“It’s All in Your Head”: A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions
Abstract
Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.
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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 [20]
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Different logics of pain: the gendered dimension of chronic pain in a relational setting
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Medical invalidation: A concept analysis
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Health Controversies: Long-Term Disagreement Management Challenges
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Assessing the Risk for Falls in Older Adults After Initiating Gabapentin Versus Duloxetine
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The Demands of the Menstrual Movement: Stigma, Misinformation, and Social Inequalities
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Gabapentinoid Use by Self-Reported Indication and Level of Evidence
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Self-citationMultimorbidity in Chronic Overlapping Pain Conditions: From Burden to Integrated Care
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Pain, Shame, and Power: An Autoethnographic Exploration of Chronic Pain
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Unheard Voices: Communicative (Dis)enfranchisement in Women’s Health Experiences in China
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Give and take: an evolutionary framework for social transactions in pain
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Navigating power and silence: Communicative disenfranchisement in menopause healthcare communication
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Women’s and healthcare professionals’ experiences of gynaecological examinations in Taiwan
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- Authors
- Hintz, E. A.
- Affiliations
- University of Connecticut (US)
- Corresponding author
- Hintz, Elizabeth A.
- ORCID
- Hintz, Elizabeth A.
- Venue
- Health Communication
- Publisher
- Informa UK Limited
- Published
- 2022-06-12
- Volume
- 38
- Issue
- 11
- Pages
- 2501-2515
- ISSN
- 1041-0236 (ISSN-L)
- 1532-7027
- OpenAlex
- W4282590574
- Cited by
- 106
- References
- 97
- Citations by year
- 2026: 36 · 2025: 30 · 2024: 22 · 2023: 15 · 2022: 3
- FWCI
- 20.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Communication (publishedVersion)
- PubMed (publishedVersion)
- Funders
- associated
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Keywords
- chronic overlapping pain conditions, female patients, patient-provider communication, gender, silencing, stereotyping, patient agency, health care access, patient-provider relationship, intersectionality, race and class
- MeSH terms
- Chronic Disease, Communication, Female, Humans, Professional-Patient Relations, Qualitative Research, Chronic Pain
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