Using interpretative phenomenological analysis (IPA), three individual transcripts were used to explore the experiences of adjustment to chronic pain following successful sacral neuromodulation. This analysis aims to provide insight into the parallel of having a corrective device that eliminates bladder dysfunction and causes persistent device related pain.
The phenomenological aspect of IPA refers to capturing participant’s perceptions of their experiences. The researcher then makes sense of these events by offering an interpretation (Smith, Flowers & Larkin, 2009). What follows is my interpretation of participant’s first-person accounts of living which chronic pain following device implantation. As the analysis is a co-construction of ‘giving voice’ and ‘making sense’ of lived experiences (Larkin, Watts & Clifton, 2006), my interpretations may differ from another researcher. However, it was a priority that my interpretations were grounded in participants’ reflections.
This chapter presents the preliminary findings of one superordinate theme that has four inter-related subthemes. The superordinate theme selected is “The Dilemma: Helping Vs. Hindering”. The four inter-related subthemes are:
1. “It Works!”
2. “Pain is the Problem”
3. “The Future”
4. “Gritted Teeth”
As a novice IPA researcher, it was a conscious choice to use participants own words or expressions as subtheme titles. I believe that using participant’s language evokes their embodied and lived experiences. I recognise that this approach of titling themes may differ from other IPA researchers. However, as the focus of IPA is to understand the first-person perspective from the third-person position (Larkin, Watts & Clifton, 2006), I wanted to ensure that I stay as close as possible to participant’s experiences during interpretation, which researchers can miss if titles become too conceptual.
Due to the volume of findings, for this assignment, only one subtheme will be discussed with my interpretation that best illuminates the research question what are individual’s experiences of adjustment to chronic pain following successful sacral neuromodulation. To protect confidentiality, I gave participants’ pseudonyms.
Superordinate Theme 1: The Dilemma: Helping vs. Hindering
This superordinate theme aims to capture the positive and negative lived experiences of the women living with chronic pain from a device that’s restoring their bladder function. It highlights participants’ awareness that their persistent pain is a consequence of their sacral nerve stimulator. It also considers the impact of their device-related pain. This ‘dilemma’ of whether the device helps or hinders their quality of life emerged when participants described their experiences of restored bladder function, living with pain and contemplating their future. The four subthemes have been labelled “It Works!”, “Pain is the Problem”, “The Future”, and “Gritted Teeth”.
All participants describe their experiences of managing their pain with others. This theme reflects participant’s determination to summon up their strength during their experiences of pain in efforts of not letting others know how they honestly feel. It speaks to the nature of participant’s unwillingly having to accept their pain experience in hopes of overcoming their difficulties around others.
Below, Mira provides an introduction to “gritted teeth” when describing her interactions with others while experiencing device-related pain:
“And I always try and put a brave face on. I always try and be happy, I always try and be the one, you know? Somebody walks past me at work and I’ll smile at them. “Morning! Alright?” That’s me. That’s who I am. I try and make things pleasant for other people even if It’s unpleasant for myself. Even if, through gritted teeth, I’m saying morning. Whether that may be because I’m in pain or I just don’t want to say good morning to that person, I do, I do it. Because that’s, that’s me.”
Mira’s comments seem to indicate a continuous effort of pushing through discomfort in the presence of others. The repetitive use of the word “always” at the beginning of the excerpt can be interpreted as Mira being determined to be the winner in the fight against her pain. Mira’s self-concept is also noted here. That is, she holds beliefs about herself to be “the one”, a positive, happy individual. Comments such as “That’s me. That’s who I am” and “Because that’s, that’s me” suggest that she is aware of how the pain she experiences can produce changes within her. Mira appears to be competing with herself in the sense that she doesn’t want to lose who she is because of her pain. Thus, by using determination Mira is fighting against changes or disruptions in her self-perception.
It appears that Mira is hiding behind her pain. Lynn’s account also demonstrates a sense of hiding when articulating her experiences with others:
“You can’t continue telling people the shit that you’re going through. Excuse my French. It’s, it’s just, it’s embarrassing.”
I took note of Lynn’s forceful tone when she expressed this comment. Like Mira, it appears that Lynn is determined to refrain from telling others about her pain-related experiences. This sense of having to endure pain in efforts of saving face highlights Lynn’s personal experience. Unlike Mira, the comment “it’s embarrassing” suggests prior experiences of judgment from others. Paired with the use of the word “continue” which gives the impression of no change, an interpretation can be that Lynn’s frustration stems from previously telling others about her bladder difficulties, but now having to say that receiving the implanted device has fixed those problems but now results in chronic pain. This choice to not tell others about her experiences shows in her comment:
“Erm, so it’s, like your exchanging one problem for another problem.”
Lynn finds her current circumstances embarrassing because her difficulties are continuous and she fears judgment from others. Both Mira and Lynn commit to the experience of “gritted teeth” to defend against revealing their experiences of pain to avoid humiliation from others.
Here, Jennifer echoes Lynn’s experience of having to persevere through pain in her following reflection:
“You become conscious thinking about what are other people thinking looking at me and stuff like that. Like you think, ‘they don’t understand I’ve been through stuff’. And I think people can, are too judgemental sometimes. You know, they don’t know what people are going through and they’re just too quick to judge rather than, like, talk about stuff and, you know, what’s the full story rather than…you know. They just think ‘ah well she looks funny, so she must be funny’. You know, I just don’t think it’s always fair with the device. You know, people are just like ‘she doesn’t look right so I won’t talk to her’. It really gets you down.”
Jennifer’s account suggests that she insists on keeping the impact of her pain to herself. This effort illuminates when describing the consequences of what happens when she does not mask her pain experience around others. For example, there is a sense of isolation and withdrawal in the remarks “ah well she looks funny, so she must be funny” and “she doesn’t look right so I won’t talk to her”. There is also the sense of disappointment as being another consequence of not masking one’s pain experience from others. Jenner’s comment of “they don’t understand I’ve been through stuff” suggests that perhaps she has experienced a lack of empathy and understanding from others. Thus, her constant effort to avoid letting others whiteness how she truly feels. Interestingly, at the beginning of her comment, Jennifer uses “me” and “I” then later refers to “people” and “she” when articulating her experiences. This use of distance may mirror Jennifer’s unwillingness to show how pain affects her in the presence of others. It also points towards her psychological process of always thinking about how others perceive her. The comment “You know, I just don’t think it’s always fair with the device” illustrates perfectly the awareness Jennifer has of having to consistently consider others over herself, despite having to live with continuous pain.
“Gritted Teeth” focused on providing a spotlight on an aspect of participants lived experiences of pain following sacral neuromodulation. It highlights how participants living with chronic pain minimise their experiences around others. All participants confirmed that the pain they’re experiencing is stronger than what they’re manifesting. They also point toward the struggles of getting others to recognise this. Looking at this subtheme as it relates to the superordinate theme, it develops a picture of participants’ inner world and captures the conflict of whether they find the sacral nerve stimulator beneficial or detrimental in their lives.
Reflections on the Analysis Process:
As one cannot access another’s inner world completely, IPA recognises that interactions between researcher and analysis are dependent on the researcher’s values, assumptions and interest (Tuffour, 2017). Thus, it is important to consider my conceptions which have been used to make sense of participants’ personal experiences.
As noted in earlier chapters, my prior professional experience within Uro-Neurology has influenced my decision to undergo this exploration of adjustment to chronic pain following sacral neuromodulation. Naturally, because of this previous experience, I recognise that it may sway my interpretations and analysis of the data. The strategies I’ve undertaken to bracket my own experiences when understanding my participant’s world included keeping a reflective journal, attending IPA student workshops, supervision and frequent peer discussions with fellow trainee psychologists. Attending led to the development of an awareness of potential biases that would have influenced theme development. It also highlighted my constant anxiety about presenting participants experiences authentically. It was at this moment where I decided to use participants’ own words for theme development to ensure they adequately reflect participants’ accounts rather than my opinion of them.
While I enjoyed the creativity of grouping together superordinate and subthemes, I found the process of writing up the analysis difficult. Partly because of a lack of experience as an IPA researcher and because of my own experience of adjustment during the time of writing. While I understood that my past would influence the development of themes, I did not consider its impact on the write-up. During this time, engaging in personal therapy was beneficial. As IPA necessitates the drawing on the researcher’s knowledge and experience, the researcher is also expected to write the data in a way that avoids the ethical issue of researcher’s subjective interpretations of data (Webster, Lewis & Brown, 2014). Although attending personal therapy is not required for IPA research, I found it to be helpful in avoiding the overinterpreting or misinterpreting of data. Without the reflexivity developed in my therapy about my own experiences during the writing phase, I would not have been able to combat the potential pitfalls of capturing a picture that’s not evident in participants’ data.