Charlotte Paterson’s research while affiliated with University of Bristol and other places

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Publications (70)


Methodological exemplar of integrating quantitative and qualitative evidence- Supportive care for men with prostate cancer: what are the most important components?
  • Literature Review
  • Full-text available

July 2016

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170 Reads

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11 Citations

Journal of Advanced Nursing

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Theresa H.M. Moore

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Maggie Evans

AimsTo present a methodological exemplar of integrating findings from a quantitative and qualitative review on the same topic to provide insight into components of care that contribute to supportive care that is acceptable to men with prostate cancer. Background Men with prostate cancer are likely to live a long time with the disease, experience side effects from treatment and therefore have ongoing supportive care needs. Quantitative and qualitative reviews have been published but the findings have yet to be integrated. DesignIntegration of quantitative and qualitative synthesized evidence. Data sourceTwo previously published systematic reviews. Review methodsSynthesized evidence on supportive care for men with prostate cancer was integrated from two previously published systematic reviews: a narrative quantitative review and a qualitative review with thematic synthesis. These two streams of synthesized evidence were synthesized using concurrent narrative summary. Data from both reviews were used to develop a set of propositions from which a summary of components of care that likely to contribute to supportive care acceptable to men with prostate cancer were identified. ResultsNine propositions were developed which covered men's supportive care focusing on the role of health professionals. These propositions were used to compose nine components of care likely to lead to supportive care that is acceptable to men with prostate cancer. Some of these components are no/low cost such as developing a more empathic personalized approach, but more specific approaches need further investigation in randomized controlled trials, for example, online support. Conclusion This methodological exemplar demonstrates the integration of quantitative and qualitative synthesized data to determine components of care likely to lead to provision of supportive care acceptable to men with prostate cancer.

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Resisting Prescribed Opioids: A Qualitative Study of Decision Making in Patients Taking Opioids for Chronic Noncancer Pain

September 2015

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90 Reads

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11 Citations

Pain Medicine

Background Opioids are increasingly prescribed for chronic noncancer pain across the developed world. Clinical guidelines for management of these patients focus on over-use. However, research into other types of long-term medication indicates that many patients minimize drug use whenever possible.Objective To identify the varying influences on patients’ decisions about their use of prescribed opioids and explore whether concepts of resistance and minimization of intake apply to these patients.DesignA multiprofessional team performed a qualitative interview study using the constant-comparative method. Patient's decision making was explored in depth and with a thematic analysis utilizing a published “Model of medicine-taking.”Setting and participantsA purposive sample of 20 participants drawn from two pain clinics in Melbourne, Australia. The sample was biased toward patients interested in nonmedication pain management options.FindingsPatients’ needs to obtain relief from severe pain, maintain function, and minimize side effects could lead to under-use as well as over-use of prescribed opioids. In keeping with the published Model of medicine-taking, resistance to taking opioids was a common and important influence on behavior. In the face of severe chronic pain, many participants used a variety of strategies to evaluate, avoid, reduce, self-regulate, and replace opioids. Furthermore, participants perceived a resistance to opioids within the system and among some healthcare professionals. This sometimes adversely affected their adherence.Conclusions Both patients and doctors exhibit aspects of resistance to the use of prescribed opioids for chronic noncancer pain, suggesting that this shared concern could be the basis of a productive therapeutic alliance to improve communication and shared decision making.SummaryClinical guidelines for opioids use for chronic noncancer pain focus on over-use. Our qualitative interview study found that many patients resisted and minimized the use of opioids. Using a published “Model of medicine-taking,” we identified various influences on patient decision making. Both patients and doctors had concerns about using opioids for chronic noncancer pain. These could be the basis of a productive therapeutic alliance to improve communication and shared decision making.


Table 1 . Study characteristics of review studies 
Table 3 . Types of peer support 
Prostate cancer and supportive care: a systematic review and qualitative synthesis of men's experiences and unmet needs: Prostate cancer and supportive care

February 2015

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125 Reads

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176 Citations

Prostate cancer is the second most common cancer in men worldwide, accounting for an estimated 1.1 million new cases diagnosed in 2012 (www.globocan.iarc.fr). Currently, there is a lack of specific guidance on supportive care for men with prostate cancer. This article describes a qualitative systematic review and synthesis examining men's experience of and need for supportive care. Seven databases were searched; 20 journal articles were identified and critically appraised. A thematic synthesis was conducted in which descriptive themes were drawn out of the data. These were peer support, support from partner, online support, cancer specialist nurse support, self-care, communication with health professionals, unmet needs (emotional support, information needs, support for treatment-induced side effects of incontinence and erectile dysfunction) and men's suggestions for improved delivery of supportive care. This was followed by the development of overarching analytic themes which were: uncertainty, reframing, and the timing of receiving treatment, information and support. Our results show that the most valued form of support men experienced following diagnosis was one-to-one peer support and support from partners. This review highlights the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects.


Figure 2 Conceptual framework of the decision-making process for complementary and alternative medicine (CAM) by patients with cancer. Conventional medical-decision making is included in this framework because making decisions about CAM cannot be separated from making decisions about conventional medicine. Social factors, cultural norms, and demographic and disease-related factors constitute the "contextual factors" discussed in the text. Transitions from one phase to another within the decision-making trajectory may occur at times of crisis or milestones, such as the end of conventional treatment and transition to survivorship or palliative care. 
Decision-making about complementary and alternative medicine by cancer patients: Integrative literature review

April 2014

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1,034 Reads

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58 Citations

Open Medicine

Background: Patients with cancer consistently report conflict and anxiety when making decisions about complementary and alternative medicine (CAM) treatment. To design evidence-informed decision-support strategies, a better understanding is needed of how the decision-making process unfolds for these patients during their experience with cancer. We undertook this study to review the research literature regarding CAM-related decisionmaking by patients with cancer within the context of treatment, survivorship, and palliation. We also aimed to summarize emergent concepts within a preliminary conceptual framework. Methods: We conducted an integrative literature review, searching 12 electronic databases for articles published in English that described studies of the process, context, or outcomes of CAM-related decision-making. We summarized descriptive data using frequencies and used a descriptive constant comparative method to analyze statements about original qualitative results, with the goal of identifying distinct concepts pertaining to CAM-related decision-making by patients with cancer and the relationships among these concepts. Results: Of 425 articles initially identified, 35 met our inclusion criteria. Seven unique concepts related to CAM and cancer decision-making emerged: decision-making phases, information-seeking and evaluation, decision-making roles, beliefs, contextual factors, decision-making outcomes, and the relationship between CAM and conventional medical decision-making. CAM decision-making begins with the diagnosis of cancer and encompasses 3 distinct phases (early, mid, and late), each marked by unique aims for CAM treatment and distinct patterns of informationseeking and evaluation. Phase transitions correspond to changes in health status or other milestones within the cancer trajectory. An emergent conceptual framework illustrating relationships among the 7 central concepts is presented. Interpretation: CAM-related decision-making by patients with cancer occurs as a nonlinear, complex, dynamic process. The conceptual framework presented here identifies influential factors within that process, as well as patients' unique needs during different phases. The framework can guide the development and evaluation of theorybased decision-support programs that are responsive to patients' beliefs and preferences.


Chaos to Hope: A Narrative of Healing

April 2013

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36 Reads

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15 Citations

Pain Medicine

Aims: To investigate the progression of the illness and opioid journeys of people who are taking opioids for chronic non-cancer pain. Methods: In-depth qualitative interviews were conducted with 20 people who were taking opioids for non-cancer pain. A purposive sample was drawn from patients attending two pain clinics in Melbourne, Australia. Transcripts were analyzed within case, as individual narratives, and across case, as a thematic analysis. Conceptual explanatory variables were developed. Results: The experience of taking opioids for chronic non-cancer pain varies greatly between individuals and these diverse narratives-chaos, restitution, and quest narratives-raise questions about why and how some individuals find a way forward, while others remain in situations of chaotic and worsening ill health. We offer an explanation for this variability in terms of four key influences: support from individual health professionals and the health system; medical explanation or solutions; social support and social responsibilities; and the use of non-pharmaceutical interventions and self-help strategies. A unifying theme was the importance of maintaining hope. Conclusion: The four key factors influencing the progress of people taking opioids for chronic non-cancer pain are rooted in the provisions made by society for caring for this patient group and involve relationships between patient and provider, between patients and their social world, and between different providers and their professional knowledge. In our patient sample, effective support involved the provision and maintenance of hope, and professionals who are knowledgeable about opioids and chronic pain, good communicators, and cognizant with their patients' social support and responsibilities.


Table 1 The Normalisation Process Model-a summary of the original model (adapted from May 2006) Endogenous Processes Endogenous processes comprise elements of professional/patient relations and their associated material practices in the clinical encounter
Embedding chiropractic in Indigenous Health Care Organisations: Applying the normalisation process model

November 2012

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110 Reads

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5 Citations

BMC Health Services Research

Background Improving the health of Indigenous Australians remains a major challenge. A chiropractic service was established to evaluate this treatment option for musculoskeletal illness in rural Indigenous communities, based on the philosophy of keeping the community involved in all the phases of development, implementation, and evaluation. The development and integration of this service has experienced many difficulties with referrals, funding and building sustainability. Evaluation of the program was a key aspect of its implementation, requiring an appropriate process to identify specific problems and formulate solutions to improve the service. Methods We used the normalisation process model (May 2006) to order the data collected in consultation meetings and to inform our strategy and actions. The normalisation process model provided us with a structure for organising consultation meeting data and helped prioritise tasks. Our data was analysed as it applied to each dimension of the model, noting aspects that the model did not encompass. During this process we reworded the dimensions into more everyday terminology. The final analysis focused on to what extent the model helped us to prioritise and systematise our tasks and plans. Results We used the model to consider ways to promote the chiropractic service, to enhance relationships and interactions between clinicians and procedures within the health service, and to avoid disruption of the existing service. We identified ways in which chiropractors can become trusted team members who have acceptable and recognised knowledge and skills. We also developed strategies that should result in chiropractic practitioners finding a place within a complex occupational web, by being seen as similar to well-known occupations such as physiotherapy. Interestingly, one dimension identified by our data, which we have labelled ‘emancipatory’, was absent from the model. Conclusions The normalisation process model has resulted in a number of new insights and questions. We have now established thriving weekly chiropractic clinics staffed by a team of volunteer chiropractors. We identified an ‘emancipatory’ dimension that requires further study. We provide a worked example of using this model to establish, integrate and evaluate a chiropractic service in an Indigenous Australian community.


Chronic illness and self-management in primary care: characterising the ‘work’ of older patients with coronary heart disease

Objectives:Self-management policy presents opportunities for patients with long-term conditions to improve their health by becoming active agents in their care. However, the ‘work’ of self-management for patients appears to need certain skills and attributes. The aim of this research was to characterise the self- management ‘work’ of older patients with coronary heart disease (CHD) in primary care and to identify the skills and attributes required for participation. Methods:This qualitative study employed longitudinal diary-interviews with 21 patients, 65 years and over, and interviews with 8 professionals, in 3 contrasting socio-economic general practice areas in the South West of England. Results:An ideal conceptual model of self- management developed from the literature identified four concepts described as: active, competent, efficacious and responsible, which exemplify an ‘ideal’ self-manager. This model was tested throughout data collection. Patients in areas of low deprivation demonstrated sufficient attributes and skills associated with an improved outcome for their heart, in contrast to patients in areas of higher deprivation. A knowledge and skill deficit and factors associated with bereavement, retirement, financial hardship, caring responsibilities and co- morbidities impacted on optimum self- management. An alternative model of self- management emerged, using the metaphor of work, including 5 dominant occupational roles and 3 levels of occupational status to explain the approach to self-management embodied by patients within this study. Conclusions:This occupational model provides a contextually sensitive method for describing the older person’s experience of living with CHD, within their life-world. This sociological perspective is relevant to policy makers and professionals in primary care.


GP support for self-care: The views of people experiencing long-term back pain

October 2012

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14 Reads

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10 Citations

Family Practice

Background: Promotion of self-care for persistent back pain and other long-term conditions has become a central component in health care policy in the UK, and general practitioners face increasing demands to support patients' self-care efforts. Gaining insight into patients' views may facilitate support. Objective: To describe patients' experience of self-care for long-term back pain and their views on provision of support for self-care. Methods: Adults experiencing persistent back pain were purposively sampled from a community-based survey. In-depth qualitative interviews were audiotaped, transcribed and analysed using the constant comparative method to inductively derive a thematic account of the data. Results: Most of the 23 interviewees felt a responsibility to self-care. Individual capacity for self-care, however, was variable and could be inhibited by factors such as caring roles or lack of diagnosis and information. GP support for self-care was largely considered to be desirable, although the feasibility of greater provision of support was questioned. Some interviewees expressed a strong preference for alternative models of care and support. Conclusion: Self-care for back pain is contextualized by the individual's capacity to self-care and preferences for support. Doubt over the ability of GPs to provide support for self-care may mean that those who have specific needs are reticent to seek help. The role of self-care in the management of back pain should be discussed openly at the consultation level, and GPs may be well placed to signpost patients and provide guidance on the safety of specific self-care activities.


‘all in the Same Boat—: A Qualitative Study of Patients’ Attitudes and Experiences in Group Acupuncture Clinics

August 2012

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1,076 Reads

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34 Citations

Acupuncture in Medicine

Group acupuncture clinics have been introduced in a London hospital and in two general practices in Hertfordshire for the treatment of knee osteoarthritis (OA). Encouraging preliminary reports have been published of the efficacy of the treatment delivered in this setting but its acceptability to patients has not yet been established. The aim was to investigate the acceptability and perceived advantages and disadvantages of acupuncture delivered in the group setting for the treatment of knee OA. Semistructured interviews were conducted with 16 patients in their own homes and with four nurses over the telephone. Interviews were recorded, transcribed, fully anonymised and analysed thematically. Group acupuncture was delivered with enthusiasm by nurses, was acceptable and popular with patients and recognised to be cost-efficient. Factors affecting acceptability were situational, interpersonal and intrapersonal. Situational factors included adequacy of the physical space used, flexibility of the appointment system and the changing and adaptable nature of the group. Interpersonal factors were mutual support, the exchange of information, the provision of mixed or single-sex sessions and the role of the acupuncture nurse. Intrapersonal factors that increased acceptability were less clear, but nurses expressed the view that the group setting was less suitable for patients with complex conditions or severe pain. Acceptability is very high and may be maximised by taking a number of factors into account: full information should be provided before treatment begins; flexibility should be maintained in the appointment system and different levels of contact between fellow patients should be fostered; sufficient space and staffing should be provided and single-sex groups used wherever possible.


Figure 1: The first IMCO-model.
Figure 2: The integrative MS treatment model.
An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

April 2012

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118 Reads

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14 Citations

BMC Complementary and Alternative Medicine

The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004-2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients' resources and competences on a physical, an emotional and a cognitive level.


Citations (54)


... 3.14. 作者主导一行和本疗法之间的关系 本文写到这里,我不由得发现作者的主导一行和这种五行针灸疗法之间有一定的关系。作者的主 导一行为火,这一点作者自己也承认过了,因为火是她的"特殊领地",五行循环中火这一段是 她的"家园"。作为火一行,开放,热烈,追求"轰轰烈烈",大幅面的影响力,轰动效应。缺 少的和不喜欢的是金一行的踏实,仔细,严谨,一步一个脚印地追求完美,所以火克金。而金强 幸运的是,我们还真的找到了这样一篇研究文章。Paterson C (2011)发表了一篇文章24 ,他们将 80 个患有慢性疾病的,频繁看病的,西医检查为原因不明的病人,随机分为两组:针灸组和对照 组。两组都给予西医常规治疗,而针灸组另外给予此五行针灸。病种:51%的病人患的是慢性肌肉 关节疼痛, 13% 为情感障碍,10% 为头痛,另外 10% 为慢性疲劳综合征。针灸为每周一次,然后 (7) 对于作者所采用的五行选穴法则,应该是受到日本针法的很大影响。我们对于日本针法采用如此五行选 穴方法不了解,也许这是很不同于中国应用五行的方法。但是就我们现在对于灵枢-难经体系的理解,同一 经络上母穴和子穴同时使用;或者母经和子经同时使用,造成同时补和泻的方法并不是采用五行的主流方 法。 两周一次,再后是一个月一次。26 周内共 12 次针灸。8 名五行针灸师对针灸组实施了五行针刺 治疗。治疗方法因人而异。治疗后检查病人症状改善程度,主要指标是"症状改善程度自我评价 表" (MYMOP)及其它(见表 1)。治疗 26 周后,针灸组症状从 4.3 降为 3.3 (下降了 23%); 而对照组从 4.6 降为 4.0(下降了 13%). 两组差异无显著性区别。也就是说,治疗半年 12 次,患 者症状下降了仅仅 23%,而且和没有接受针灸的病人组相比,从统计学意义上讲没有区别!该指 标最大程度为 6,就是说,转换为平常采用的 10 分指标,针灸治疗使得症状从 7.1 下降到 5.5;而 对照组从 7.6 下降到 6.6. ...

Reference:

Nora 五行针灸主要依靠心理安慰性作用吗?
Acupuncture for 'frequent attenders' with medically unexplained symptom: a randomised controlled trial (CACTUS Study)
  • Citing Article
  • June 2011

British Journal of General Practice

... We agree that this is one type of sham acupuncture. There are a variety of types of sham acupuncture, including needle location (e.g., use of nonacupoints or irrelevant acupoints), degree of needle insertion (e.g., no penetration of depths believed to be suboptimal), and needle stimulation (e.g., no or suboptimal manual or electrical stimulation) (3,4,12,13). We and others have noted that each of these kinds of sham acupuncture has its limitations. ...

Developments in acupuncture research: big-picture perspectives from the leading edge. Society for Acupuncture Research Symposium, 2007. Conference Report.
  • Citing Article
  • September 2008

... Because the effects of ADT can be severe, it has been recommended that men be monitored for sexual dysfunction and depression [17]. The best opportunity to detect those who might be experiencing distress is during follow-up appointments, which offer an ideal opportunity to monitor patient progress [20,21]. In support of previous calls for greater involvement of the role of primary care in providing follow-up for cancer patients [22], NZ general practitioners (GPs) could step into this role and encourage more discussion with patients concerning ongoing needs related to their PCa. ...

Methodological exemplar of integrating quantitative and qualitative evidence- Supportive care for men with prostate cancer: what are the most important components?

Journal of Advanced Nursing

... Of primary importance is the scientific evidence component of EBM. Although there is sufficient scientific evidence to suggest the use of several CIH approaches [6][7][8], concerns have been raised about external validity and generalizability of the outcomes and conclusions [9][10][11][12][13][14]. It has also led to a degree of skepticism by CIH practitioners [15][16][17][18]. ...

Controversies in acupuncture research: Selection of controls and outcome measures in acupuncture clinical trials

Journal of alternative and complementary medicine (New York, N.Y.)

... Opioid use in acute, operative and cancer pain is well established and clinically supported, but concerns have been increasingly raised about opioid use in chronic non-cancer pain [3]. Concerns relate to a variety of harms including dependence in particular but also increased risks of overdose and fatalities [4], respiratory depression and hyperalgesia, misuse, abuse and medication-error-related adverse events [5] and sociological concerns about stigma and shame also [6,7]. Exacerbating these concerns have been trends of increased prescribing and availability of opioids in many high-income countries and more specifically prescribing of higher strength opioids [8][9][10]. ...

Resisting Prescribed Opioids: A Qualitative Study of Decision Making in Patients Taking Opioids for Chronic Noncancer Pain
  • Citing Article
  • September 2015

Pain Medicine

... A population-based registry collecting patient-reported outcomes (PROs) from men with prostate cancer can provide a rich epidemiological impression of survivorship problems as well as assist individual men. It is widely known that prostate cancer (PCa) treatment can result in bothersome urinary, sexual and bowel symptoms that can have a significant impact on quality of life (QoL) [1][2][3][4][5][6]. Provider assessments may differ sharply from patient assessments, so PROs offer a unique opportunity to enhance patient-centred care by capturing health-related QoL (HRQoL) from the perspective of the patient [7][8][9][10]. ...

Prostate cancer and supportive care: a systematic review and qualitative synthesis of men's experiences and unmet needs: Prostate cancer and supportive care

... Patients' decision-making on medical treatment decisions is complex and known to depend on multiple factors [17][18][19]. While factors influencing patients' decision-making between different treatment options have been investigated within the field of operative dentistry [20][21][22], patients' decision-making for repair or replacement of partially defective restorations is unclear. ...

Decision-making about complementary and alternative medicine by cancer patients: Integrative literature review

Open Medicine

... A targeted citation search for additional publications associated with trials identified as constraining relationships identified one further report 18 of a study located in the original search as an abstract. 19 Eighty-one of 785 trials were identified as having a practitioner-participant relationship constraint-a prevalence of 10.3% (figure 1). Of these, 31 20- 22 27 28 32 37 39 42 47 50 51 58-61 63 65 67 72 78 80 86 88 89 93 of the 192 randomised trials of musculoskeletal or neuropathic pain (16.1%) were constrained. ...

‘How is it for the patient?’ Participating in a sham-controlled acupuncture trial for migraine
  • Citing Article
  • December 2006

Focus on Alternative and Complementary Therapies

... Only one such tool was shortlisted because it was developed for TCAM and IM use. However, it is still in its early development phase [270,271]. Rather than measuring use, another approach is to measure compliance with prescribed medications and other advice given by practitioners. Numerous questionnaires have been written for this purpose. ...

Medication change as an outcome: developing the Medication Change Questionnaire
  • Citing Article
  • December 2010

Focus on Alternative and Complementary Therapies

... Biographical disruption has been extensively described in people with persistent physical symptoms and clinical syndromes predominantly characterised by symptoms. This includes chronic pain (Toye et al., 2014;Wasson, 2018;Zheng et al., 2013), fatigue (Whitehead, 2006, Asbring, 2001 and multiple symptoms (Spillmann et al., 2017;Nettleton, 2006;Nettleton et al., 2005). The construct of "medically unexplained symptoms" is particularly problematic because the lack of a medical explanation (or in some cases the imposition of an unwanted psychological one) implies that the symptoms may not indicate a medical condition, but rather a problem with the person, or the self (Hartog et al., 2020;Rossen et al., 2019;Werner, Isaksen, & Malterud, 2004). ...

Chaos to Hope: A Narrative of Healing
  • Citing Article
  • April 2013

Pain Medicine