Invalidation of chronic pain: a thematic analysis of pain narratives

Abstract

Purpose

Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain.

Method

A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain.

Findings

Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation.

Conclusion

Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.

IMPLICATIONS FOR REHABILITATION

• Pain-invalidation can occur at the level of the self, social others, or healthcare professionals.

• Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.

• Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.

Keywords:

• Chronic pain
• invalidation
• narratives
• thematic analysis
• identity

Acknowledgments

The authors wish to express appreciation to librarian Ms. Terena Solomons for her expertise and assistance provided in developing a comprehensive search strategy. In addition, the authors wish to express gratitude to Ms. Helen Balfour for her assistance and specialist copyright advice.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors wish to acknowledge support of the Australian Government through a Research Training Program (RTP) scholarship issued to first author, Melinda Nicola.