Abstract
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering – with and without self-reflection – are discussed. PerspectiveThis article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.
Highlights
Suffering holds a central place within pain research, theory, and practice
From our synthesis of the literature, we developed the following 4 key attributes of pain-related suffering: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one’s sense of self is an integral part of suffering
Future Research Qualitative research is needed to explore disruption to different aspects of the self and how this may relate to the pre-reflective mode of suffering among people living with pain
Summary
Suffering is given a central place of importance within the pain literature. It is emphasized within seminal models of pain, and clinical research and practice are commonly framed in relation to the potential for mitigating pain-related suffering. Identity is often regarded as an important and central component of the self.[57] Outside the field of pain, there is a well-established literature base on identity that has focused on the development and integration of one’s various life roles, values, goals, and stories.[1,55,56,57,58] This line of research has produced interview guides and coding schemes to study life stories.[86] These established methods might be valuable in the context of pain and suffering to study thematic aspects of identity, including ways it may be disrupted, restored, or reconstructed in relation to personal, contextual, and environmental factors This has the potential to offer novel contributions to the field as the bulk of the psychology of pain literature has focused on states and traits, yet the construct of identity[57] in relation to pain and suffering remains largely undeveloped. There is a need for qualitative research that explicitly explores disruption to the minimal self,[38,96] especially considering recent advancements in other fields.[45,61,62,63,66] There are opportunities to draw from the extensive selfhood literature on the relation between the minimal and narrative self, how these different aspects of the self may be disrupted, and how these disruptions may shape individuals’ prereflective and reflective self-experiences.[25,38,39,40,41,65,96] there is a need to explore the concept of “pre-reflective suffering” involving alterations in the subjective experiences of one’s body and world
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