This study uses a phenomenological methodology underpinned by the philosophy of Martin Heidegger to explore the lived and living experience of patients with chronic pain. Pain is a universal phenomenon shared by all and yet is very difficult to define. It can be regarded as a physical sensation, an emotion or even interpreted as punishment for the sufferers 'misdeeds'. There have been many attempts to define the phenomenon with the accepted definition now being that of the International Association into the Study of Pain (IASP) (1994; 1979) that states that pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue damage or described in terms of such damage. This definition attempts to incorporate the multi-dimensional aspects of the pain experience including the range of psychological factors that can influence the experience.
Pain is then further classified into acute or chronic pain. Acute pain is often taken to mean the sudden severe pain which accompanies injury or disease. Chronic pain, however, is pain that persists beyond the time of expected healing often without cause (IASP, 1994). Such chronic pain is believed to serve no useful purpose and although there may be a history of an initial injury or trauma, the pain endures longer than the usual healing period. Pain is considered to be chronic in nature if it persists for more than three months. 'Chronic pain syndrome' is a phrase that has been used to further define the context of chronic pain in terms of a psychosocial disorder where the patients' central
focus is solely their pain (Middleton 2004). Sanders et al (2005: 304) further define chronic pain syndrome as a pattern of behaviours that "involves the complaint of enduring or recurring pain; has persisted longer than typical for an associated condition, or is associated with an intermittent or chronic disease process; has responded inadequately to appropriate medical and/or invasive care; and is associated with significant and reliable impairment of functional status". They also state that chronic pain patients may show mood disturbance, anger or hostility; however, these are not essential to confirm a diagnosis of chronic pain. Main and Spanswick (2000: 57) would prefer the use of the term "psychologically mediated pain syndrome" which further indicates that
psychological factors have been specifically investigated and proven. Chronic pain is then sub-classified into non-malignant and malignant chronic pain. Within the context of this study, the phrase 'chronic pain' is used to indicate pain that has been present for at least three months and for which there is no longer any known pathological cause.
The differences between acute and chronic pain may explain why some health
professionals have difficulty in understanding the chronic pain phenomenon and that is because they have not experienced the relentless onslaught that typifies chronic pain. Acute pain although being a universally shared human experience can be experienced at different levels, with the acute pain having been caused through injury or injuries of varying severity. For example not all people will have experienced the acute pain felt after a surgical procedure; however, most people will have experienced, at some time in their lives, the acute pain of trapping their finger in a door. This does not mean that all health professionals can empathise with the acute pain experience and despite the observation by Thomas (2000) who states that nurses who have personally suffered pain
are more sympathetic to the patient in pain, it is not practical to ensure that only those health professionals who have personally experienced surge1y should care for those patients having surgery. Even if this recommendation could be enforced there will always be the issue of health professionals comparing how they managed a personal pain experience against the patient's experience and potentially finding that the patient is not achieving the same degree of pain control. This then could lead to the health professional "disbelieving" the patient and assuming the patient to be unnecessarily exaggerating their pain. The issues around believing a patient's pain experience are many and this is the
central focus of this thesis.
This research reported here originated from a desire to discover what it was like to live with chronic pain. As a clinical nurse specialist in pain management I was accustomed to assessing patients with acute and chronic pain, and believed that I was able to differentiate between the varying effects that different types of pain had upon people. Of interest also, was the different ways in which people managed their own pain, some people appearing to cope well with their pain and still enjoying life whilst others seemed to struggle more. This view, however, was generated from knowing these patients within the context of the pain clinic. It was therefore of further interest to explore their living experience of chronic pain through using a daily diary which chronicled patients' lives as they were lived, outside of the pain clinic setting. Although van Manen (1990: 36) argued
that the concept of' living experience' does not exist as it "can never be grasped in its immediate manifestation but only reflected as past presence". From interviews alone this may be true as the patients were asked to detail their life with chronic pain whereas the diaries allowed for reflection, if the patient chose, whilst giving them an opportunity to present their lives to me as researcher whilst it was being lived with chronic pain.
As all patients recruited to the study were known personally to the researcher there was an assumption that there was already an established relationship between the patient and myself as their nurse. Thus the role of nurse as researcher was one used to full advantage during the interview process which was based on a phenomenological framework was low in preliminary structure but highly focused on the lived experience of chronic pain.
Patients frequently express relief at ' being believed' by health professionals involved in pain management. This apparent need to feel that their pain story is credible appears to be unique to chronic pain patients. The invisibility of the pain, the lack of a diagnosis or label and the accompanying psychological problems can lead a patient to feel isolated, depressed, or even that the pain is "all in their imagination". Having someone believe their account about their chronic pain problem possibly helps patients to take the first step forward in learning to manage their pain instead of being managed by the pain.
There are voluminous amounts of literature pertaining to chronic pain and some studies do explore the lived experience of chronic pain (Blomqvist and Edberg, 2002; Thomas, 2000; Hellstrom and Carlsson, 1996; Seers and Friedli, 1996), this study contributes to that body of knowledge by providing illuminating findings that may provide a deeper understanding and empathic insight into a phenomenon which can disable patients mentally, physically and emotionally.