Some conceptual and ethical concerns about current views of pain (original) (raw)

Reconsidering the International Association for the Study of Pain definition of pain

Pain reports, 2018

The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as "always subjective," the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social "intersubjective space" in which pain occurs, and the limitations of language. Based on these results, a revised definition of pain is offered: Pain is a...

A Criticism of the IASP's Definition of Pain

Like other fundamental experiences, the phenomenal qualities of pain seem to defy description. But unlike these experiences it is difficult to define pain in terms of a consistent relationship with the extra-mental world. The IASP’s solution is to qualify an imprecise characterisation of pain’s phenomenal qualities through an association with tissue damage and an ability to recognise pain sensation. In this paper I will argue that the IASP’s definition lacks the clarity and coherence necessary to provide an adequate definition of pain. I begin by setting out the difficulties of defining pain. I then describe the IASP’s solution and provide a detailed criticism of their approach. I also discuss inconsistencies evident in their wider taxonomy. In the final section I argue that pain can be objectively grounded by reference to pain’s evolutionary role and suggest an alternative definition.

Reconsidering the International Association for the Study of Pain definition

Pain Reports, 2018

Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language. Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.

Meanings of Pain Volume 2: Common Types of Pain and Language

Meanings of Pain Volume 2, 2019

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. “It is my opinion that this ... work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” - Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword

When, How, and Why Did “Pain” Become Subjective?

Philosophy of Medicine

The pain-assessment literature often claims that pain is subjective. However, the meaning and implications of this claim are left to the reader’s imagination. This paper attempts to make sense of the claim and its problems from the history and philosophy of science perspective. It examines the work of Henry Beecher, the first person to operationalize “pain” in terms of subjective measurements. First, I reconstruct Beecher’s operationalization of “pain.” Next, I argue this operationalization fails. Third, I salvage Beecher’s insights by repositioning them in an intersubjective account. Finally, I connect these insights to current pain-assessment approaches, showing that they enrich each other.

Defining Reality: How Biomedical Researchers Determine the Existence of Pain

2 Chronic pain challenges the standard construction of pain and illness, which dictates that an illness or pain is "normal" if its duration is brief, and its effect is acute. As a virtually universal human experience, pain functions as the most readily apparent sign that some type of physical injury has occurred, thereby prompting the potential need for medical attention on some level. In spite of its universality and apparent simplicity of function, the concept of pain is itself engulfed in a complex scientific discourse regarding how to perceive, measure, and validate the existence of what is ultimately a subjective experience. As a new conceptual category, chronic pain adds another layer to this discourse by altering the classification of pain as a symptom to that of being considered a medical condition itself. Whereas acute pain is treated as the body's "normal" response to tissue damage, pain lasting longer than three months is generally defined by medical practitioners and researchers in the U.S. as chronic, and as representing a doubly "abnormal" state: being in pain is "abnormal," as compared to being pain-free, but chronic pain is doubly so, for it goes beyond the standard temporal time frame for "normal" pain, particularly if no physical evidence of its source has been detected. This characterization of chronic pain is consistent with the characteristics of a category of medical conditions referred to by scholars of science and medicine as a "contested illness." Contested illnesses, addressed more thoroughly later in this paper, are those that defy standard biomedical explanation; in addition to chronic pain, they include such conditions as Chronic Fatigue Syndrome (CFS), fibromyalgia, and Gulf War-related illness.