EXPLORING PAIN AND CLINICAL COMMUNICATION
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The overarching aim of this dissertation is to explore and better understand how clinical contextual factors and patient education (e.g., delivery of pain-related explanations and diagnoses) shape meaning and the experience of pain for patients with low back pain (LBP). To do this, I completed philosophical, methodological, and empirical projects. The format of this dissertation is by publication, meaning that the body of the dissertation contains a series of separate, but related chapters that are each in manuscript format. Chapter One is a general introduction with an overview of contextual factors and meaning pertaining to pain and clinical communication. Chapter Two reflects my philosophical work; drawing from enactivism, phenomenology, and the cognitive sciences I explore how pain and meaning are generated. This resulted in the development of an enactive approach to pain that considers pain as a 5E process (Embodied, Embedded, Enacted, Emotive, and Extended). I then used this philosophical foundation to develop the 5E qualitative approach, which I tested in a study in Chapter Three. This qualitative study explored the co-construction of pain-related meanings between patients with LBP and clinicians, with a focus on clinical interactions involving pain-related explanations and diagnoses. The most interesting finding from the study was the use of pain-related metaphors and how they shaped patients’ meaning and lived experience; which led to the pain-related discussion of metaphors in Chapter Four. Chapter Five reflects the methodological work; I present a process paper for researchers about the novel 5E qualitative approach that explores taken-for-granted aspects of context and interaction in the process of enacting (bringing forth) meaning and first-person experience. Chapter Six is a reflexive case report from my own clinical practice that reflects on contextual factors, pain education, and enactive theory. In Chapter Seven, I conclude this dissertation with a summary of findings and limitations. I also discuss reflexivity and the knowledge translation initiatives I engaged in during my doctoral studies and present an overview of early uptake and application of my research by others. I close with implications and future directions for education, clinical practice, and research.