The purpose of this study was to inductively develop a gender-sensitive substantive theory to explain the underlying processes of women's experiences of living with chronic nonmalignant pain. The study employed grounded theory design and methodology. The theoretical sample included 19 women aged 21-76 years living with nonmalignant pain of 1-27 years duration. Data included transcripts of in-depth unstructured interviews, women's critical incident health diaries, field notes reflecting participant-observation at chronic pain support group meetings, and theoretical memos. A substantive theory emerged through constant comparative analysis of the data.

Women's progress through their experiences of living with chronic nonmalignant pain occurred in three stages that were described using the metaphor of the formation of a geode. These stages were represented by CATEGORIES of processes that illuminated a pattern of movement from the beginning of a woman's pain experience to her new life of health with chronic pain. Stage 1 (FORMING THE CAVITY) included focusing on the pain, searching for a diagnosis and cure, and losing former ways of life. In Stage 2 (FORMING THE CRYSTALS), the women described grieving their losses, caring for themselves and being cared for by others, relieving more pain, and hoping for new lives. In Stage 3 (OPENING THE GEODE), women described focusing on fulfilling their lives despite the continuing presence of pain. Some women did not progress through these healthy stages and instead progressed toward illness (FORMING A STONE). Whether a woman progressed toward health or illness while living with chronic pain was influenced by patterns of validating. She could validate her own experience or have her experience validated by others. Validating occurred when her experience of pain was viewed as somatogenic. Validating did not occur if the pain was viewed as the consequence of psychological need, an attempt for secondary gain, or sin.

The significance of this study was its focus on: the lived experiences of chronic nonmalignant pain from the perspectives of the sufferers, the generation of theory based on the relationships among the personal and social processes of living with chronic nonmalignant pain, and the development of knowledge of women's health.