There are many studies that use quality of life and sense of well-being interchangeably and of course there are then quality of life questionnaires specific to many conditions. I have not seen a specific definition of well-being for individuals with chronic pain.

We performed a study from a broader persepctive looking at domains that may be important for measuring well being in patients with chronic complaints, not chronic pain only. See attachment

We have studied this in children, and found that children with recurrent pain had impaired Health-related Quality of Life, please see: Petersen, S., B. L. Hagglof, et al. (2009). "Impaired health-related quality of life in children with recurrent pain." Pediatrics 124(4): e759-767.

Raymond, there's no attachment - it would be great to look at this. I wondered if there is a patient-centred study? (ie derived from what people with chronic pain define as well-being)

These are great leads - I'm specifically looking at well-being from the perspective of individuals with chronic pain. Thanks so much for your help. I does look as if this is a bit of a gap in the literature maybe?

Great question - let´s know if you find anything. You could consider a phenomenological approach i.e. what do the patients themselves believe to be causative of their functionality. Raheim/Halland 2006 may be helpful.

What kind of well-being? Physical? that's a contradiction of terms. Mental? A possibility. Spiritual? The best alternative for those in pain; which includes all shades of pain that afflicts mankind. The words of Solomon are a good resource. ec

I don't think having a health problem precludes feeling well as an individual. I suppose that's what I'm getting at - if people who have a health problem consider themselves to be well, how are they defining this? I think it's associated with good mental health, engagement with occupations of value, good social connections, etc but I'm struggling to locate any specific literature. I feel a piece of research coming up!

The New Zealand Mental Health Survey might have some good data (there is also world data). They measured chronic pain quite well, but there is no measure of well-being, only the absence of mental illness. The problem with this and most research in this area is the deficit perspective. We are always looking at what is wrong with people. The relatively new field of positive health psychology switches the focus to wellness and flourishing - even in the context of disease and illness. Well worth putting some research out there.

Thanks Nic, this is what I thought - it's something I really want to look at, in people who have chronic pain, and from their perspective. Probably a mixed methods design to elicit some comparative data but also bringing in the phenomenological perspective.

I fully agree with the view that a health problem, per se, is not equal to feeling bad or having a low quality of life, and there is literature supporting this view as well. I do wonder, however, whether this view can be applied in the case of pain, given the core definition of pain requesting it to be "an unpleasant sensory and emotional experience" (International Association for the study of Pain, IASP) and as stated by the IASP "always unpleasant".

Tha'ts an interesting conundrum Solveig. I agree that the definition of pain is "unpleasant" but the concept of wellbeing doesn't, I think, negate the concept of an individual feeling generally "well". For example, I have persistent pain in the form of fibromyalgia, but I feel generally well. My sense of wellbeing comes from "moment by moment" mindfulness (as much as I can!), and from distinguishing between the sensations I experience and my judgements of the meaning of that pain. In my PhD studies, participants say they also feel well, and function at a very high level (competitive athletes, entrepreneurial business people, nurses etc).

I'm trying to find other studies looking at this construct in this population, but it doesn't look like it has been studied - so probably a fruitful area for further research!

Thanks Simon, I will. You're quite right in saying that pain intensity doesn't capture the dimensions of wellbeing - it's a complex construct that I'm not sure has been completely explored from the perspective of the individual with pain. The research I've been doing suggests that people view the pain itself as less of a problem once they know it doesn't represent harm - and in the context of important activities.

Ahh, there's a difference, in my experience, between people we see in treatment centres vs those who live "well" in the community. A survey in NZ by Dominick, Blyth and Nicholas (2011) showed that a sizable percentage of people with moderate to severe chronic pain don't seek treatment (20.1% (CI 95% 18.1 – 22.1)). Clinically, the theories underpinning both cognitive behavioural approaches and Acceptance and Commitment Therapy (ACT) suggest that it's not the experience, but the meanings we attribute to the experience that change the distress and disability from pain. It's interesting to me that there is a reasonably consistent finding that people can and do live well without using treatments for their pain, and I'm curious to find out how (hence the subject of my PhD). These people say they do feel "well", it's hard to suggest to them that they're mistaken!

Evers et al. (2012) examined an individual-level well-being scoring method of the Gallup-Healthways Well-being Index. While this study was not focused on chronic pain specifically, this measure may be useful in establishing a starting point. One option would be to use this as a base and then conduct a pilot study focused on a qualitative analysis of interviews with individuals coping with chronic pain to ensure that you have captured all the constructs in which you are interested.

Here is the link to the article: http://www.psywb.com/content/2/1/2

T. Lentz