Qualitative meta-synthesis: the experience of chronic pain across conditions.
OBJECTIVE
To synthesize qualitative descriptions of the experience of chronic pain across conditions.


BACKGROUND
Chronic pain is a transdiagnostic symptom in that while somatic pathology plays a role in activating pain pathways, psychological and social factors contribute to the experience of pain over time. The treatment of the underlying condition may require both biomedical intervention and biopsychosocial approaches.


METHODS
Qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research (CERQual) developed by Grading of Recommendations Assessment Development and Evaluation (GRADE) working group to evaluate the strength of the evidence.


METHODS
PubMed and Ovid Medline from 2000-2015.


METHODS
Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings.


RESULTS
Forty-one papers exploring the experience of chronic pain were included in the review. Five meta-themes were identified across the studies: 1) the body as obstacle; 2) invisible but real; 3) disrupted sense of self; 4) unpredictability; and 5) keeping going. There was high confidence in the evidence for three themes: 'the body as obstacle'; 'disrupted sense of self' and 'keeping going'; and moderate confidence in the evidence for 'invisible but real' and 'unpredictability'.


CONCLUSIONS
The findings in this review suggest there are similarities in the experience of chronic pain across a range of conditions that have implications for the development of transdiagnostic pain management strategies and interventions.
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Marie
http://orcid.org/0000-0002-7220-8658
M
Crowe
School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia.
Lisa
http://orcid.org/0000-0002-6395-0279
L
Whitehead
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Philippa
P
Seaton
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
Jennifer
J
Jordan
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Catherine
C
Mccall
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Virginia
V
Maskill
Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
Henrietta
H
Trip
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D059350:Chronic Pain / Q000517:prevention & control / Q000523:psychology*; D059026:Diagnostic Self Evaluation; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012649:Self Concept; D055815:Young Adult
nursing; pain; qualitative approaches; systematic reviews and meta-analysis