M. Dillon1, R. Olson2, M. Miciak3, P. Window4, J. Setchell5
1University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia, 2University of Queensland, School of Sociology, Brisbane, Australia, 3University of Alberta, Alberta, Canada, 4Royal Brisbane and Women's Hospital, Physiotherapy, Brisbane, Australia, 5University of Queensland, Brisbane, Australia
Background: Distress is often pathologized and poorly understood in physiotherapy, including in chronic pain contexts; it is often seen as a physiological or psychological problem located within the patient, with pain often separated from emotion in clinical practice. Yet, distress is complex, relational, and sociocultural; it cannot be contained to one individual or disciplinary silo. Emotions, distress and chronic pain are so deeply entangled, they are inseparable.
Purpose: Building on sociological theories of emotion, we undertook a critical affective approach to understand and (re) conceptualise emotions such as distress in chronic pain care, to explore where/how distress occurs in physiotherapy during clinical interactions with people with chronic pain, and how physiotherapists navigate such interactions.
Methods: The study employed two key qualitative research methodologies:
1) ethnographic observations of physiotherapy clinical interactions; and
2) participatory dialogues.
In ethnographic observations (n=15), a trained observer recorded physiotherapy clinical interactions in two public musculoskeletal clinics. Across six, two-hour collaborative participatory dialogues, discussions with clinicians investigated experiences with distress and current approaches to understanding distress, in caring clinically for people with chronic pain. Data analysis was conducted iteratively and concurrently across three exploratory spaces with
1) researchers in research team analysis meetings,
2) clinicians in participatory dialogues, and
3) patients in patient panels.
1) ethnographic observations of physiotherapy clinical interactions; and
2) participatory dialogues.
In ethnographic observations (n=15), a trained observer recorded physiotherapy clinical interactions in two public musculoskeletal clinics. Across six, two-hour collaborative participatory dialogues, discussions with clinicians investigated experiences with distress and current approaches to understanding distress, in caring clinically for people with chronic pain. Data analysis was conducted iteratively and concurrently across three exploratory spaces with
1) researchers in research team analysis meetings,
2) clinicians in participatory dialogues, and
3) patients in patient panels.
Results: Analysis suggests that distress in physiotherapy and chronic pain care is relational and moves between people, the social and spatial environments. It can be understood as a complex assemblage involving subjectivities, thoughts, feelings, social formations, and institutions, as well as political, economic, human and non-human elements. Distress can be expressed and recognised in subtle ways, through histories, words, actions, and body language. Yet, distress is often missed, dismissed or navigated poorly by physiotherapists.
Conclusions: Traditional ways of conceptualising distress can be limiting and potentially harmful for both patients and physiotherapists. This reconceptualization of distress may help physiotherapists recognise and attend to distress in chronic pain care with more nuance.
Implications: We offer a (re)conceptualisation of distress for physiotherapy and chronic pain care, enabled by tracing key human and non-human elements entangled in situations of distress when caring for people with chronic pain. This broader approach may enable clinicians to be more attentive to the many factors that may contribute to their own and patients’ distress, assisting them to better recognise and navigate distress in clinical interactions. Further research is needed to explore how physiotherapists may rework distress navigation through application of this theoretical approach to relations of care with people with chronic pain. This framing also suggests that distress is not always problematic or something to be avoided; if navigated well, distress can enhance care relations and therapeutic approaches.
Funding acknowledgements: Nil
Keywords:
Chronic pain
Emotions
Qualitative reserach
Chronic pain
Emotions
Qualitative reserach
Topics:
Pain & pain management
Musculoskeletal
Mental health
Pain & pain management
Musculoskeletal
Mental health
Did this work require ethics approval? Yes
Institution: Royal Brisbane and Womens Hospital and University of Queensland
Committee: Metro North Hospital and Health Service HREC
Ethics number: HREC/2021/QRBW/77069
All authors, affiliations and abstracts have been published as submitted.
