A transdisciplinary framework for chronic illness and chronic pain: a sequential qualitative meta-synthesis

Chronic pain is a common, disabling feature of many long-term conditions, yet its clinical management remains fragmented across disciplines, diagnoses, and organizations. Although a substantial qualitative literature describes patients' lived experience of chronic illness and chronic pain, these findings have rarely been synthesized into a transdisciplinary framework explicitly oriented toward coordinated clinical care. We therefore aimed to develop such a framework grounded in lived experience and relevant to clinical application.

We conducted a sequential qualitative meta-synthesis in two phases. Phase 1 comprised a systematic review of 104 primary qualitative studies and qualitative evidence syntheses published between 2009 and 2025 examining lived experiences of chronic illness and chronic pain. Searches across eight databases were screened using explicit eligibility criteria. Study quality was appraised using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool, and confidence in synthesized findings was assessed using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research. Through iterative hermeneutic reading, thematic coding, and meta-ethnographic translation, we identified recurrent experiential themes, grouped them into higher-order domains, and visualized their relationships using node graphs. Phase 2 reviewed 52 additional studies on transdisciplinary principles, collaboration, implementation, and systems practice. These principles were mapped onto the experiential domains and integrated into a clinically oriented transdisciplinary framework. In total, 156 studies were included across both phases.

Phase 1 identified recurrent and interconnected experiential domains characterizing chronic conditions as lived processes, including social isolation, identity disruption, physical debilitation, emotional distress, cognitive burden, uncertainty, and struggles for legitimacy within healthcare and social systems. These domains were not discrete but dynamically interrelated. Phase 2 identified core transdisciplinary principles, particularly communication, collaboration, participation, reflexivity, and systems thinking, that aligned closely with these experiential domains. Their integration produced a novel transdisciplinary framework that conceptualizes chronic illness and chronic pain as dynamic, relational, and temporally unfolding processes and links lived-experience domains to clinically relevant collaborative pathways.

This study advances a transdisciplinary framework for chronic illness and chronic pain that is grounded in qualitative evidence and oriented toward clinical application. The framework offers a structured basis for person-centered assessment, interdisciplinary communication, longitudinal care planning, and coordinated management of complex chronic conditions.