How do you write pain? A preliminary study of narrative therapy for people with chronic pain

Chronic pain in the 21st century has been described as a health problem of epidemic proportions that, for a small but significant percentage of the population, appears to be tenaciously resistant to intervention. This preliminary study examined the use of time-specific free-form writing on assigned topics related to the experience of pain in terms of the effect on patients' perceived level of disability and self-efficacy, selection of positive coping skills, beliefs about pain, and feelings of anger about their current position. In addition, in order to better understand the pain experience, we identified emergent themes from the written narratives. A total of 10 patients were recruited from a multi-disciplinary pain treatment programme in a large urban centre. Standardised instructions were given for five discrete writing tasks, each lasting for 20 minutes. Participants performed sequential writing tasks at approximately 1-week intervals. Self-report measures of coping strategies, pain beliefs, pain-related disability, and affect were recorded at the first and last writing session, and at 1- and 3-month follow-up. We also conducted thematic analysis of the participants' free-form writing. We initially saw changes in coping styles, together with a reduction in levels of anger and catastrophising. These changes seemed to correspond closely to the completion of the writing exercises. The initial changes did not persist over the 3-month follow-up. Four predominant themes emerged across participants' narratives, namely control, anger, withdrawal from others, and the role of activity. These results suggest that narrative writing offers potential benefit for coping with pain, and for reducing unhelpful cognitions and behavioural patterns associated with chronic pain.