The meaning and the process of acceptance for patients with chronic non-specific musculoskeletal pain when participating in pain rehabilitation

Abstract

Background: We know that acceptance-based therapies have evidence in the context of chronic pain. However, what is unknown is how individuals experience the meaning of acceptance before entering pain rehabilitation and howmultiprofessional teamwork influences the different meanings and processes of acceptance. Given the complexity of acceptance and adjustment to a chronic condition such as persistent pain, it is essential, for example, to further explore these processes using a bodily existential perspective. Purpose: The overall aim was to explore ways of living with chronic non-specific musculoskeletal pain and to understand the meaning and the process of acceptance in relation to the individuals’ bodily experiences and sense of self. Methods: Six women and 3 men (between 18 and 52 y/o) were interviewed at the beginning, in the middle and at the end of a sixteen week-long rehabilitation programme. To explore the embodied nature of acceptance and to bring out the diversity and variation in the individuals’ experience, interpretative phenomenological analysis (IPA) was chosen. Results:Three differentmeanings and processes of acceptance were found. First, acceptance as a process of personal empowerment, “the onlyway tomove onwith life”. The individuals expressed that the rehabilitation programme helped them to integrate the body in their sense of self – a trusting cooperation between self and body gave rise to hope. Secondly, acceptance as an equivocal project, “a possible but challenging way forward”. This placed the individuals in a challenging position of ambivalence. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also a feeling of uncertainty and doubt about one’s ability. In the rehabilitation programme focus should also be placed on the experiences of the ambiguous body. Thirdly, in acceptance as a threat and a personal failure, “no way forward”, the integration of the aching body in sense of self was impossible since pain was incomprehensible, unacceptable and unfair. No changes during the rehabilitation programme could be described. Conclusion(s):Acceptance canbe experienced as the only way forward, a possible but challenging way forward, or a threat and capitulation as well as a personal failure. Experiences of the lived body and the sense of self are related to the personal meaning of acceptance. Individuals with chronic pain have different ways of experiencing their body: as a guide and a resource, as something ambiguous and confusing, which is difficult but important to understand, or as something disappointing, entrapping and alien. Individuals with chronic pain have different ways of experiencing their sense of self: as pride in having accomplished difficult and necessary changes to go on with life, as uncertainty on how to manage responsibility including fear of failure, or as a feeling that pain is defining them and that they are entrapped. Implications:The study contributedwith valuable knowledge to develop clinical interventions with focus on the lived body and inspire the use of the full potential of the physiotherapists’ role in pain rehabilitation programmes.