Theory of Adapting to Chronic Pain

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Chronic pain is often a complex health issue which is not easy to ease or cure  but is likely to be encountered in most every area of nursing.  With chronic pain comes lasting discomfort, especially in instances of chronic illnesses. Chronic pain develops through gradual worsening of symptoms which manifest in the joints, pelvis, back, or other parts of the body. The symptoms last anywhere from a period of one moth to more than six months. Therefore, managing pain must be the priority of the nurse whose role should strongly focus on the healthiest lifestyle possible for the patient with a chronic illness.  There are multiple theoretical frameworks nurses can apply to help alleviate suffering by the patient experiencing unrelenting chronic pain. Theories are a vital component of the foundations in nursing practice. Nurses are required to apply conceptual frameworks implemented to assist in describing and predicting behaviors and possible outcomes. The middle-range theory of unpleasant symptoms is a resource implemented to enhance self-care in patients with chronic pain.

Middle-Range Theory of Unpleasant Symptoms

According to Kolebaek and Snis (2018), the middle-range theory is more concrete and applicable as it relates to patients with chronic pain in comparison to other theories. This particular theory explains that similarities exist among unpleasant symptoms that describe a specific chronic illness. The presentation of these symptoms may be treated or managed by nursing interventions. The theory describes a chronic condition fulfilling three criteria: the symptom the patient is experiencing, contributing factors or illnesses to the extent of the symptoms, and outcomes of the symptoms (Nguyen, Haas, and Pugh, 2017). In addition, according to the theory, symptoms usually take place simultaneously, ultimately resulting in a cluster phenomenon. For example, pain and nausea which commonly present together, may depict a certain illness. This combination often makes it more difficult to differentiate, which often requires further assessment.

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According to Fernandes, the middle-range theory is a qualitative paradigm approach that was developed in the primary healthcare realm.  The theory can be used in guiding any presenting healthcare scenario through examination of a patient’s behavior, change process, explanation of observations, and the description of outcomes observed. (Fernandez, 2015). The theory presents nurses with a platform that is easy to understand and follow due to the explanatory nature of the model.

Demonstrate concepts linked to the patient, nursing, expected results, and integration of existing theories and frameworks of nursing. The framework identifies both barriers and critical individuals in the management of chronic illness such as pain. Patient’s beliefs, attitudes, autonomy, background, and independence are crucial in identifying possible barriers. The level of perceived vulnerability, support system, and degree of self-sufficiency are all major contributors in the patient’s response to a certain degree nurse guided self-care. The framework also highlights the need for nurses to possess professional knowledge, counseling skills, focus on patient advocacy, and recognition of behavioral changes in order to lessen or alleviate patient suffering. Such skills and knowledge would enable a nurse to effectively communicate which in turn would necessitate the evaluation of management deficits, shared-decision-making, and coping strategies. The ultimate desired outcome would be a relief in pain which would lead to a lifestyle change in chronic patients.

The use of Middle-Range Theory to Explain Chronic Pain

The middle-range theory explains how a health condition may change the physiological, psychological, and situational condition of a patient. Certain health conditions manifest similar symptoms of timing, the degree of discomfort, quality, and intensity. A patient’s severity rating of a condition is representative of both physical intensity as well as emotional aspect of discomfort and disruptions in quality of life. The use of language to verbally express the sensations or symptoms experienced often reflects the patient’s quality of life. Sometimes inadvertently, the patient is giving clues to the nurse/provider, making it vital to engage active listening skills. There are three types of variables that affect the timing, intensity, extent of discomfort, and quality of the condition including situational, psychological, and physiological features (Nguyen, Haas, Pugh, 2017).

Physiological features include the level of energy of a patient which psychological features include response to the illness, understanding of symptoms, and mental status. On the other hand, situational features which are shaped by the physical environment, affect how a patient experiences or interprets the symptoms. Middle-range theory discusses the impact of the symptom encountered. The description demonstrates how the symptoms a patient experiences from a chronic illness shifts the situational, physiological, and psychological state. For instance, it explains how chronic pain and the symptoms that ensue have a negative impact on social relationships and a patient’s societal role. Chronic pain may also affect eating habits, a physiologic aspect, or increased depression/anxiety, a psychological aspect. Chronic pain has the potential to cause changes in major areas of life, as employment. The demonstration of the relationship among the overlapping symptoms of chronic pain and their ultimate impact on the functioning of an individual enable nurses to develop vital interventions in lessening chronic pain.

Nursing Interventions for Chronic Pain

The middle-range theory demonstrates the importance of the culmination of experience, skills, and knowledge in the decision-making and implementation of self-care plans for chronic pain patients (Jaarsma, Cameron, Riegel, 2017). Nurses should be trained to ensure patients gain skills and proficiency in self-care. Nurses are advised to verify patients understand all aspects of self-care, which can easily be achieved by observation.

Intrinsic or extrinsic motivations are also factors that have proven to help in adaptation to chronic pain. Intrinsic motivation is the engagement in an activity because of the recommendation from an external force (Jaarsma, Cameron, Reigel, Stromberg (2017). When patience perceives participating in a certain activity results in benefits, they are more likely to be motivated. For instance, performing self-care may be accompanied by benefits such as the reduction in pain symptoms and overall improvement in the patients’ health. Factors that may motivate a person to adapt to chronic pain include lifestyle changes, such as maintaining a healthy lifestyle, deliberate focus of positive feelings, and partaking in activities that provide pleasure (Jaarsma, Cameron, Riegel, 2017). Support from the family and close friends is a significant aspect that middle-range theory highlights for enabling patients to implement self-care plans for chronic pain (Jaarsma, Cameron, Riegel, 2017). Caregivers provide immeasurable contributions to self-care as patients depend on their families and social circle as contributors in the quest of pain relief. Caregivers are strategically placed to provide not only motivation but also practical support that can influence self-care behaviors and manage possible depressive symptoms. (Jaarsma, Cameron, Riegel, 2017).


Chronic pain is a condition that is hard to maintain and ultimately cure. Nurses are required to develop individualized interventions for patients suffering with chronic pain. The middle-range theory explains the procedure of evaluating the health and mental condition before developing nursing interventions for self-care. Nurses must encompass the physiological, psychological, and spiritual aspects of a patient experiencing chronic pain to evaluate the extend of possible planning and implementation needed.  These efforts enable the nurse to individualize interventions to achieve the best possible outcome for the patient. The potential weakest link in these theories is the nurse. The position we hold and how we utilize our knowledge has the ability to make dealing with chronic pain tolerable. The theory of adapting to chronic pain highlights a number of vital pieces of information a nurse must gather before developing a self-care plan. These include the patients’ level of independence, and knowledge regarding management of their individual symptoms. Factors such as support from caregivers, self-sufficiency, attitudes, culture, beliefs, and level of motivation are all equally important effectively capitalize chronic pain management.

As mentioned in my introduction, I am not currently practicing. However, with the prominence of pain reported by patients, I felt this topic was one that will be applicable in my future endeavors. Adequately controlled chronic pain could potentially alleviate dependence on pain medications. Avoiding dependence on even one individual would be a win.

Reference list

  1. Drevenhorn, Eva. A proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension., April 26,2018: 1-11.
  2. Fernandes, M. J. Grounded theory: Building a middle-range theory in nursing. Biomed Biopharm Res, 12.1(2015):11-20.
  3. Kolbaek, Ditte, and Snis, U.L., Proactive Review: Toward and emerging middle-range theory of learning from experience in the context of work. N.d. Web. August 26, 2018.
  4. Nguyen, J. Haas R. E., Pugh, L. The application of the theory of unpleasant symptoms to the educators and practice of nurse anesthetists. Nursing and Healthcare Journal, 11.4(2017): 1-8.
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Theory of Adapting to Chronic Pain. (2019, Jun 02). Retrieved from