This study will investigate the effects of cognitive restructuring about the meaning of chronic pain on improvement in patients at the Boston Pain Center (BPC) at Spaulding Rehabilitation Hospital. It focuses on the program's efforts to change, via group participation in a setting considered to be a therapeutic community, patients' subjective experience of their pain and its meaning. The two-year project's methodology consists of two two-month periods of intensive participant-observation of two cohorts of resident patients, interviews with these patients and their families and interviews with 100 former patients, their families, and BPC staff. The project hypothesizes that as a result of the BPC experience some chronic pain sufferers come to see their condition as meaningful rather than meaningless, and themselves as belonging to a subculture of chronic pain sufferers. An important feature of the treatment involves undergoing an ideological and identity shift and converting to a new ethos regarding their pain problem. The research examines presence and degree of this conversion, comparing it to independently obtained indicators of improvement. Also considered are sociocultural factors behind some patients' failing to improve, and staff as sponsors, nurturers, or saboteurs of patient improvement. Qualitative data acquired in observations and interviews are compared with quantitative data on individual patients studies and in the aggregate. The project will add to our understanding of the differences between biomedical, behavioral, and cultural models of chronic illness; the significance of medical and lay concept regarding moral responsibility for a disorder; psychosomatic processes and their treatment; the emergence of chronic pain as a biomedical disease category; the effectiveness of multidimensional approaches to chronic illness; the role of family and cultural factor in the etiology, expression, diagnosis, and outcome of chronic pain; and the importance of group therapy and cognitive restructuring in mental and physical illness and health.
| Jackson, J E (1994) The Rashomon approach to dealing with chronic pain. Soc Sci Med 38:823-33 |
