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Pain Research and Management
Volume 9, Issue 3, Pages 145-153
Original Article

The Life Adjustment Process in Chronic Pain: Psychosocial Assessment and Clinical Implications

Ann-Christine Gullacksen1 and Jan Lidbeck2

1Department of Social Work, School of Health and Society, Malmö University, Malmö, Sweden
2Pain Management Clinic, Hospital of Helsingborg, Helsingborg, Sweden

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Previously, the subjective dimension of suffering from chronic pain has only infrequently been reported in the literature. However, in recent years qualitative psychosocial research has added new perspectives that describe how suffering from chronic pain affects life. The present paper refers to a qualitative study on the subjective experience of women diagnosed with chronic musculoskeletal pain. In a model for life adjustment, turning points and passages are described in three stages. In Stage I, there was increasing pain, disability, and physical and mental exhaustion. Alongside frustration and chaos there was a struggle to restore daily life; therefore, the picture of a healthy future was still intact. Acknowledging that pain may not be temporary marked the transition into Stage II, which was characterized by sorrow and loss, and the picture of the future faded. Once given an explanation of pain (a 'pain diagnosis'), a new understanding developed, with gradual improvement of coping skills. Adjustment eventually progressed into Stage III with the constructive use of past experiences, and competence and control increased. A new picture of the future emerged that could be handled. However, living with pain still required regular maintenance work. The outcome of qualitative investigations, including the one presented here, is discussed along with certain clinical implications. The following clinical implications are reviewed in the present study: distrust from health professionals may obstruct the adjustment process, prolong sick leave and hinder rehabilitation; providing the patient with a diagnosis (eg, an explanation of pain mechanisms) will facilitate life adjustment; acknowledging the individual experience of suffering from chronic pain will make concepts related to pain behaviour, secondary gain and sick role liable to question; and vocational rehabilitation measures should be harmonized with the actual stage of life adjustment.