Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain

Abstract

Interpretative phenomenological analysis (IPA) is a qualitative approach which aims to provide detailed examinations of personal lived experience. It produces an account of lived experience in its own terms rather than one prescribed by pre-existing theoretical preconceptions and it recognises that this is an interpretative endeavour as humans are sense-making organisms. It is explicitly idiographic in its commitment to examining the detailed experience of each case in turn, prior to the move to more general claims. IPA is a particularly useful methodology for examining topics which are complex, ambiguous and emotionally laden. Pain is a prime exemplar of such a phenomenon: elusive, involving complex psycho-somatic interactions and difficult to articulate. In addition to the 1998 article, published in this Special Issue, two further papers are suggested that the interested reader might wish to look out for.

It is 16 years since our article on the experience of pain first appeared in the British Journal of Health Psychology. We are delighted to see it reprinted here, taking this as an indication of its ongoing resonance. We wish to take the opportunity to say a little on how we think interpretative phenomenological analysis (IPA) can make a valuable contribution to research on pain.

IPA is a qualitative approach which aims to provide detailed examinations of personal lived experience (Smith et al.¹). It has three primary theoretical underpinnings. Phenomenology is a philosophical approach, initially articulated by Husserl, which aims to produce an account of lived experience in its own terms rather than one prescribed by pre-existing theoretical preconceptions. IPA recognises that this is an interpretative endeavour because humans are sense-making organisms. In IPA, therefore, the researcher is trying to make sense of the participant trying to make sense of what is happening to them. Finally, IPA is idiographic in its commitment to examining the detailed experience of each case in turn, prior to the move to more general claims.

There is now a very large corpus of research studies applying IPA in psychology and also in cognate disciplines. Much of this research is on the patients’ perspective on illness, and it includes a number of papers on the experience of pain. There are a number of reasons why IPA is a particularly useful methodology for examining pain. First, IPA is especially valuable when examining topics which are complex, ambiguous and emotionally laden. And pain is a prime exemplar of such a phenomenon: elusive, involving complex psycho-somatic interactions and difficult to articulate. IPA is helpful here because of the painstaking attention it gives to enabling the participant to recount as full an account as possible of their experience. This requires a high level of skill on the part of the interviewer – a combination of strong empathic engagement and highly attuned antennae ready to probe further into interesting and important aspects. The small sample size of most IPA studies then enables the micro-level reading of the participants’ accounts, which offers the possibility of some entree into the understanding of this elusive condition. And the inquiry is sharpened by IPA’s inductive, interpretive analysis, providing an illumination of what is presented but importantly grounding that firmly in a close examination of what the participant has said.

We offer here suggestions of two further papers the interested reader might wish to look out for. The article by us reprinted in this Special Issue acted as a reconnaissance of the terrain of the lived experience of pain. Something which particularly interested us was the impact of pain on identity which was beginning to emerge as a theme in that article. We therefore decided to explore this in more detail, and the resultant study appears in Smith and Osborn.² Analysing interviews with six adults with long-standing severe back pain, we detail the corrosive effect of the pain on participants’ sense of identity. Patients present pejorative descriptions of their current self: ‘miserable git, cow, this monster’ and contrast this tainted self with a truer self from the past. The article focuses on the dynamic interplay between these different self-perceptions.

A second article exemplifies the ability of a good IPA study to access and illuminate a difficult or sensitive subject. Marriott and Thompson³ interviewed eight women who had vulval pain. A key consequence of this condition for the women lies in its impact on their sexuality and relationships. As part of this, the women judge themselves as failing in their role as a loving partner. The article is a well crafted, careful and intimate account of how the women’s lives are affected by the vulval pain.

For the future, we hope to see more IPA work on the lived experience of pain because, as we have suggested, we see a close fit between what the methodology can offer and some of the issues that warrant further examination.