Multidimensional experience of pain in adults with cirrhosis: A qualitative descriptive study

The incidence of liver disease is projected to increase significantly by 2030, affecting 1.5 billion of the global population and approximately 3 million in Canada. With various etiologies, the progression of liver disease to cirrhosis varies from months, years, or decades. Experiencing pain can severely debilitate a person living with this condition. However, there is limited qualitative evidence to understand the subjective pain experience of individuals with cirrhosis. Understanding this experience with cirrhosis is crucial for providing comprehensive, person-centered care. The aim of this study was to qualitatively explore the multidimensional experience of pain for persons with cirrhosis. A qualitative descriptive approach was used, recruiting participants from a hepatology clinic in Toronto in 2021. Participants completed a Brief Pain Inventory Short Form questionnaire and a semistructured interview. Data analysis was guided by Hsieh and Shannon's stepwise directed content analysis. Fifteen interviews were conducted with adults (mean age: 54 years, 53% men, 47% women) with cirrhosis, most unable to work, with approximately half married/partnered. Participants reported diverse physical symptoms including visceral and musculoskeletal pain, often described as a constant experience. Psychologically, pain contributed to significant fatigue and emotional distress, affecting self-care and daily activities. Socioculturally, pain disrupted social interactions and financial stability, intensifying reliance on support systems. Participants reported limited effectiveness of pharmacological interventions, reliance on mindfulness and rest, and frustration with unmet pain management needs. These interrelated themes collectively impaired quality of life and independence. Exploring the multidimensionality of pain for persons with cirrhosis provides valuable insights to address the gaps in current pain management strategies.