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Understanding Chronic Pain Patient's Quality of Life Using Interpretative Phenomenological Analysis Approach

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Understanding Chronic Pain Patient's Quality of Life Using Interpretative Phenomenological Analysis Approach
  Journal of Advanced Social Research Vol.2 No.2, April 2012, 110-119 Understanding Chronic Pain Patient’s  Quality of Life Using Interpretative Phenomenological Analysis Approach  Affizal Ahmad, Samaneh Talaei School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,  Article Info Received: 12 th  March 2012 Accepted: 25 th  March 2012 Published online: 1 st  April 2012 ISSN: 2231-8275 © 2012 Design  for   Scientific Renaissance All rights reserved   A BSTRACT   Chronic pain affects different aspects of individual’s lives  and may relate to a low quality of life. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or is described with such damage. The purpose of this study is to identify and understand the consequences of chronic pain on patient’s quality of life. This qualitative stu dy was conducted in the Pain Clinic and Neurology Clinic of the Universiti Kebangsaan Malaysia Medical Centre. Thirty four chronic pain patients were interviewed using open-ended structured questions in the English language. The data were analyzed using Interpretative Phenomenological Analysis (IPA). Three themes (with a total of 6 sub-themes) were identified consisting of tolerance with life, inactive daily activity, and unpleasant sleep experience. Chronic pain patients claimed that pain prevented them from performing their daily activities effectively and efficiently. The severity of pain caused the patients to go to sleep or taking analgesic to reduce their pain. Understanding the needs of healthy and quality life among chronic pain patients could lead to identify and justify an ideal treatment programme. Betterment of  personal management of chronic pain may contribute to improvement of the quality of life.   Keywords: Chronic pain, quality of life, Interpretative Phenomenological Analysis 1.   Introduction The World Health Organization Quality of Life (1997) defines quality of life as individual’s perception of affected in a complex way by the physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to most important features of their environment. In the latter half of the twentieth century, researchers were interested in quality of life, followed by the ways in which is affected by chronic disease. Chronic pain can affect the patient’s well -being, level of function, and quality of life (Vasudevan, 2004). Majority of chronic patients often reported sleep disturbance and mood disturbance such as anxiety and depression, which need more healthcare services (Cella-Schmidt & Richardson, 2003; Vasudevan, 2004). Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or is described with such damage. If pain persists for six months or longer is typically referred to as chronic  pain  ( Merskey & Bogduk, 1994).  Journal of Advanced Social Research Vol.2 No.2, April 2012, 110-119 111 Studies by Skevington et al. (2001), Ecceleston et al. (2003), and Palermo et al. (2008) reported that reduced activity, distress due to pain, and inability to get enough sleep are major health problems faced by chronic pain patients. Independently, these factors are associated to significant reductions in quality of life. In addition, according to the World Health Organization (2004), chronic pain is one of the most underestimated healthcare problems in the worldwide. In addition, as pain becomes prolonged and persistent, patients’ a  bility seems to decrease. Therefore, patients tend to feel helpless, lonely, anxious, depressed, and even angry (Erickson, 2005; McWilliams et al., 2003). The concern for improving the quality of patients’ lives, the extent to which a disease or its treat ment interferes with lifestyles, patient’s activities, and interests are as important as maintaining the quality of life (Cella, 1994; Devins, 2010). This has led to increased interests to understanding the functional well-being or activities of daily living among chronic pain  patients (Eccleston et al., 2003; Lame et al., 2005). On top of previous valuable studies and findings, the current study aims to identify and understand the consequences of chronic pain on patient’s quality of life.   2.   Relationship between Quality of Life and Chronic Pain Chronic pain can be damaging to the social functioning of people with pain problems, apart from being harmful to patients’ physical and psychological functioning (Tuzun, 2007). Chronic pain may result in a decrease in social activities interactions due to fatigue, sleep disturbance, injured physical functioning, anxiety, and depression (Tuzun, 2007). Several studies (Lame et al., 2005; Palermo et al., 2008) have examined experiences related to the quality of life and sleep quality in different age groups. The study carried out by Lame et al. (2008) looked into the role of chronic pain cognitions in explaining the various domains of quality of life. They conducted a cross-sectional study at the clinic for pain and pain management in the University Hospital of Maastricht in the Netherlands among 1,208 chronic pain patients. The male patients aged between 15 to 94 years and the females 14 to 88 years. Results notably showed that patients experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localizations have the lowest quality of life. Palermo et al. (2008) displayed that poorer sleep is significantly correlated with greater activity limitation and lower health-related quality of life. They examined equal samples of 20 patients with chronic pain and 20 healthy adolescents aged between 12 to 17 years. Participants with chronic pain were recruited from a multidisciplinary paediatric chronic pain clinic in Portland via a letter or in person at the time of clinic visit. They reported that lower actigraphic sleep efficiency was associated with greater activity limitations. They also mentioned that patients with chronic pain complained that sleep disturbance affects their daily functioning. Additionally, they noted that sleep disturbances, depressive symptoms, and  persistent pain can contribute to functional impairment. These complications can reduce the quality of life among chronic patients. They also reported that clinicians can help design such trials to determine treatments for improving health in adolescents with sleep disturbances (Palermo et al., 2008).  Journal of Advanced Social Research Vol.2 No.2, April 2012, 110-119 112 3. Methodology 3.1 Qualitative Method This qualitative study was designed to collect self-reported data from participants using a qualitative research procedure for data collection and analysis. Qualitative research has much to offer researchers studying health and health care settings, and is increasingly being used in health services research (Carter & Handerson, 2005). Additionally, qualitative research can either explain an unexpected finding, or help develop more suitable research materials (Carter & Handerson, 2005; Orb et al., 2001; Turner, 2010; Willing, 2001). The current research aimed to describe a phenomenon from the participants’ experience and points of view through interviews. 3.2 Participation and Procedure The study group consists of male and female chronic pain patients from the Pain Clinic and Neurology Clinic, at the Universiti Kebangsaan Malaysia Medical Centre (Malaysia). To confirm the number of samples that is appropriate for this study, the saturation theory was used. In a qualitative study, sample size is often justified by interviewing participants until “data saturation” is reached (Francisa et al., 2010). According to this theory, saturation occurs when the categories studied become full of data and ideas, such that further information would not provide any new understanding or perception (Mason, 2010). Interview guide was developed by the researchers to gain as much information as possible on chronic pain patients’ life experiences. Five ‘open -e nded’ questions were formulated, arranged, and used in a logical sequence, and open to possible probes and prompts, which might follow the answers to each of the questions. The data was analyzed following the Interpretative Phenomenological Analysis (IPA) method so as to create a comprehensive account of themes and subthemes that have significance in the srcinal text (Smith et al., 1999). All interviews were recorded and transcribed verbatim. The first step in the analysis involved repeated reading of the transcripts and annotated descriptions on each transcript regarding key phrases and processes. These descriptions included summaries of contents, connections between different aspects of the transcript and initial interpretations. Within each transcript, the notes were condensed to  produce initial themes, with care being taken to ensure that these themes were consistent with the data. When this process had been repeated with each transcript, the resulting sets of initial themes were examined to identify recurrent patterns across the transcripts producing a final set of super ordinate themes at the end of the process. The links between the themes and data set were rechecked at this stage. Finally, the themes were reorganised in such a way as to  produce a logical and coherent research narrative. The summary of data processing can be seen in Fig. 1.  Journal of Advanced Social Research Vol.2 No.2, April 2012, 110-119 113 Fig. 1. The flow chart of data analysis using the IPA phenomenological analysis 3.3 Analysis This research tries to gain rich information from a small sample of chronic pain patients. In this regard, Smith’s IPA (Smith et al., 1999; Smith & Osborn, 2008) is considered as an appropriate method of data analysis to be used in this study. IPA is a particular qualitative approach that has created noticeable interests among health psychologists (Chapman & Smith, 2002). The aim of IPA is to identify how participants make sense of their experiences, events, and actions. Moreover, IPA uses purposive sampling to find a more closely defined group for whom the research questions will be significant (Chapman & Smith, 2002). 4.   Result The study group consists of 34 patients. The group comprised 15 (14.54%) males and 22 (59.46%) females, all afflicted with chronic pain. The mean age of the participants was 43.68 (±15.89) years. Patients reported suffering chronic pain more than 3 years. 4.1 Description of the Theme It is interesting to note that the raw data showed enormous richness in describing each theme of the life and daily experiences as experienced by the interviewees. The majority of the interviewees willingly provide simultaneous response on their respective experiences. The interview also managed to extract other significant answers which are related to the objective of the study. The interpretative process conducted on the raw data resulted in the development of the three themes, that is, ‘ tolerance with li fe’, ‘inactive daily activit y ’, and ‘ unpleasant sleep experience ’. The IPA method used was able to further separat e data from each theme onto different sub-themes. The two sub-themes that emerged for ‘ tolerance with life’ is: (i) being patient with the life, and (ii) self-control. The two sub- themes for ‘inactive daily activity ’ are: (i) force to leave task, and (ii) decreased interest in usual activities. Finally, the two sub-themes for ‘ unpleasant sleep experience ’ are: (i) sleep disturbance, and (ii) sleep as escapism from pain. Table 1 shows the breakdown of themes and sub-themes of quality of life among the chronic pain patients. Low qualities of life seem to be caused by Recorded interview Transcribe verbatim and coding Identify theme Identify subtheme  Narrative Repeat reading transcribed & annotated description  Journal of Advanced Social Research Vol.2 No.2, April 2012, 110-119 114 long term of chronic pain, and these can be manifested among the chronic pain patients in the form of physical, emotional, and cognitive disturbances. In the result presentation, empty brackets ( ) are used to clarify the information by authors and square brackets [ ] are used to indicate omission of words, and ellipsis points (…) are used to indicate a pause in the flow of the informants’ speeches.  Table 1: Distribution of Themes and Sub-themes of Quality of Life among Chronic Pain Patients Themes Sub-themes Tolerance with life (i) Being patient with the life (ii) Self-control Inactive daily activity (i) Force to leave task (ii) Decreased interest in usual activities Unpleasant sleep experience (i) Sleep disturbance (ii) Sleep as escapism from pain 4.2 Description of Sub-themes 4.2.1 Tolerance with Life (i) Being Patient with the Life From the analysis, it seems that chronic pain patients try to display some rational thought and positive thinking on their current situation. Patients with chronic pain seem to learn to accept things the way they are. They seem to understand and be patient with the life they have gone through. Nearly all of the interviewees display open-mindedness with their life conditions. They expressed the emotional feelings with similar wards such as “happy,” and “comfortable” in their current life situations. As two interviewees said:   “It is good enough for me to live (with the pain), and I’m happy with my life now.”   “I appreciate myself… who I am” . (ii) Self-Control Data showed that the interviewees consciously aware about the difficulties and hassles occur by or during the pain. Majority of them reported of having some self control. Here, self control performs as the ability to control one's emotions, behavior and desires in order to lessen or cope with such pain. Patients also reported that people around them and noises could contributed to increase the pain. This experience inevitably led to some patients keeping themselves away from others. As an example, a 40-year-old female patient mentioned that light and noise can strengthen her headache and leading her to get upset. She expressed her desire to be alone from others to avoid severe pain. She said that she would be unable to accept even her son whenever she had pain because someone around could exacerbate the pain. An excerpt below serves as an example: “I’ll avoid light [ ] noise, too many people around get me upset… I feel my headache coming more… when I have pain, I have to sleep.” “I keeping myself alone, control myself in the room, I like to be alone”.  
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