The Social Context of Pain Management

Abstract

Management of pain, especially when chronic, represents an ongoing challenge in clinical medicine. Why is it so challenging? Part of the reason involves the wide range of treatments available in the current clinical armamentarium, the mastery of which is demanding. Indeed, the demands are of a magnitude sufficient to argue for pain medicine as a distinct medical specialty, “algiatry.” Technical aspects aside, the subjectivity of the pain experience challenges current medical models that rely on objective test results. Diagnostic testing, typically the bedrock of clinical decision making, frequently yields results that correspond poorly to patient reports of pain intensity and observable levels of pain-related disability. Thus, despite the diagnostic technology available to modern medicine and the recently enhanced status accorded to pain (as a fifth vital sign), the bedrock of clinical decision making for pain involves the clinical interview. Based largely on inferences made in the course of that interview, the provider must judge the nature of the patient's experience (i.e., the severity and other qualities of pain) and determine what, if any, changes in treatment are necessary. It is well-known that a host of variables can affect judgments made in the context of a social interaction, such as a medical encounter. Indeed, there is a long history of research in social psychology regarding …