Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization

There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in manag-ing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experi-ence that people living with chronic pain are obliged to simplify in order to fit existing logics of medi-cine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual.Perspective: This article explicates the health work of people living with chronic pain and margin-alization, drawing on their situated experience. We offer the concept of chronic struggle as a concep-tualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.(c) 2022 The Author(s). Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

There have been recent calls to re-think chronic pain in response to social inequities. Many clinically oriented accounts lack critical theoretical understanding. To truly rethink pain, we must also reconsider suffering and listen to the experiences of people with chronic pain.