“Managing Pain by Tradition”: a constructivist grounded theory study exploring how patients live with and manage their pain

Living with persistent unresolved chronic pain is known to negatively impact on a person’s physical, psychological, and social well-being. Chronic pain associated with chronic leg wounds or ulcers can affect up to 65% of patients. Consensus in the literature recognises diverse challenges posed by this pervasive symptom, warranting a greater clinical understanding into what might influence social processes to inform how patients living with chronic venous leg ulcers manage their pain. The overarching aim of grounded theory is to develop theory from data, developing concepts to understand data with a view towards theory development. Existing grounded theory studies have explored this topic, though none with a constructivist-led approach allowing for a flexible, shared negotiation using co-constructive processes between the researcher and participant to interpret meaning. This Irish study applied Charmaz’ approach to the grounded theory method to explore this phenomenon and elicit a greater understanding of patient experience and perception living with and managing their chronic pain as they do. Core grounded theory strategies (simultaneous data collection and analyses, constant comparison method, theoretical sampling, theoretical coding, theoretical saturation) drove theory, grounded in interviews (n=44) with 28 participants in an Irish community setting. Study findings developed a conceptual framework comprising three categories illuminating ‘what is going on’ for participants striving to manage their pain namely: ‘Being resigned because ‘it is what it is’; ‘Persistent ‘Cinderella-ing’; and ‘Reconstructing disrupted living’. The researcher applied co-constructive processes (memoing and diagramming) to further refine and hone the conceptual framework and articulate relationships between and within categories generated by theoretical abstraction. Derived from the data, this study generated a novel substantive theory. A process explaining how participants managed their pain influenced by tradition. ‘Managing pain by tradition‘. Implications for clinical practice highlight the importance of collecting pain history and biography to capture a comprehensive biopsychosocial-led pain assessment