The development and maintenance of chronic pain and disability : A process theory

Abstract

Chronic pain and associated disability are prevalent problems with considerable and widespread impact. Currently, a wealth of aetiological theories exist for these, with each focussing mainly on one small aspect of this complex area. These theories are summarised and discussed. The theories are generally cross-sectional in nature and usually focus solely on the endpoint of chronic pain and disability, rather than the ongoing processes by which chronic pain and disability are developed and maintained. Process theories are lacking in the chronic pain area. This thesis presents a new theory examining the process involved in the development and maintenance of chronic pain and disability. The theory was derived using grounded theory methods. The participants interviewed were all currently suffering from chronic pain associated with a variety of medical diagnoses. The areas examined with respect to this research were wide-ranging, thus leading to the creation of a broad process theory. This theory encompasses much of the existing chronic pain literature in addition to identifying additional areas for examination. It proposes a data-driven micro model theory which examines the development and maintenance of chronic pain and disability at a process level. The theory of development and maintenance of chronic pain and disability identifies background/vulnerability factors which serve to predispose the individuals to develop chronic pain. These factors are based around the core concept of attachment, and continue, in a similar form, to maintain acute and chronic pain and disability. Once individuals experience pain they enter the acute pain phase of the theory. This identifies treatment beliefs and behaviour as important factors to the development of chronic pain. This section of the theory contains a cyclical treatment process. It is influenced by the background/vulnerability factors, particularly attachment style. If acute pain persists for at least six months, the individuals enter the chronic pain section of this theory. This is again a cyclical management process, primarily driven by the individuals' implicit theories about pain management, which were found to be influenced by the core category of attachment style. The concepts identified in this data-driven theory of the development and maintenance of chronic pain and disability are discussed in relation to the current literature. This includes chronic pain and health-related literature, existing chronic pain theories, and where applicable, general literature in the concept areas. Limitations of the study, directions for future research, and clinical implications are then presented.