Identifying the Psychological Dimensions of Perceived Suffering in Patients With Medically Unexplained Pain

Abstract

The aim of this study was to identify the psychological dimensions of perceived suffering in patients with medically unexplained pain using a qualitative approach. This qualitative study employed thematic analysis. Twenty-three adult patients from Tehran with chronic medically unexplained pain participated in the research. Data were collected through semi-structured interviews and continued until theoretical saturation was reached. Data were analyzed using Nvivo 12 software and a three-phase coding process (open, axial, and selective). Data analysis resulted in three main themes: "emotional disturbances," "disruption in meaning and identity," and "coping and psychological regulation." At the emotional level, participants experienced helplessness, chronic anxiety, inner sadness, and shame. Identity and existential challenges such as personal disintegration, meaninglessness, and spiritual struggles were also prominent. Patients reported a range of coping mechanisms from maladaptive (avoidance, dependency) to adaptive (acceptance, meaning-making, self-care). Perceived suffering in patients with medically unexplained pain is a multilayered experience that extends beyond physical discomfort to psychological, social, and spiritual domains. Recognizing these dimensions is essential for designing more effective and human-centered therapeutic interventions.