The sands of time: Adolescents’ temporal perceptions of peer relationships and autonomy in the context of living with chronic pain

The incidence of chronic and recurrent pain increases in adolescence. Prevalence of adolescent chronic pain is estimated to be 11-44%, with approximately 5% adolescents experiencing moderate to severe chronic pain. Adolescents with chronic pain also report unwanted changes in emotional, social and developmental functioning. Very little is known about how adolescents with chronic pain make sense of their development, the role of pain in that development, and how such developmental trajectories progress over time. A multi-methods qualitative study was designed to explore how adolescents make sense of their experience of chronic pain in the context of development. Nine adolescents (8 girls) aged 12 to 22 years old (Mean = 15.7, SD = 2.8) were recruited from a UK national pain service. Adolescents completed an interview on entering the service, and a follow-up interview 12-months later. They also completed monthly diaries in this 12-month period. Data comprised 18 interviews and 60 diary entries, which were analysed using inductive reflexive thematic analysis. Analyses generated one overarching theme entitled ‘tug of war: push and pull’, demonstrating developmental tension related to pain, and the cumulative impact these had over time. This overarching theme comprised two sub-themes which capture these tensions across the developmental domains of peer relationships and autonomy. The first sub-theme, ‘the shifting sands of peer relationships’, explores the ever-changing closeness between self and peers. The second sub-theme referred to ‘restricted choices’ and how pain limited the participants’ autonomy but that this, over time could push development forward. These results extend previous cross-sectional research on the developmental consequences of chronic pain, showing the dynamic fluctuations and alterations to developmental trajectories over time.