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WITHIN Blog: March 2020

Reviewing a mega-ethnography of qualitative research into chronic pain by Toye, Seers, Hannink & Barker (2017)

By Jenna Gillett on behalf of the WITHIN team.

As a team interested in the novel construct of mental defeat, we keep ourselves up-to-date with emerging research on relevant concepts for the study of chronic pain. One article that caught our eye was that by Toye, Seers, Hannink & Barker (2017). These authors conducted a mega-ethnography of 11 qualitative research papers exploring the lived experiences of those with chronic pain…

Box 1: Glossary

Qualitative research is non-numerical in form, most commonly it relates to using interviews or analysing words and how these are spoken by people. By collecting qualitative data, researchers are able to delve deeper into the meaning or real-life experiences that people have, and is generally considered to be richer than numbers and charts, though what is arguably less generalisable across wider settings.

A mega-ethnography is a way of synthesising the outcomes and themes that arise in lots of different qualitative research studies. The mega-ethnography method allows researchers to combine concepts from this rich data type to build a ‘bigger picture’ of the topic – in this case, the experiences of people living with chronic pain.

Mental Defeat is a psychological construct that has been applied to characterise the experience of chronic pain. It relates to the perceived loss of autonomy in the face of pain and results in the individual noticing a shift in their self-identity towards negative self-appraisals e.g. “I am no longer me” or “I am defined by my pain” (Tang, Goodchild, Hester & Salkovskis, 2010).

The article identified 82 studies initially and whittled these down to 11 qualitative research papers reporting more than 5000 international participants living with chronic pain. The authors established 7 conceptual categories to lived experience of chronic pain:

  1. My life is impoverished and confined
  2. Struggling against my body to be me
  3. The quest for the diagnostic ‘holy grail’
  4. Lost personal credibility
  5. Trying to keep up appearances
  6. Need to be treated with dignity
  7. Deciding to end the quest for the grail is not easy

If you are reading this as someone with chronic pain, you may be screaming ‘yes!’ at these emerging themes from the study; identifying with the generalised attack that chronic pain has on one’s self and identity. To extract a particularly powerful quote from the article “I am now irreparably altered” (p6, Toye et al., 2017). We cannot help but notice this sense of being ‘altered’ by chronic pain strongly relates to mental defeat - the central focus of the WITHIN study.

When looking at one of the questionnaires used to measure mental defeat, the Pain Self Perception Scale (Tang, Salkovskis & Hanna, 2007), items such as “I felt I was completely at the mercy of what happened to me” as well as “I felt I had lost important battles in life” resonate with the general themes and quotes that emerged from the mega-ethnography. For example, under the conceptual category of ‘struggling against my body to be me’:

“I have lost my battle with pain to keep hold on to my personal sense of self. I am no longer what I used to be” (Bunzli et al., 2013 as cited by Toye et al., 2017, p6).

“I am a different person” (Snelgrove & Liossi, 2013 as cited by Toye et al., 2017, p6).

We noticed that there was a distinct similarity across the 7 themes – they all relate to a sense of self and how that sense of self is impacted by chronic pain. The 7 conceptual categories identified were firmly grounded on patient experience and spoke to us powerfully on how chronic pain can influence a person’s sense of self. There is a need to highlight how this changed sense of self can result from living with pain and what that might mean for patients.

To conclude, we very much enjoyed reading this paper by Toye et al. (2017) as it provided insightful findings as the first mega-ethnography in the context of chronic pain research. We can’t help but think that all the 7 “conceptual categories” are linked to mental defeat and hope our planned research will shed some further light on this topic.


Bunzli, S., Watkins, R., Smith, A., Schütze, R., & O’Sullivan, P. (2013). Lives on hold: a qualitative synthesis exploring the experience of chronic low-back pain. The Clinical journal of pain, 29(10), 907-916.

Snelgrove, S., & Liossi, C. (2013). Living with chronic low back pain: a metasynthesis of qualitative research. Chronic illness, 9(4), 283-301.

Tang, N. K., Goodchild, C. E., Hester, J., & Salkovskis, P. M. (2010). Mental defeat is linked to interference, distress and disability in chronic pain. Pain, 149(3), 547-554.

Tang, N. K., Salkovskis, P. M., & Hanna, M. (2007). Mental defeat in chronic pain: initial exploration of the concept. The Clinical journal of pain, 23(3), 222-232.

Toye, F., Seers, K., Hannink, E., & Barker, K. (2017). A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC medical research methodology, 17(1), 116.