This is particularly relevant to conditions becoming chronic because in these circumstances, pain is often first thought of as a burden requiring strength and adaptable coping strategies on the way to recovery, before turning into a permanent condition representing a forever lasting, defeating threat.”Ī slippery beast indeed. “The perception of pain evolves depending on its application within a context in a given time frame… the meaning of pain is therefore never fixed. The evolving meanings of pain Find out about Taming the Beast – click image However, understanding the meaning of pain and suffering is not trivial, and each individual will experience a unique process of acquiring meaning for his or her own pain that can evolve across time and experience. This latter kind of suffering – “existential suffering” is posited as a fourth and final dimension of pain. Exploration of the meaning of this suffering has led to distinctions between suffering experienced as a “ feeling that will come to an end” and suffering that is experienced as a “prolonged condition… a situation of endless affliction such as the loss of a child or a chronic pain condition… making one’s torment the basis of everlasting reality ”. To the traditional model of pain, with its sensory-discriminative (intensity) and affective-motivational (unpleasantness) dimensions, a third dimension is suggested – “pain-related suffering”. This presents an unavoidable circularity that illustrates the futility of trying to develop purely objective measures for pain. Notably, the establishment of the reliability of objective, third person behavioural approaches to assessing pain has ultimately relied on correlation with subjective, first person pain report. This seeming paradox highlights the great challenge that pain, especially chronic pain, presents both the clinician and the researcher, and defies the notion that objectivity in medical judgements must be based on empirical facts. The chapter commences with a reflection on the experience of sitting across from chronic pain sufferers reporting unrelenting pain at the “highest pain imaginable” level, while observing “no tangible, apparent, physical expression to match the elevated scores and the descriptions of a torturous internal state”. The challenge for me was to do the chapter justice while offering readers of an easily graspable summary of the work. Dr Smadar Bustan’s contribution- A Scientific and Philosophical Analysis of Meanings of Pain in Studies of Pain and Suffering, is a complex chapter with ideas deriving from a long philosophical tradition. I was delighted to be asked to present a chapter from the recent collection Meanings of Pain. Click image to watch a lecture from Dr Bustan This post originally appeared as an invited chapter commentary on the Body in Mind website.
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