Pain, suffering and risk

Abstract

A primary role of medicine is often perceived as treating or alleviating pain, but what actually constitutes pain can be defined in many ways. A major impediment to a more adequate conceptualization of pain is thought to be the manner in which it has been ‘medicalized,’ over the course of the twentieth century resulting in the inevitable Cartesian split between body and mind. Consequently, the dominant conceptualization of pain has focused almost exclusively upon the neurophysiological aspects, both in diagnosis and treatment, with the subsequent inference that it can be rationally and objectively measured. Social science, in particular the sociological literature on chronic illness, offers a framework for understanding the experience of pain by focusing on ‘lived experience,’ including narratives of suffering. Medically, pain is often explained in terms of risk by attempting to measure so-called objective symptoms, whereas accounts of suffering may encompass more easily the notion of total pain (Saunders 1976), which includes psychological, spiritual, interpersonal and even financial aspects of chronic pain, as well as its physical aspects. This paper proposes that illness narratives and phenomenological accounts have become intrinsic to the understanding and treatment of pain and, using examples from empirical research, considers how pain narratives challenge biomedical approaches to chronic pain, which are inevitably framed in the discourse of risk.