Thriving when living with chronic pain: A qualitative evidence synthesis of individuals' experiences

Abstract

Introduction: Research has begun to focus on positive adjustment to, and aspects of, living with chronic pain, which aligns with a positive psychology approach. This systematic review aimed to synthesize available qualitative data to understand the characteristics and approaches that enable people to thrive whilst living with chronic pain.

Methods: Five electronic databases (MEDLINE, PsycINFO, CINAHL Plus, Scopus and ProQuest) were searched from their inception until January 2024 using a combination of terms for 'chronic pain', 'thriving' and 'qualitative methods'. Inclusion criteria stipulated qualitative data pertaining to facilitators, barriers and inequalities in experiences of thriving in adults living with chronic pain (without a clear underlying cause). The methodological quality of studies was assessed using the Critical Appraisal Skills Programme Tool. Data were analysed using thematic synthesis, with GRADE-CERQual used to determine confidence in the evidence.

Results: In total, 4162 studies were screened; 17 were included in the qualitative synthesis. Thematic synthesis yielded four overarching themes: (i) attitudes towards pain and its impact on life; (ii) behavioural strategies and openness to trying new things; (iii) perceiving love, support and connection with others; and (iv) ascribing meaning to life alongside pain. GRADE-CERQual indicated moderate confidence in findings.

Discussion: Findings align with Seligman's five pillars of well-being (PERMA) model and indicate clinical implications for supporting patients to thrive alongside pain.

Keywords: PERMA; acceptance; chronic pain; living well; positive psychology; thriving.

FIGURE 1

Conceptual map of positive adjustment to chronic pain, drawing on definitions of flourishing (VanderWeele et al., 2019), thriving (Brown et al., 2017) benefit‐finding (Cassidy et al., ; Helgeson et al., 2006), post‐traumatic growth (Tedeschi et al., 2018) and resilience (Seligman, 1992). No hierarchy between concepts is intended. Created in https://BioRender.com/dsr824w.

FIGURE 2

PRISMA diagram illustrating the screening process.

FIGURE 3

Visual summary of the findings. Notes under each theme indicate the PERMA pillars with which each theme best aligns.