Patients' and professionals' understandings of the causes of chronic pain: blame, responsibility and identity protection.

A social constructionist analysis of how sense is made of the causes of chronic pain is reported. It is recognised that there is a multiplicity of stories available in any culture from which understanding can be reached. Q-factor analysis is used within a critical framework as Q-methodology. Sixty chronic pain patients and pain professionals completed the sorting procedure. Four factors were derived that account for the causes of chronic pain. These are reported as the patients' account, the professionals' account, the scientists account and the alternative practitioner's account. Common to all four accounts are the themes of responsibility, blame and the need to protect identity. It is argued that in all accounts responsibility is repositioned away from the sufferer or the healer. In all of the accounts blame is resisted or deflected away from individual ownership. Finally, it is argued that when pain is no longer useful as a symptom, identity is challenged, weakened and at risk for both chronic pain patients and pain professionals. Implications of this study for chronic pain research and treatment are discussed.