Thwarted credibility work and double binds in medically unexplained pain in Japan: a qualitative study

This study examined how people living in Japan with medically unexplained pain (MUEP) perform credibility work across clinics and everyday life, where and why credibility work falters, and the interactional double binds organizing these failures.

We qualitatively analyzed first-person illness narratives from 16 adults with MUEP in the DIPEx-Japan Chronic Pain Archive, including cases of fibromyalgia, complex regional pain syndrome, chronic pain disorder, and undiagnosed persistent pain. An inductive reflexive thematic analysis was conducted using credibility as a guiding sensitizing concept.

Credibility work appeared cyclical and attritional rather than a direct route to belief. Information-seeking and efforts to translate invisible pain met test-centric norms and role expectations. During treatment negotiations, scarce options and firm professional boundaries narrowed shared decisions, leading patients to titrate what to say and when. Defensive practices (appearance normalization and economizing talk) thinned the information reaching clinicians, ending in expectation deflation and withdrawal. Recurring double binds organized this drift as follows: search suppression versus delegation, clinical translation versus test supremacism, preference expression versus resource constraints, and appearance normalization versus preventive silencing.

In Japanese MUEP care, diagnostic uncertainty and power imbalance shift credibility work from trust-building to damage limitation. Clear communication, recognition of non-test evidence, and concrete 'next-step' planning can help sustain credibility.

We extend credibility work by identifying four MUEP-specific double binds and showing how scarcity and hierarchy invert credibility.