Background Chronic pain is a highly prevalent long-term condition, impacting both the individual living with pain, and wider society. It is experienced unequally, with higher prevalence among women, socioeconomically disadvantaged, and racially marginalised groups. ‘Acceptance’ of the long-term nature of chronic pain is associated with improved quality of life, mood and function, but is typically framed as an individual behaviour. However, qualitative studies of lived experiences challenge this framing, demonstrating complexity related to socio-cultural and healthcare experiences, and difficulties with language and meaning.

We framed acceptance of chronic pain as socially constructed and aimed to conceptualise acceptance of chronic pain in adults.

Methods We conducted a systematic database search across MEDLINE, CINAHL, PsycINFO, Web of Science and AMED, including all languages, followed by double-blinded screening, and grey literature searching. We included: qualitative studies using adults; chronic pain as the primary condition; study included an aim to research the acceptance concept.

PROSPERO protocol: CRD42021253509.

We conducted the synthesis stages of meta-ethnography with co-researchers involved in data extraction, providing checks and feedback throughout.

Results We included ten studies from: Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand.

Our ‘lines of argument’ include:

1. Accepting life with chronic pain involves a fluid and continuous journey with fluctuating states of acceptance, a turning point, iterative steps and relationship to mental health.

2. The language and meaning of acceptance shows a contested concept, related to the underpinning nature of chronic pain, and cultural models of health and illness.

3. The individual’s journey can include a challenge to identity, negatively influenced by capitalist and ableist ideology and structures, with the associated individualism limiting the accepting process for some with chronic pain, particularly those ascribed lower socioeconomic status.

4. We found it helpful for individuals to experience a caring, supportive and coherent system that includes healthcare, workplaces and political discourse being adaptive to the realities of chronic pain.

We combined these into an ‘ecosystem,’ with the conceptual framework represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain.

Conclusion Our findings broaden conceptualisation of ‘acceptance of chronic pain’ beyond an individualised psychological construct, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem. While we must personalise care for the individual, it should not be de-contextualised from our social world, and we used meta-ethnography to expand our understanding of key influences on the acceptance of chronic pain.