title: A Qualitative Examination of Pain Centrality Among Veterans of Iraq and Afghanistan Conflicts.
abstract: Centrality of pain refers to the degree to which a patient views chronic pain as integral to his or her life or identity. The purpose of this study was to gain a richer understanding of pain centrality from the perspective of patients who live with chronic pain.
  
  
  
  Face-to-face interviews were conducted with 26 Veterans with chronic and disabling musculoskeletal pain after completing a stepped care intervention within a randomized controlled trial. Qualitative data were analyzed using an immersion/crystallization approach. We evaluated the role centrality plays in Veterans’ lives and examined whether and how their narratives differ when centrality either significantly decreases or increases after participation in a stepped care intervention for chronic pain.
  
  
  
  Our data identified three emergent themes that characterized pain centrality: 1) control, 2) acceptance, and 3) preoccupation. We identified five characteristics that distinguished patients’ changes in centrality from baseline: 1) biopsychosocial viewpoint, 2) activity level, 3) pain communication, 4) participation in managing own pain, and 5) social support.
  
  
  
  This study highlights centrality of pain as an important construct to consider within the overall patient experience of chronic pain.
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.|Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.|Regenstrief Institute Inc, Indianapolis, IN, USA.
authors.forename: Samantha D
authors.initials: SD
authors.lastname: Outcalt
authors.affiliation: Regional Research Institute, School of Social Work, Portland State University, Portland, Oregon.|Departments of Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.|Regenstrief Institute Inc, Indianapolis, IN, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.|Regenstrief Institute Inc, Indianapolis, IN, USA.|Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Miech
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.|Regenstrief Institute Inc, Indianapolis, IN, USA.|Department of Communication Studies, IUPUI, Indianapolis, Indiana USA.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
mesh_terms: D055826:Afghan Campaign 2001-; D059350:Chronic Pain / Q000523:psychology*; D006801:Humans; D054542:Iraq War, 2003-2011; D059352:Musculoskeletal Pain / Q000523:psychology*; D014728:Veterans / Q000523:psychology*
keywords: Chronic Pain; Veterans; Qualitative Research; Pain Centrality; Pain Cognitions