Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 19, Issue 4

Issues

Improving patient–practitioner interaction in chronic pain rehabilitation

The merits of a discursive psychological approach

Baukje B. Stinesen
  • Corresponding author
  • Research Group Cross-Media Communication in the Public Domain, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Petra Sneijder
  • Research Group Cross-Media Communication in the Public Domain, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Albère J.A. Köke
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
  • Zuyd University of Applied Sciences, Faculty of Health and Technology, Heerlen, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rob J.E.M. Smeets
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • CIR Revalidatie, Eindhoven/Zwolle, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-07-12 | DOI: https://doi.org/10.1515/sjpain-2019-0034

Abstract

Stimulating patients to approach their pain from a biopsychosocial perspective is central to chronic pain rehabilitation. However, conversations between patients and their healthcare professionals about the social and psychological factors that may contribute to the continuation of pain and disability can be challenging. The current scientific literature does not sufficiently pinpoint the difficulties in patient–practitioner interaction on chronic pain, and it falls short of answering the question of how a joint exploration of the social and psychological factors that might be involved in the patient’s pain and evolving disability can be enhanced. In this theoretical article, we introduce discursive psychology as a potentially valuable research perspective to gain a better understanding of the difficulties in patient–practitioner interaction in the context of chronic pain rehabilitation. Discursive psychology focuses on features of people’s talk (e.g. that of patients and practitioners) and is concerned with the social practices that people perform as part of a specific interactional context. In this paper, we provide an introduction to the main theoretical notions of discursive psychology. We illustrate how discursive psychological analyses can inform our understanding of the specific sensitivities in conversations between patients with chronic pain and their practitioners. Finally, we address how a better understanding of these sensitivities offers a gateway towards improving these conversations.

Keywords: chronic pain; patient–practitioner interaction; discursive psychology

References

  • [1]

    Nicholas MK, Linton SJ, Watson PJ, Main CJ. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Phys Ther 2011;91:737–53.Web of ScienceCrossrefPubMedGoogle Scholar

  • [2]

    Hasenbring MI, Rusu AC, Turk DC. From acute to chronic back pain. New York: Oxford University Press, 2012.Google Scholar

  • [3]

    Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007;133:581–624.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [4]

    Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of intervention and outcomes. Rheumatology 2008;47:670–8.PubMedCrossrefGoogle Scholar

  • [5]

    Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain 2006;7:779–93.CrossrefPubMedGoogle Scholar

  • [6]

    Oosterhof B, Dekker JHM, Sloots M, Bartels EAC, Dekker J. Success or failure of chronic pain rehabilitation: the importance of good interaction – a qualitative study under patients and professionals. Disabil Rehabil 2014;36:1903–10.CrossrefWeb of SciencePubMedGoogle Scholar

  • [7]

    King R, Robinson V, Ryan CG, Martin DJ. An exploration of the extent and nature of reconceptualisation of pain following pain neurophysiology education: a qualitative study of experiences of people with chronic musculoskeletal pain. Patient Educ Couns 2016;99:1389–93.CrossrefWeb of SciencePubMedGoogle Scholar

  • [8]

    Moseley G. Reconceptualising pain according to modern pain science. Phys Ther Rev 2007;12:169–78.CrossrefGoogle Scholar

  • [9]

    Verbeek J, Sengers M, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine (Phila Pa 1976) 2004;29:2309–18.PubMedCrossrefGoogle Scholar

  • [10]

    Frantsve L, Kerns R. Patient-provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. Pain Med 2007;8:25–35.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [11]

    May CR, Rose MJ, Johnstone FCW. Dealing with doubt: how patients account for non-specific chronic low back pain. J Psychosom Res 2000;49:223–5.CrossrefPubMedGoogle Scholar

  • [12]

    Swaan J, Schiphorst Preuper H, Smeets R. Multifactorial analysis in specialized medical rehabilitation [Multifactoriële analyse in de medisch-specialistische revalidatie]. In: Verbunt J, Swaan J, Schiphorst Preuper H, Scheurs K, editors. Handbook of pain rehabilitation: for primary, second-line and third-line medical care [Handboek pijnrevalidatie: Voor de eerste-, tweede-en derdelijnsgezondheidszorg]. Houten: Bohn Stafleu Van Loghum, 2019:69–85.Google Scholar

  • [13]

    Coran J, Koropeckyj-Cox T, Arnold C. Are physicians and patients in agreement? Exploring dyadic concordance. Heal Educ Behav 2013;40:603–11.CrossrefGoogle Scholar

  • [14]

    de Jong J, Vlaeyen J, Onghena P, Goossens M, Geilen M, Mulder H. Fear of movement/(re) injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clin J Pain 2005;21:9–17.CrossrefGoogle Scholar

  • [15]

    Linton SJ. Intricacies of good communication in the context of pain: does validation reinforce disclosure? Pain 2015;156:199–200.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [16]

    Goossens M, Vlaeyen J, Hidding A, Kole-Snijders A, Evers S. Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clin J Pain 2005;21:18–26.PubMedCrossrefGoogle Scholar

  • [17]

    Mertens V. ‘Be prepared!: motivational interviewing as pre-treatment in chronic pain rehabilitation [dissertation]. Maastricht: Maastricht University, 2015.Google Scholar

  • [18]

    Smeets R, Beelen S, Goossens M, Schouten E, Knottnerus J, Vlaeyen J. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Clin J Pain 2008;24:305–15.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [19]

    Mertens V, Goossens M, Verbunt J, Köke A, Smeets R. Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized control. Trials 2013;14:1–14.Google Scholar

  • [20]

    Edmond SN, Keefe FJ. Validating pain communication: current state of science. Pain 2015;156:215–9.Web of ScienceCrossrefPubMedGoogle Scholar

  • [21]

    Holloway I, Sofaer-Bennett B, Walker J. The stigmatisation of people with chronic back pain. Disabil Rehabil 2007;29:1454–64.Web of ScienceGoogle Scholar

  • [22]

    Åsbring P, Närvänen A. Women’s experiences of stigma in relation to chronic fatique syndrome and fibromyalgia. Qual Health Res 2002;12:148–60.Google Scholar

  • [23]

    Nettleton S. ‘I just want permission to be ill’: towards a sociology of medically unexplained symptoms. Soc Sci Med 2006;62:1167–78.PubMedCrossrefGoogle Scholar

  • [24]

    Glenton C. Chronic back pain sufferers – striving for the sick role. Soc Sci Med 2003;57:2243–52.PubMedCrossrefGoogle Scholar

  • [25]

    Ong BN, Hooper H, Dunn K, Croft P. Establishing self and meaning in low back pain narratives. Sociol Rev 2004;52:532–49.CrossrefGoogle Scholar

  • [26]

    Smith JA, Osborn M. Pain as an assault on the self: an interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychol Heal 2007;22:517–34.CrossrefGoogle Scholar

  • [27]

    Osborn M, Smith JA. The personal experience of chronic benign lower back pain: an interpretative phenomenological analysis. Br J Health Psychol 1998;3:65–83.CrossrefGoogle Scholar

  • [28]

    Werner A, Isaksen L, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59:1035–45.CrossrefPubMedGoogle Scholar

  • [29]

    Wiggins S. Discursive psychology. Theory, method and applications. London: Sage, 2017.Google Scholar

  • [30]

    Horton-Salway M. Mind and body in the discursive construction of ME: a struggle for authorship of an illness [dissertation]. Loughborough: Loughborough University, 1998.Google Scholar

  • [31]

    Horton-Salway M. The construction of ME: the discursive action model. In: Wetherell M, Taylor S, Yates S, editors. Discourse as data: a guide for analysis. London: Sage, 2001.Google Scholar

  • [32]

    Horton-Salway M. Narrative identities and the management of personal accountability in talk about ME: a discursive psychology approach to illness narrative. J Health Psychol 2001;6:247–59.CrossrefGoogle Scholar

  • [33]

    Wiggins S, Potter J. Disursive psychology. In: Willig C, Stainton-Rogers W, editors. The SAGE handbook of qualitative research in psychology, 2nd ed. London: Sage Publications Ltd., 2017:93–109.Google Scholar

  • [34]

    Potter J, Hepburn A. Discursive psychology as a qualitative approach for analysing interaction in medical settings. Med Educ 2005;39:338–44.CrossrefPubMedGoogle Scholar

  • [35]

    Potter J. Discursive social psychology: from attitudes to evaluative practices. Eur Rev Soc Psychol 1998;9:233–66.CrossrefGoogle Scholar

  • [36]

    McKinlay A, McVittie C. Identities in context. Individuals and discourse in action. Chichester: Wiley-Blackwell, 2011.Google Scholar

  • [37]

    Potter J. Representing reality: discourse, rhetoric and social construction. London: Sage, 1996.Google Scholar

  • [38]

    Wooffitt R. Telling tales of the unexpected: a sociological analysis of accounts of paranormal experiences [dissertation]. York: University of York, 1989.Google Scholar

  • [39]

    Goffman E. Footing. Semiotica 1979;25:1–29.CrossrefGoogle Scholar

  • [40]

    Haakana M. Laughter as a patient’s resource: dealing with delicate aspects of medical interaction. Text 2001;187–219.Google Scholar

  • [41]

    Zayts O, Schnurr S. Laughter as medical providers’ resource: negotiating informed choice in prenatal genetic counseling. Res Lang Soc Interact 2011;44:1–20.CrossrefWeb of ScienceGoogle Scholar

  • [42]

    Arminen I, Halonen M. Laughing with and at patients: the roles of laughter in confrontations in addiction group therapy. Qual Rep 2007;12:484–513.Google Scholar

  • [43]

    Edwards D, Potter J. Discursive psychology. London: Sage, 1992.Google Scholar

  • [44]

    Lamerichs J, Te Molder H. Reflecting on your own talk: the discursive action method at work. In: Antaki C, editor. Applied conversation analysis: intervention and change in institutional talk. London: Palgrave Macmillan UK, 2011:186–206.Google Scholar

  • [45]

    Lamerichs J, Koelen M, Te Molder H. Turning adolescents into analysts of their own discourse: raising reflexive awareness of everyday talk to develop peer-based health activities. Qual Health Res 2009;19:1162–75.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [46]

    Burbaum C, Stresing A-M, Fritzsche K, Auer P, Wirsching M, Lucius-Hoene G. Medically unexplained symptoms as a threat to patients’ identity? A conversation analysis of patients’ reactions to psychosomatic attributions. Patient Educ Couns 2010;79:207–17.CrossrefWeb of SciencePubMedGoogle Scholar

  • [47]

    Stokoe E. Simulated interaction and communication skills training: the ‘Conversation-Analytic Role-Play Method’. In: Antaki C, editor. Applied conversation analysis: intervention and change in institutional talk. London: Palgrave Macmillan UK, 2011:119–39.Google Scholar

  • [48]

    Jefferson G. Glossary of transcript symbols with an introduction. In: Lerner G, editor. Conversation analysis: studies from the first generation. Amsterdam: John Benjamins Publishing Company, 2004:13–32.Google Scholar

About the article

Received: 2019-02-20

Revised: 2019-04-01

Accepted: 2019-04-15

Published Online: 2019-07-12

Published in Print: 2019-10-25


Authors’ statements

Research funding: Authors state no funding involved.

Conflict of interest: Authors state no conflict of interest.

Informed consent: Informed consent was obtained from all individuals in this study.

Ethical approval: The research has been approved by an accredited Research Ethics Committee: METC Z, The Netherlands (reference number: 17-N-160).


Citation Information: Scandinavian Journal of Pain, Volume 19, Issue 4, Pages 843–853, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2019-0034.

Export Citation

©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

Comments (0)

Please log in or register to comment.
Log in