• Samantha D Outcalt, Christina Nicolaidis, Matthew J Bair, Laura J Myers, Edward J Miech, and Marianne S Matthias.
• Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.
• Pain Med. 2017 Feb 1; 18 (2): 211-219.

ObjectiveCentrality of pain refers to the degree to which a patient views chronic pain as integral to his or her life or identity. The purpose of this study was to gain a richer understanding of pain centrality from the perspective of patients who live with chronic pain.MethodsFace-to-face interviews were conducted with 26 Veterans with chronic and disabling musculoskeletal pain after completing a stepped care intervention within a randomized controlled trial. Qualitative data were analyzed using an immersion/crystallization approach. We evaluated the role centrality plays in Veterans’ lives and examined whether and how their narratives differ when centrality either significantly decreases or increases after participation in a stepped care intervention for chronic pain.ResultsOur data identified three emergent themes that characterized pain centrality: 1) control, 2) acceptance, and 3) preoccupation. We identified five characteristics that distinguished patients’ changes in centrality from baseline: 1) biopsychosocial viewpoint, 2) activity level, 3) pain communication, 4) participation in managing own pain, and 5) social support.ConclusionsThis study highlights centrality of pain as an important construct to consider within the overall patient experience of chronic pain.

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