PAIN: THE CONCEPT AND THE CONFUSION
I am hopeful that this inaugural blog will be the first of many discussions in these virtual pages which explore the concepts and the misconceptions in regards to the management of pain, whether it be the pain of every day life or the pain of ill health at the end of life.
For most of us, the severity of pain is to some extent a function of age, sex, race, ethnic background, culture, religion, and spiritual and social factors. Culture in particular has an important role, because it is often the case that individuals from different cultures perceive and respond to pain in a variety of ways. Equally important, especially when one considers the psychological effects pain has on a person, cultural factors can influence whether a pain-sufferer even reports pain to those who might be able to assist the sufferer.
An obvious example is the stoic patient who will not tell his doctor of the pain he is suffering; he will not have the treatment he deserves, pharmacologic or otherwise. On the other hand, he might feel free to report the pain to his son-who then proceeds to telephone me, complaining of my failure to adequately treat his father.
Before anyone can adequately treat pain, one must understand pain. This begins with the most basic and first step: Understanding the definition of pain.
Western definitions of pain have described pain as an unpleasant disruption in daily life. Ancient philosophers saw pain as an emotion, or a sensation; and something which is necessary to prove existence, and perhaps something to survive as a prelude to success.
A more physical view of pain might describe pain as a response to potentially harmful stimuli, and therefore giving pain the status of a protector of sorts: If our senses are intact, we will reflexively pull our hands away from a hot cooktop we carelessly leaned against while talking on the phone.
The more psychologically inclined among us would regard the pain from that misfortune with the hot cooktop to be an unpleasant sensory and emotional episode.
The religious among us might view pain as a punishment for deeds from the past, present, or future.
It is a worthy goal, in my opinion, to consider pain from both a psychological and physiological perspective. This approach will give much more success to those who treat the patient with pain.
Now, only if it were that simple. Because just when we Westerners were secure in our understanding of mind and body, our Chinese friends remind us that there is much more, as Chinese consideration of pain is influenced by the philosophical and religious beliefs of Taoism and energy theory, Buddhism and Confucianism.
In future blogs there will be opportunities to discuss the management of pain through religious, philosophical, physiological and psychological manipulation. I am hopeful that viewing the experience of pain through different angles of the spectrum will foster a better understanding of the management of pain, and therefore result in better treatment of pain.