Table 2 Representative quotations from interviews (n = 20)

Pharmacologic management

 “I control [the pain] a lot of times. Sometimes I can’t control it, and then I go to the analgesics” (female, age 75).

 “If the pain is really bad, I take medication. But I try not to take medication every day” (female, age 55).

 “Sometimes the rheumatologist treated me with Methotrexate. But after about 20 days, my liver got inflamed, and I automatically stopped taking it. And I’ve never gone back to using it” (female, age 32).

 “They [friends] tell me that [diclofenac] does a lot of damage. And I almost never take it” (female, age 79).

 [Referring to why she limits medication use] “There are times you take certain medications, and you feel it in your stomach” (female, age 59).

 “I stopped taking Prednisone because [friends] say it causes liver damage” (female, age 73).

Non-pharmacologic management

 “I sit for a while, I relax, and that’s it” (female, age 63).

 “I try to forget about the pain, and a lot of the time I do get better, when I forget about the pain” (male, age 20).

 “I do therapy with the electric blanket, a wet towel from the freezer, and cold water” (female, age 75).

 “When the pain comes, I only tell God because he is the one I acknowledge” (female, age 52).

 “Often when I’m in pain, there are times I don’t want to take painkillers. So I put myself in God’s hands, and I pray a lot” (female, age 59).

 [Referring to how she copes with painful episodes] “I go to God, because everybody has to go to God” (female, age 75).

 “I do believe that God has helped me, because I didn’t have the strength. I asked God, and He gave it to me. So there is the belief that God exists. It’s a belief that God will give me the strength, and He gave it to me” (male, age 20).

Endurance

 “I learned how to endure it” (female, age 74).

 “Once the problem happens to you, you have to keep going and get up. Because when you are in pain, as long as you can, you endure it” (female, age 52).

 “If you have something, you have to fight it. You can’t throw it behind you. You have to accept things” (female, age 75).

 “Sometimes if you have a positive outlook, things get better” (female, age 59).

 “When you are in pain, you endure it. But when the pain is really bad, you take a painkiller” (female, age 72).

Family support

 “I have to depend on my husband to be able to do something” (female, age 55).

 [Referring to relationship with family] “Lots of bonding, lots of support, lots of strength from them, especially from my parents” (female, age 44).

 “I’ve learned several things from my family with their support and assistance. Being here, I have gotten more support than if I had been doing well, you could say. They [family] always think of you first, they always want [you] to get better” (male, age 20).

 “He [brother-in-law] is the one that helped me get the operation” (female, age 79).

 “They [my family] always went to the doctor. I follow my mother’s example” (female, age 59).

Postoperative expectations and pain management

 “It will be painful, because it’s an object put inside me. I have to overcome [the pain]” (female, age 75).

 “At least the time to come [after surgery] is going to relieve the pain” (female, age 76).

 “All recoveries are painful. They are never easy. It all depends on your mentality” (female, age 75).

 “I trust in God and the doctor that it will be a success” (male, age 74).

 “I trust in both God and the surgeons, since I know they are very good and all. You being the team that you are, everything will work out well. That’s really what we hope for, and God willing, that this pain will go away; it’s really tiresome” (female, age 32).

 “The people at home are lifting me up in prayer, so that I will get well [following surgery]. With God’s help and the doctors” (female, age 75).