Abstract
Chronic pain is prevalent in adolescents and presents a significant public health concern. A small yet notable proportion of adolescents may be disabled by their pain and struggle to live with chronic pain in their everyday lives. Past literature has adopted a dominant focus on the negative aspects of living with chronic pain, with a deficits-based approach to pain treatment. Despite this, there is evidence to suggest that some adolescents can function well while living with chronic pain. Such adolescents may adapt to living with pain in a positive way or even flourish in their experience of pain.The work presented in this thesis reflects my primary aim of gaining a detailed understanding of flourishing within the context of adolescent chronic pain. Flourishing is conceptualised as an umbrella term that encompasses high levels of well-being, a sense of ‘life going well’, and positive changes or outcomes and constructs, either as a result of, or despite, chronic pain. To provide a comprehensive picture of flourishing, this thesis also includes consideration of the wider social context in which adolescent chronic pain is experienced, including the influence and viewpoints of parents, peers, and healthcare professionals.
A total of four studies were conducted to investigate flourishing in adolescent chronic pain. In Chapter 3, I begin with a scoping review to explore the current scope of knowledge in the research area of flourishing in adolescent chronic pain, and identify existing gaps in the literature. Results identified a dearth of knowledge and research in the area of flourishing in adolescent chronic pain, with only four papers included in the final review. Within these papers, flourishing is defined in relation to commonalities of enhanced maturity and growth, benefit finding, and social support. In Chapter 4, I seek to broaden this limited knowledge by using questionnaires to measure the relationships between four positive constructs linked with chronic pain and three pain-related outcomes. The results of this study supported the notion that flourishing in adolescent chronic pain is possible, but that it is complex and multifaceted, with varying relationships with other pain-related outcome variables. In Chapter 5, I seek to qualitatively investigate adolescents’ experiences, understandings and perceptions of flourishing while living with chronic pain using daily diary entry and follow-up interview data collection methods. The results generated two themes: ‘Appreciating the moment’ and ‘Becoming a better version of myself’. Themes address how adolescents’ comparisons with self and others at various time points facilitate an appreciation for achievements and pleasures in life due to living with chronic pain. Adolescents also perceive their chronic pain to have positively influenced their current and future life paths, and identify growth in both personal and social functioning as a result of their chronic pain experience. Finally, in chapter 6, I adopt a unique Q-methodological approach to investigate shared perspectives of adolescents living with chronic pain, their parents, and the healthcare professionals who treat them. Data analysis indicated three dominant factors: ‘Pain is not a barrier to flourishing’, ‘Adapting to a new life’, and ‘Adopting a positive perspective’. These factors express the viewpoints that life can still be enjoyed and lived to its fullest despite chronic pain, but flexibility and acknowledgement of limitations may be required. Additionally, acceptance, resilience, problem-solving, and stress management may be required to flourish with chronic pain. Participants’ understandings of flourishing may also include benefit finding and the appreciation and enjoyment of life and achievements. Collectively, key findings in this thesis include the notions that flourishing is multifaceted and complex, flourishing is possible but variable, and flourishing is understood and defined differently by individuals.
Findings from this work may be used to guide future research to broaden our knowledge of flourishing in adolescents with chronic pain. Findings may also be used to inform clinical practice that promotes the adoption of positive psychological approaches to pain management, communication and treatment.
| Date of Award | 13 Sept 2023 |
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| Original language | English |
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| Supervisor | Abbie Jordan (Supervisor), Sarah Halligan (Supervisor), Joanna McParland (Supervisor) & Liesbet Goubert (Supervisor) |