Clarifying pain behaviour and pain expression

Meanings of Pain, Vol. II

In her 1926 essay "On being ill" Virginia Woolf laments the poverty of our language for pain: "let a sufferer try to describe a pain in his head to a doctor and language at once runs dry," she notes. Looking at studies of patient-doctor exchanges about pain, particularly those dealing with chronic pain, it seems that Woolf's worry is born out. a Both patients and clinicians frequently report problems around communicating and assessing pain, with patients expressing dissatisfaction with their doctors and doctors often finding exchanges with chronic pain patients difficult and frustrating. Yet we know that positive patient-clinician interaction matters to both parties and that a patient's sense that they are being listened to can increase their overall sense of well-being , as well as promoting adherence to lifestyle changes and medical interventions that lead to reduced levels of experienced pain. So, how could we go about improving pain communication, and thereby enhance quality of life, particularly for chronic pain patients? This chapter explores that question by reflecting on what might be learned from philosophical accounts of the meaning of pain terms, seeing how these views impact on practical issues around pain communication and shed light on a newer model of how to think about pain communication (one that we hope might deliver concrete clinical improvements).

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

Pain Forum, 1999

Journal of Linguistic Anthropology, 2009

Frontiers in Pain Research, 2023

This article contributes a perspective on pain motivated by the philosopher Ludwig Wittgenstein. According to Wittgenstein, the child learns from others that the occasions on which it manifests certain reactions - the reactions that human beings manifest when injured - make it appropriate to self-ascribe 'pain'. When the child can signal correctly that she is in the requisite bodily state, then she has a conception of pain. Using the concept pain to symbolise an experience also makes it possible to tell other people what is going on and to solicit their help in managing the pain. In pain discourse, we can say "Sam can tell that Jason is with pain", or "She could tell you that Jason is with pain if she wanted to". These uses are linked to social milieu where rules are learnt for the application of concepts, such as the concept stoicism. In many rural communities, adults tell other adults about pain when it interrupts work or social activities. Otherwise, it is normative to "carry on". The rural stoic who tells another about pain only if he wants to can complicate clinical pain management, which can undermine the patient's special authority. In contrast, convergence in pain definitions and judgements between the patient and health professional can protect the authority of the patient and improve the clinical interaction. Pain is not simply a quale that is privately perceived; it must be capable of being expressed. Thus, pain has a social role, which is learnt. The study of linguistic rules in pain discourse could help explain the learning and application of the concept pain.

Chapter in the Routledge Handbook of Philosophy of Pain, ed. Jennifer Corns (forthcoming)

2012

What is pain, what does it mean that the subject has a relationship with it, and how does this affect his identity and existence? My definition of pain is derived from that proposed by scientists such as Melzack and Wall, and Freud. Pain is a dynamic, multilayered, diverse collection of experiences which impact and influence the subject throughout life. Pain is a kind of conglomerate of past, traumatic, neurobiological, psychological and emotional imprints-pain as in suffering or being in pain. The aim of this thesis is to argue that it is not pain, as such, but the relationship of the subject to (his/her) pain which is most significant to his/her processes of life. In examining the combination of two theories of pain, namely, Freud's psychosexual theory of development and Melzack's theory of the Neuromatrix, my thesis endeavours to evidence my theory by using case study methodology. The similarities in the theories which are a hundred years apart have sparked my interest to propose that there is the distinct possibility for the existence of what I have named a Psychomatrix-patterns of pain (loss-abandonment, grief, rejection, desire) imprinted from infancy within an innate matrix that are specifically translated by their own 'psychological and emotional neural loops' and therefore, similar to the neuromatrix concept. As pain is triggered these 'loops' become more ingrained as information is analysed and coded to create a continuous (subjective) experience of suffering or being in pain. This is also true for positive emotions, such as love and joy, however I suggest that pain is the primary, and most significant emotion that needs to be understood in order to understand the others which are triggered by the same neuralpsychological and physicalpathways as incidental emotions of the quality of existence. A vast spectrum of (on-going) research has identified the impact of cultural, religious, social and political factors on pain and pain management. I suggest that all of these figure in the conglomerate. Using a psychoanalytical frame of reference this is a theoretical and conceptual thesis. My final conclusion is that pain becomes an object that compels the subject to respond accordingly and consequently, from birth to death, defining his/her identity and existence.

Meanings of Pain Volume 1, 2016

Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is, making perceived meaning important in the study of pain. The book contributors explain why meaning is important in the way that pain is felt and promotes the integration of quantitative and qualitative methods to study meanings of pain. For the first time in a book, the study of the meanings of pain is given the attention it deserves. All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person’s life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning. Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers. (Forthcoming, Springer, 2016)

Journal of Behavioral Medicine, 1985

Observable means of communicating pain and suffering, "pain behaviors, " have been postulated to comprise an important construct relevant in both the development and the maintenance of chronic pain . Behavioral Methods for Chronic Pain and Illness, C. V. Mosby, St. Louis, Mo.]. Two groups of professionals who have direct contact with chronicpain patients (i.e., physicians and psychologists) participated in a study designed(a) to identify the latent or underlying characteristics of pain behaviors and (b) to assess the degree of agreement of these characteristics between health professionals with very different training. Multidimensional scaling and hierarchical clustering statistical techniques were employed to identify the latent structure of pain behaviors. Two primary pain behavior dimensions were identified, namely, audible-visible and affective-behavioraL Four clusters of pain behaviors were identified and labeled distorted ambulation or posture, negative affect, facial/audible expressions of distress, and avoidance of activity. The two samples of health-care providers identified virtually equivalent latent characteristics of pain behaviors. The data suggest that there is consistency in the pain-behavior construct and that the latent structure is generally congruent with Fordyce's original conceptualization. The results provide an empirically derived basis for the assessment of pain behaviors.