Dealing with grief related to loss by death and chronic pain: An integrated theoretical framework. Part 1

Abstract

Objective:Based on the present authors’ research and several approaches to grief related to loss by death and nonmalignant chronic pain, the paper suggests a new integrated theoretical framework for intervention in clinical settings.Methods:An open qualitative review of the literature on grief theories was performed searching for a new integrated approach in the phenomenological tradition. We then investigated the relationship between grief, loss and chronic nonmalignant pain, looking for main themes and connections and how these could be best understood in a more holistic manner.Results:Two main themes were formulated, “relearning the world” and “adaptation”. Between these themes a continuous movement emerged involving experience such as: “despair and hope”, “lack of understanding and insight”, “meaning disruption and increased meaning”, and “bodily discomfort and reintegrated body”. These were identified as paired subthemes.Conclusions:Grief as a distinctive experience means that health care must be aimed at each individual experience and situation. Grief experience and working with grief are considered in terms of relearning the world while walking backwards and living forwards, as described in our integrated model. We consider that this theoretical framework regarding grief should offer an integrated foundation for health care workers who are working with people experiencing grief caused by death or chronic pain.

A narrative approach to explore grief experiences and treatment adherence in people with chronic pain after participation in a pain-management program: a 6-year follow-up study

“…Despite the vast literature on suffering chronic pain, little research has been conducted from a qualitative mixed-methods perspective that includes narratives and images. Moreover, although chronic pain has been widely studied in terms of its origin, treatment, and outcomes, there has been limited research into the relationship between chronic pain and grief,5 change processes, and follow-up 8. To address fully and holistically the needs of people living with this problem, we believe that a narrative approach, in which both written reports and images are used, may shed further light on chronic pain and grief beyond traditional interviews, and may allow us to better grasp individuals’ stories.…”

“…Ferrell and Coyle4 noted that grief is a dimension of these processes and is closely linked to pain. Grief caused by chronic pain can be considered a personal and fundamental experience that carries many meanings, and includes emotional, cognitive, behavioral, and bodily manifestations and expressions 5. People tend to endure health problems like chronic pain by suppressing their emotions until they can acknowledge their losses and suffer emotionally 6.…”

“…People tend to endure health problems like chronic pain by suppressing their emotions until they can acknowledge their losses and suffer emotionally 6. Experiencing and handling such situations may be described as challenging movements between relearning the world on the one hand and adaptation on the other so that the self is reintegrated 5. Assistance is often required from a multidisciplinary team using several approaches based on cognitive behavioral therapy (CBT) 3,7–11.…”

Moving Through Loss: Addressing Grief in Our Patients

“…A writer of an article on dealing with grief comments: "All experiences connected to loss may occur in various strengths and lengths independent of what is lost." 3 Naomi M. Simon, MD, MSc, a board-certified psychiatrist, an associate professor at Harvard Medical School, and director of the Complicated Grief Program at Massachusetts General Hospital in Boston, Massachusetts, agrees that there is no single way to grieve and no single definition of "normal" grief. She comments:…”

“…3 The authors of that article suggest that "relearning the world" and "adaptation" are key factors in the grieving process independent of the cause of grief. The authors also suggest that there is ongoing movement on the continuum between despair and hope, lack of understanding and insight, meaning disruption and creating meaning, and bodily discomfort and a reintegrated body.…”