Pain beliefs and coping strategies of people with mild/moderate learning disabilities in chronic pain.

It has been shown that pain beliefs and coping strategies, identified by the adult and child pain literatures, play a mediating role in the experience of chronic pain. Certain pain beliefs have been linked to negative outcomes such as increased levels of disability or psychological distress, and can influence the success of pain interventions. Differences between the pain beliefs and coping strategies of adults and children have been attributed to various factors (eg cognitive developmental level). Some of these factors are also relevant for people with learning disabilities. However, there has been no research into the pain beliefs and coping strategies of this population. This is due, in part, to beliefs that people with learning disabilities do not, or cannot experience pain. This study aims to use in-depth interviews and a Grounded Theory Approach to explore the pain beliefs and coping strategies of eight adults with mild/moderate learning disabilities who experience chronic pain associated with Osteoarthritis or Rheumatoid Arthritis. The analysis identified various pain beliefs and coping strategies which were compared to those identified in the adult/child literatures. Differences and similarities, and the factors/processes involved in these are discussed. Many of these are associated with the wider experience of having a learning disability (e.g. level of understanding, power or reliance, being different and being taken seriously). Most important is the finding that many of the participants experienced that others, whom they needed to acknowledge that they are in pain, did not or were not able to, further adding to the distress the participants experienced. Possible reasons for this are discussed. Clinical implications of these findings include the need for appropriately tailored pain assessments and interventions for people with learning disabilities, and support for staff/ carers/ professionals to acknowledge and respond appropriately to the pain of people with learning disabilities. Some suggestions on the implementation of this are given.