This thesis is based on two theoretical models of chronic illness: Large, Butler, James, and Peters (1990) introduced a systems model of musculo-skeletal pain which incorporated many of the variables believed to be important in the development and maintenance of pain. Feldman’s model (1974) addressed the difficulties of adapting to chronic illness. Five studies evaluated specific aspects of these models. The epidemiology of pain in New Zealand (NZ) was derived from a psychiatric epidemiology project. Approximately 80% of NZ adults had experienced a life disrupting episode of pain which had required medical consultation. Subjects who reported episodes of pain were more likely to have psychiatric diagnoses of anxiety, depression, and phobia. They were more likely to describe their health as poor and were currently consulting their doctor more than people who did not report an experience of pain. The estimated average cost of health consulting by people attending Auckland Hospital Pain Clinic (AHPC) for the previous year was $1333(NZ). Most people had some subsidy of costs. The health consulting of the AHPC group was higher than that reported in the NZ health literature. Self image and the experience of pain were assessed in two studies. The first asked subjects at AHPC to describe the typical thoughts, feelings, and behaviours, of someone with chronic pain. Subjects described loss of self esteem, alienation from family and friends, fear of the future, frustration and anger. The descriptions focused on psychological aspects of the experience of pain. The second study of self image used repertory grid technique. Two standardised Illness Self Construct Repertory Grids (ISCRG) were evaluated. Issues in the use of standardised grids are discussed and some aspects of ISCRG application are explored. The two ISCRG indicated subjects often identified themselves as a physically ill person and felt isolated from others. People with pain and their "closest other” (CO) completed the ISCRG(A) and questionnaires on the quality of their relationship. Closest others overestimated the role of the physical illness in their partners’ life and believed that they understood them better than the individual with pain thought they did. The personality dimensions of alexithymia and hypnotisability have been hypothesised as pathways for the development of psychosomatic illness. Individuals with chronic pain were tested to establish whether they weremore alexithymic and more hypnotisable than subjects in a general population control group. This was not verified. The constructs of alexithymia and hypnotisability require critical examination. The experience of pain is common and is associated with psychological distress and high health service use. Self construct appears to be a major factor determining response to pain and to treatment programmes. Chronic pain appears to be a particular challenge for individuals who must accept alteration in their lifestyle with perhaps little understanding of what the future may hold. / Whole document restricted, but available by request, use the feedback form to request access.
| Identifer | oai:union.ndltd.org:ADTP/275572 |
| Date | January 1991 |
| Creators | James, Frances Ruth |
| Publisher | ResearchSpace@Auckland |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Whole document restricted but available by request. Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated., http://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm, Copyright: The author |
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