Table III.

Themes and subthemes developed in the process of meta-synthesis to integrate the findings.

	Themes	Meaning	Subthemes	Key aspects and their sources	Articles
Metaphor (normalizing suffering)	Identity of pain	Quality of pain, sources of pain, factors affecting pain, predictability of pain, consequences of pain	Age-bounded	Chronic problems (O, F), multiple physical pain (O, F), episodes of illness (O), iatrogenic pain (O, S)	Gran et al. (2010), Gudmannsdottir and Halldorsdottir (2009), Higgins (2005), Mentes et al. (2004), and Yates et al. (1995)
			Life-bounded	Mood and emotion changes (O, S), huge losses in life (O), losing independence (O), being abandoned (O), losing freedom (O), being pressurized (O), sadness and loneliness (O, S)	Clark et al. (2004), Gran et al. (2010), and Gudmannsdottir and Halldorsdottir (2009)
	Recognition of pain	Validation of pain, vulnerability and uncertainty, taking pain seriously, reporting of pain, being noticed by professional eyes	Care-centered perspective	Dramatic description of pain (F), lack of trust to reported pain (O), ambiguous portrayal of pain (F, S), overlap with other feelings (F, S), denial or exaggeration of pain (F, S), attitudinal barrier to assess pain (O, S)	Clark et al. (2004), Gran et al. (2010), Gudmannsdottir and Halldorsdottir (2009), Higgins (2005), Mentes et al. (2004), Yates et al. (1995)
			Person-centered perspective	Language insufficiency to describe pain (O, S), cognitive impairments (F, S), communication barriers (S), non-formal assessment (S)	Clark et al. (2004), Higgins (2005), and Mentes et al. (2004)
	Response to pain	Pain relieving methods, coping with pain, attitudes and expectations of pain-free living in the old age, living conditions in the nursing home, caring about	Imposed pain	Aging is not necessarily mean pain (O), non-pharmacologic pain relief strategies (O, F, S)	Gran et al. (2010), Gudmannsdottir and Halldorsdottir (2009), Higgins (2005), Mentes et al. (2004), and Yates et al. (1995)
		pain by healthcare staff, available methods of pain relief	Expected pain	Pain as an inseparable part of living (O, F, S), putting up with pain (O), pain as a sign of courage (O), testing faith and higher spirituality (O), being afraid of addiction (O, S), attitudes of pain medication (O, S)	Clark et al. (2004), Gran et al. (2010), Gudmannsdottir and Halldorsdottir (2009), Higgins (2005), Mentes et al. (2004), and Yates et al. (1995)

O, Older people; F, family; S, staff.