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A Qualitative Examination of Pain Centrality Among Veterans of Iraq and Afghanistan Conflicts.

Outcalt SD, Nicolaidis C, Bair MJ, Myers LJ, Miech EJ, Matthias MS. A Qualitative Examination of Pain Centrality Among Veterans of Iraq and Afghanistan Conflicts. Pain medicine (Malden, Mass.). 2017 Feb 1; 18(2):211-219.

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Objective: Centrality of pain refers to the degree to which a patient views chronic pain as integral to his or her life or identity. The purpose of this study was to gain a richer understanding of pain centrality from the perspective of patients who live with chronic pain. Methods: Face-to-face interviews were conducted with 26 Veterans with chronic and disabling musculoskeletal pain after completing a stepped care intervention within a randomized controlled trial. Qualitative data were analyzed using an immersion/crystallization approach. We evaluated the role centrality plays in Veterans’ lives and examined whether and how their narratives differ when centrality either significantly decreases or increases after participation in a stepped care intervention for chronic pain. Results: Our data identified three emergent themes that characterized pain centrality: 1) control, 2) acceptance, and 3) preoccupation. We identified five characteristics that distinguished patients’ changes in centrality from baseline: 1) biopsychosocial viewpoint, 2) activity level, 3) pain communication, 4) participation in managing own pain, and 5) social support. Conclusions: This study highlights centrality of pain as an important construct to consider within the overall patient experience of chronic pain.

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