Living with chronic pain following a pain management programme

Chronic pain is pain that has lasted for longer than six months (B. H. Smith, Elliott, & Hannaford, 2004) and has a wide ranging impact on individuals’ lives, affecting physical, social and psychological functioning (B. H. Smith et al., 2001). Despite the impact of chronic pain and the significantly increased use of healthcare (Von Korff, Wagner, Dworkin, & Saunders, 1991), the effectiveness of treatments for chronic pain are limited to a minority of individuals, whether of a medical or psychological orientation (Turk, 2005). One approach to chronic pain is through pain management programmes, which aim to increase individuals’ quality of life, psychological functioning and levels of activity (British Pain Society, 2007). Although previous reviews of the effectiveness of pain management programmes have concluded that such programmes are effective (Eccleston, Williams, & Morley, 2012; Flor, Fydrich, & Turk, 1992; Scascighini, Toma, Dober-Spielmann, & Sprott, 2008), these reviews have focussed on the short-term (less than 12 months) outcomes. Considering that such programmes do not ameliorate pain and that individuals will often experience pain for the rest of their lives there is a need for review of the long-term outcomes of these programmes. Paper one of this thesis is a review of the quantitative literature concerning long-term (greater than 12 months) psychological and quality of life outcomes of pain management programmes. Whilst quantitative research concerning chronic pain has focussed upon the shortterm effectiveness of psychological treatments, qualitative research has focused upon the experience of chronic pain prior to interventions (Hellström, 2001; J. A. Smith & Osborn, 2007; Toye et al., 2013). In particular, this research has highlighted themes relating to a changing understanding of individuals’ bodies and a threat to their identity (Hellström, 2001; Osborn & Smith, 2006; J. A. Smith & Osborn, 2007; Toye et al., 2013). As there is now greater certainty of the effectiveness of psychological approaches to chronic pain (Eccleston, Williams, & Morley, 2012) there is currently a shift away from studies of the effectiveness of interventions to a greater focus upon the mechanisms of change (McCracken & Marin, 2014; Morley, Williams, & Eccleston, 2013). Qualitative research of living with chronic pain following pain management programmes would inform both clinicians’ and researchers’ understanding of the experience of living with chronic pain after an intervention and therefore contribute to the development of this area of research. It would also help to contextualise psychological models of chronic pain (Hayes, Strosahl, & Wilson, 2004; Vlaeyen & Linton, 2000) within a phenomenological understanding (J. A. Smith, Flowers, & Larkin, 2009). The second paper of this thesis aims to provide a phenomenological account of the experiences of participants who have completed a pain management programme 12-36 months prior to participating in the research