Using a Learning Community to Manage Pain: A Participatory Action Research Study

Background
This study evaluated whether, bringing people who have chronic pain together in collaborative learning communities can impact upon the way they manage their condition. Those who have chronic pain are often marginalised and restricted from playing a fuller role in society. These processes can indicate that they may be experiencing a form of social oppression. This justifies the use of PAR methods with this group, as they intend to foster co-operation, generate self- awareness and produce new knowledge that they can put to use in seeking ways to improve their condition. Participatory action research (PAR) has been used with other patient groups, but not with people who have chronic pain.

Aims
The aim of this study was to explore whether bringing people together people who had chronic pain in a collaborative learning community, where participants help each other learn to deal with the problems they face, produces transformation in their lives.

Methods
Participants were recruited from a Pain Clinic and a general practice in South Wales for three learning communities which were sup- ported and evaluated using PAR. Two of these were sustained over the required ten week period. Specifically a Dionysian Inquiry was established in order to promote consciousness-raising among participants in the learning communities (Heron 1996). This approach aims to and seeks transformation by a process of self-reflection and action-taking which leads to empowering participants. The basis on which transformation can occur is through meeting, communicating and cooperating with similar others. This process develops a dis- course that allows participants to raise their consciousness of the situation and make choices about whether to act on these altered perceptions.

Results
Three action cycles emerged from the dialectic between participants in the learning communities., ‘Communicating with health professionals and others’, was common to both learning communities whilst the other two ‘Accepting the need to make adjustments’ and ‘Accepting pain and disability’ emerged separately. Consequently individual transformations occurred among participants in the form of individual actions and self-reported changes in feelings. findings explain that people who have chronic pain experience oppression because:

1.The condition of chronic pain itself , materially restricts the lives of people in pain
2. Responses of others to chronic pain; particularly those in a position of power over patients, shaped by wider attitudes in society to pain, illness and disability exacerbates the situation for people in chronic pain and
3.The response of people with chronic pain, to both their condition and to others, exacerbates and reinforces their oppressed status.

Conclusion
This study demonstrates that a PAR inquiry has the potential to generate transformation in the lives of the participants and is an appropriate way to engage with people in pain. These findings are significant, as the articulation of chronic pain as an oppressive force and the possible structures by which this is enacted has seldom occurred in the literature. Without a discussion around oppression and pain which raises awareness of the various barriers people encounter, people who experience chronic pain are unlikely to overcome these obstructions and attain empowerment