Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
College of Nursing, California Baptist University, Riverside, CA, USA.
Disabil Rehabil. 2020 Apr;42(8):1141-1152. doi: 10.1080/09638288.2018.1517195. Epub 2019 Jan 11.
There is little theory to explain how and why some people cope well despite chronic pain. This study proposes a mid-level theoretical explanation for those that cope well, shedding light on factors relevant to acceptance. Classical grounded theory methodology was closely followed to generate a theory grounded in data obtained from community-dwelling people self-identified as living well despite chronic pain. The main concern of people experiencing chronic pain is resolving the problem of disrupted self-coherence. Resolution involves by (1) of pain using an idiographic model; (2) to turn from patient to person, facilitated or hindered by interactions with clinicians and occupational drive; and (3) where and allow individuals to develop . This theory demonstrates the importance of engaging in occupation during rehabilitation by framing chronic pain adjustment within a process of renegotiating the self-concept. Occupations allow individuals to express values important to their sense of self. Coping strategies are used to enable occupation and are judged by their workability in this context. When developing goals and plans with people living with pain, rehabilitation professionals should consider an individual's position within the processes involved in learning to live well.Implication for rehabilitationLiving well with chronic pain involves a process of making sense, deciding to move on with life, and flexibly persisting.Diagnosis should be accompanied by messages about hurt and harm not being equivalent, and the need for a lifelong approach to managing a chronic problem.An idiographic depiction or formulation of a person's pain and disability provides opportunities for making sense of symptoms and collaborating on treatment goals.Remaining supportive, providing "small acts" demonstrating that the person is unique and being thought of, and encouraging engagement in valued occupations allows patients to experiment with, and start to engage in what is important in their lives.Clinicians should help people extend their coping repertoire and encourage flexibility with how these are applied in the pursuit of valued occupations.The positive motivation that comes from individuals identifying highly valued occupations is an aspect that all clinicians, but particularly occupational therapists, should recognize.
尽管慢性疼痛的人如何以及为什么有些人能很好地应对，但几乎没有理论可以解释。本研究为那些应对良好的人提出了一个中层理论解释，揭示了与接受相关的因素。严格遵循经典扎根理论方法，从自认为尽管患有慢性疼痛但仍能很好地生活的社区居民那里获得的数据中生成一个扎根于理论的理论。经历慢性疼痛的人的主要关注点是解决自我一致性被打破的问题。解决问题涉及通过使用个体化模型来缓解疼痛；（2）通过与临床医生和职业驱动的互动，从患者转变为正常人，这可能会受到促进或阻碍；（3）在 和 允许个人发展 。该理论通过将慢性疼痛调整置于重新协商自我概念的过程中，展示了在康复过程中从事职业的重要性。职业允许个人表达对自我概念重要的价值观。应对策略用于实现职业，并根据其在这种情况下的可行性进行判断。在为患有疼痛的人制定目标和计划时，康复专业人员应该考虑个人在学习如何过上美好生活的过程中所扮演的角色。康复的意义慢性疼痛的良好生活涉及一个意义的过程，即决定继续生活，并灵活地坚持下去。诊断应该伴随着关于伤害和伤害不等同的信息，以及需要终身管理慢性问题的方法。对一个人的疼痛和残疾进行个体化描述或制定提供了理解症状和合作制定治疗目标的机会。保持支持，提供“小行动”表明这个人是独特的，并被人惦记，鼓励参与有价值的职业，使患者能够尝试并开始参与他们生活中重要的事情。临床医生应该帮助人们扩展他们的应对策略，并鼓励在追求有价值的职业时灵活运用这些策略。个人确定高度重视的职业所带来的积极动力是所有临床医生，特别是职业治疗师，都应该认识到的一个方面。
