providing not answers but
definitely a dialectical way of thinking of, referring to, and hopefully living with chronic pain.

5. RESEARCH DESIGN AND RATIONALE
Ontological assumption of multiple truths and multiple realities
IPA : allows focus on the experience of chronic pain and sense making , instead of creating an illness narrative or a life
history
Embodied phenomenology
Analysing a process of metacommunication (communicating the experience of communication)

6. RESEARCH Volunteers Needed:
Katerina is a trainee Counselling
Psychologist at Trinity College Dublin.
Currently researching the challenges
of communicating Chronic Pain. If you
are interested in finding out more
about how to take part, please send
an email to: papadopa@tcd.ie

7. INTERVIEW PROCEDURE
Informed consent form.
Demographic details and a personal pain history (in their own words and not in a medical/formal way).
Interview questions were suggestive and not prescriptive.
Debriefing and provision of additional information.

8. How is communication of chronic pain experienced by the people in pain
1.Can you tell me what role do you feel
communicating your pain plays in your life?
6.How did you see your pain in that
communication?
2.Now can you please describe your experience of
a time that stands out when you communicated
your pain to somebody else?
7.Talking to me now about that particular
experience, what stands out for you?
3.To what extent do you consider that you
communicated your pain successfully in that
particular time?
8.What, if anything, would you change about that
particular communication/experience?
4.How did you see yourself in that
communication?
9. Have you ever had an experience of
communicating your pain to a mental health
professional – does it stand out?
5.How did you see the other person in that
communication?
10. Is there anything else you would like to add on
your experience ?

9. PARTICIPANTS
Recruitment - Chronic Pain Association Ireland sent an invitation letter to members of their association and made a public call
(Facebook, Twitter, webpage).
Participants were requested to contact the researcher individually.
13 participants ( 10 women/3 men)
Age range from 24-55 (mean of age:38,2)
Years in chronic pain from 4 till 30 ( mean of years: 9,9)
No specific chronic pain diagnosis – no pain measure used

10. RESULTING THEMES
Superordinate Themes Subordinate Themes
1. Discouraged and Traumatized in an
undeclared battlefield
1a. “It’s a total minefield”
1b. “You just want to scream ”
1. Arriving at and departing from a
shared identity
2a. “Fellow travellers”
2b. I am not the typical patient”
1. Motivated growth: rising above the
pain
3a “Making chronic pain a long term
positive”
3b. “Let’s talk to the world”

11. DISCOURAGED AND TRAUMATIZED IN AN UNDECLARED BATTLEFIELD
Communication : unwanted, unpleasant and an option of last resort.
A sense of ambivalence and lonely fighting where words are a nuisance or luxury.
Their pain was compounded by relational traumas of ruptured/blocked communication. These traumas run the
risk of falling out of sight because of their repetitive occurrence.
Words can be felt as irrelevant or painful, while they valued an organic meeting and sharing of activities.
Feelings, following successful communication, were filtered by traumatized people, thus they were mainly:
vindication and relief.

12. Contrary to previous publications
distinguishing different types of
communication depending on its
quality and intentions (emotional
disclosure was separated from pain
talk), in this study both types blend
and what stands out is their decision
to refrain from engaging in either if
possible
Trauma dialectic: a clear conflict in
needs: “I want to be left alone” and “I
feel left out”
Disbelief, misunderstanding
,isolation, withdrawal and lack of
connection are among the major
concerns in living in pain
Narratological distress: when
the bodily knowledge is met with
social denial (Lavie-Ajayi, Almog,
& Krumer-Nevo, 2012,
DISCUSSION

13. ARRIVING AT AND DEPARTING FROM A SHARED IDENTITY
How participants perceive themselves in relation to fellow sufferers people.
An interactive strong but contextually limited communication/bond develops
Strong feelings of connection and separation highlight the ambivalence and loneliness, in their
search for identity.

14. MOTIVATED FOR GROWTH: RISING ABOVE THE PAIN
Transcendence, and gradual transformation in the form of internal communication.
Reframing the journey of suffering as one of “enlightenment”.
This self-reliance was depicted as deliberate and well-organized.
The protective function of positivity, distraction and humor
Desire to promote awareness and lessons learnt through their experiences.
Unlike the previous two themes, this theme is future-oriented and refers to growth as a process under
progress, revealing participants’ aspirations/goals.

15. DISCUSSION
The experience of self-growth following trauma and/or chronic illness has been reported in previous studies
(Asbring, 2001; Barker, 2002, Lynch, Sloane, Sinclair, & Bassett, 2013).
The process of self- communication has been noted by Frank (2013) who felt that chronic illness triggers a
“perpetual self-reflection”
Unlike a study by Thomas and Johnson (2000) depicting humor as a superficial way of preserving normalcy in
their interactions participants in this study appeared to be immunized through humor as they were able to
accept/ name both the pain and the potential growth in their experiences.

16. CONTRIBUTIONS
Theoretical : can communicating chronic pain be established as a relational trauma on its own ? Previous literature has
focused on attachment traumas as predisposing or exacerbating factors for developing chronic pain
Practical : Psychologists, need to be aware of the potential resistance and lack of desire to engage in therapy as a result of
the chronic debilitating condition and the struggles of reaching a diagnosis, so normalizing therapy and reaching out
would be the first line of approach- self disclosure would facilitate engagement
Group setting of therapy in the context of shared activities
The application of Rothschild’s work (2000) on somatic empathy in the field of chronic pain would achieve the grounding of
both the therapist and the patient, recognizing the significance of the physical aspect of communication.

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