Mazes, Conflict, and Paradox: Tools for Understanding Chronic Pain

Abstract

This article presents an argument for framing chronic pain within a complex adaptive systems (CAS) paradigm. The first aim of this article is to demonstrate how chronic pain can be framed as a CAS and how paradox, one of the core characteristics of a CAS, exists within the chronic pain experience. The second aim is to illustrate how paradox exists at multiple levels within the health care encounter and ongoing experience of chronic pain. Finally, the article will use the example of interactions at the patient/clinician level to illustrate how health care workers' efforts to deal with issues emergent from the range of paradoxes have for the most part been ineffective, and at times harmful, to persons experiencing chronic pain. This article uses the example of chronic pain to explore how the manner in which health care providers and patients recognize and deal with paradoxes can either worsen the pain experience or help generate creative new ways to manage the chronic pain condition. The CAS principles discussed in this article hold application across a range of chronic conditions for which a traditional biomedical paradigm proves insufficient.

Undercover Dogs: Pet Dogs in the Sleep Environment of Patients with Chronic Pain

“…It may be that some elements of social contract theory are at play and participants' comments reflect a sense of obligation towards the pet dog who is providing emotional resources to the owner. We do not have sufficient data from this study to speculate further but will look to social contract theorists such as Palmer (1997), to guide further research in this understudied area, Chronic pain is a complex, biopsychosocial condition (Brown 2009) and privileging biological interventions alone is inadequate. We need to better understand if removing pet dogs as a solution to improved sleep could be counter-productive and lead to more, not less, sleep-related issues, including the potential for increased reliance on sleep medication and the increased need for other costlier, demanding, and less accessible, interventions such as cognitive behavioral therapy and pain-related surgery.…”

Friendship in Later Life: How Friends Are Significant Resources in Older Persons’ Communication about Chronic Pain

“…The fact that the interlocutor shares a similar experience prevents, in a way, the asymmetry that could be built up when revealing one's own weaknesses [41]. In addition to avoiding a possible relational instability and thus saving face [41,42], a similar experience of pain, for many of the interviewees, appears to be a necessary condition for genuine communication about this topic [43]. More than an exchange of information, the communication of one's pain thus becomes a communion, echoing the inexpressible nature of the pain experienced in the flesh and exceeding the power of words alone [40].…”

Perceived injustice in injured workers: analysis of public responses to an injured worker who took Workers’ Compensation Board employees hostage

“…As one PWP put it, ‘I’m glad no one was hurt, but am surprised this sort of thing doesn’t happen more often’ ( Glottz line 294.). This lack of linearity and the emergence of unexpected behaviour are hallmarks of complex systems (36–39). Complexity theory illustrates that problems emerging from highly dynamic human system’s interactions cannot be remedied with linear solutions and logarithmic formulae based on assumptions of predictable, cause and effect relationships and human rationality.…”