Is pain ever acceptable? A qualitative exploration concerning adult perceptions of chronic pain

BACKGROUND: Although the challenges of living with chronic pain are widely documented within existing literature, to our knowledge, the acceptability of pain for people living with persistent pain, has not been fully explored. The current study aims to explore what 'acceptable pain' means to adults living with chronic non-cancer pain (CPCP).

METHODS: A total of 117 participants (aged 21 to 77 years) worldwide were recruited using opportunity sampling. Participants completed an online qualitative survey. Qualitative analysis of the data used inductive reflexive thematic analysis.

RESULTS: Two themes were generated. The first theme-'I grin and bear it', described participants' desire and drive to push through their pain to live their daily lives to the best of their ability. Contrastingly, the second theme-'Thriving versus surviving', placed greater importance on leading meaningful and happy lives despite living with chronic pain. The acceptability of pain was found to be influenced by various factors including, but not limited to, pain severity, mental health, functionality, productivity and quality of life.

CONCLUSIONS: It can be difficult to identify when a clinically significant change in pain has occurred from numerical pain rating scales. We have identified two themes and a number of factors influencing the acceptability of pain. Understanding individuals' unique perceptions of what constitutes 'acceptable pain' is crucial for clinicians when assessing and managing chronic pain. Pain is a highly subjective experience, and what one person considers acceptable may differ significantly from another person's perspective. Recommendations to improve healthcare services for adults living with CNCP are proposed and directions for future research are explored.

SIGNIFICANCE: Adults with CNCP have unique experiences of living with and managing their chronic pain. CNCP was found to affect biological, psychological, and social aspects of an individual's life. The acceptability of pain exists on a continuum where adjacent parts are not noticeably different from each other, but the extremes of the continuum appear very distinct. The acceptability of pain is determined by the different factors that influence an individuals' ability to function on a day-to-day basis as well as their quality of life. While acceptable pain and manageable pain represent distinct aspects of the pain experience, the relationship between them is complex and plays a crucial role in how individuals cope with and adapt to chronic pain.