Suspiciously terse

Christopher Hitchens was fond of this response after being introduced to the speaker’s podium with, more often than not, the same tired clichés and platitudes lifted directly from his wikipedia entry.

It’s a wonderful, multi-layered, minimalist phrase, and one that I often use during Explain Pain courses to describe the IASP definition of pain:

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Terse no doubt. But why suspiciously so? The accompanying, but very rarely cited, ‘Note’ seems to have to do a lot of work to prop up the brusque definition:

“Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.”

 

Two thoughts;

Both the definition and the note lack a first person perspective, they both seem focussed on allowing a third person to point at some state of affairs, some set of circumstances, and (objectively) state ‘that is pain’. Despite the claim that ‘pain is always subjective’ the later declarations that certain experiences ‘…should not be called pain’ while other descriptions ‘…should be accepted as pain’ appear to suggest that the arbitration – the veracity – of pain is up to others, rather than the individual having the experience.

Perhaps it’s the chicken and egg question in a different guise, but has the definition’s focus on tissue damage perpetuated the obsessive search for tissue based explanations for pain, and the all too common corollary of denying pain when no tissue ‘source’ can be found?

In my mind, the ‘Note’ seems suspiciously long.

-Tim Cocks

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4 Responses to “Suspiciously terse”

  1. davidboltononoi

    I totally agree with you Tim. As I have said many a time before, that which the owner experiences is their reality, their truth. If they use the expression pain then, in their World pain it is. Who are we to judge otherwise…..

    Reply
  2. Barrett L. Dorko

    Perhaps it would be better to say “all pain is invisible,” rather than “subjective.” This would lend it to investigation, none of which has convinced science that it is in the tissues, but is complex.

    Reply

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