title: Consciousness, complexity and chronic pain : exploring the occurrence and implications of incongruent beliefs about 'important' chronic pain treatment components
Creators: name: A. Brown, Cary
Publisher: name: University of Liverpool Repository
Year: 2023

description: Background: The biological sciences have contributed an extensive volume of research in efforts to resolve the issue of chronic pain. An expanding body of research, focusing on the psycho-social aspects of chronic pain, is also now evident. Paradigms applied to chronic pain appear to compete and lack an integrative framework. Aims: The original aim of this study was to identify and explore patterns of congruence that exist between service users and providers in relation to beliefs about which treatments for chronic pain are important. At the outset this research took a constructivist position, based within existing research which demonstrates that beliefs about chronic pain and its treatment are individually constructed and that lack of agreement between people with pain and treatment providers may contribute to negative treatment outcomes. As the iterative process of the research unfolded the aims of determining if a complex adaptive systems (CAS) analysis was appropriate for chronic pain and whether recommendations for change could legitimately be generated using a CAS paradigm, emerged. Methods: The literature was reviewed to identify conceptualizations of, and interventions for, chronic pain. Based on this information the Stage one postal survey, gathering service users' and providers' opinions about important treatment components, was designed. The survey also included Skevington's standardised Beliefs About Pain Control Questionnaire (BPCQ). The second stage employed Delphi methodology. A series of iterative questionnaires explored the original questions about congruence of beliefs, perceived impact of disagreement and suggestions for action. As additional information emerging from each Delphi round the analysis employed firstly a constructivist framework and ultimately explored the usefulness ofreframing chronic pain within a CAS framework. Findings: The participants in this study had very little inter and intra-group congruence of beliefs. While service users believed that their decision-making was influenced by four domains of the Chapman's Consciousness model (coherence, purposiveness, affect and self-image) as derived from constructivist theory, service providers stated that affect and self-image were not strong influences. Participants agreed that some action should be taken when there is disagreement about important treatments and the overwhelming majority of recommendations focused on actions the service providers should take. Very few recommendations were made of actions for the service users. Participants' responses in Delphi 3 indicated that chronic pain had a number of elements consistent with a CAS but that more linear and conflicting beliefs were also strong. Discussion and Conclusions: A constructivist perspective in itself proved insufficient to explore chronic pain's resistance to change and the implications of this for intervention. By applying CAS theory to the three key features that emerged from Delphi 1 and 2 (incongruent beliefs, differential access to information and paradoxical beliefs and behaviours) the phenomenon of chronicity was reframed. Interventions, based on complexity science principles, can effect change in the highly interactive systems that constitute the chronic pain experience. A complexity science paradigm can serve as a meta-framework, integrating the currently competing theoretical models employed in chronic pain. The NHS Modernisation Agency, and other researchers and theorists, have provided complexity science based policy statements and recommendations for affecting change in a range of healthcare settings. These can be examined for patterns and examples of how dissent and conflict can be a positive generative force for change. Examples and patterns in turn, can form templates to guide reframing the practice and operating paradigm for chronic pain service delivery.