Invalidation of chronic pain: a thematic analysis of pain narratives
Abstract
PURPOSE: Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain. METHOD: A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain. FINDINGS: Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation. CONCLUSION: Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.
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People presenting with physical injury can feel that their pain is being dismissed as being 'all in their head' when referred for psychological care.
“Additionally, people presenting with physical injury can understandably feel that their pain is being dismissed as being ‘all in their head’ when referred for psychological care.19 20”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [19]
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- Authors
- Nicola, M., Correia, H., Ditchburn, G., & Drummond, P.
- Affiliations
- Murdoch University (AU)
- Corresponding author
- Nicola, Melinda
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2019-07-10
- Volume
- 43
- Issue
- 6
- Pages
- 861-869
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W2961063803
- Cited by
- 101
- References
- 59
- Citations by year
- 2026: 20 · 2025: 29 · 2024: 15 · 2023: 16 · 2022: 10 · 2021: 6 · 2020: 5
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion)
- Funders
- Australian Government through a Research Training Program
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic pain, pain narratives, social stigma, self-judgment, help-seeking barriers, clinician attitudes, family and social support, self-image, social isolation, pain awareness, rehabilitation
- MeSH terms
- Emotions, Empathy, Humans, Narration, Chronic Pain
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