Skip to main content
SpringerLink
Log in
Book cover

Meanings of Pain pp 37–58Cite as

Diagnosing Human Suffering and Pain: Integrating Phenomenology in Science and Medicine

  • Chapter
  • First Online:

Abstract

This chapter shows that phenomenology may be critical to diagnose human suffering in science and medicine, significantly improving patients’ well-being, while providing a more thorough understanding and adequate management of on-going suffering in the context of chronic pain and other major illnesses. Historical and contemporary references from philosophy, medicine, and science explain why, to date, there is no golden rule or consensual definition of suffering. As a solution, the paper calls for a paradigmatic conceptual shift, explaining the fundamental principles, and how they are translated into an experimentally and clinically tested “Pain-related Suffering assessment tool,” as demonstrated by Bustan’s Fan Models. The tool is tailored for individual use for enhancing personalized care. And while reviving George Canghuilem’s important historical message about individuality in medicine, it seeks to combine impersonal knowledge and personal knowledge to improve medical science and practice.

Clinical Implications: The demand from physicians to be more attentive in assessing the suffering of their patients was introduced by Eric Cassell (1982) as one of the fundamental aims of medicine. This concern, taken into account by health professionals, is difficult to fulfill in the absence of appropriate measures. In addition, the focus on end-of-life suffering has excluded, in the vast majority of cases, patients with chronic pathologies and in particular those with chronic pain whose suffering is part of everyday life. This chapter therefore presents the conceptual shift necessary for the development and validation of a simple and effective clinical tool to diagnose suffering, allowing a more precise assessment and individualized care for chronic pain patients, applicable to other chronic illnesses.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Notes

  1. 1.

    This mixed solution still falls between the cracks since the suffering levels are evaluated through a direct measurement of the degree of suffering and an indirect measurement of its correlation to various experiential dimensions (physical, psychological, spiritual), each including a basic group of components.

References

  1. Bustan S, Gonzalez-Roldan A, Schommer C, Kamping S, Löffler M, Brunner M, et al. Psychological constructs and contextual factors associated with the assessment of pain and related-suffering. PLoS One. 2018;13(7):e0199814.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Bustan S. A scientific and philosophical analysis of meanings in studies of pain and suffering. In: van Rysewyk S, editor. Human meanings of pain. New York: Springer; 2016. p. 107–28.

    Google Scholar 

  3. Bustan S, Gonzalez-Roldan AM, Kamping S, Brunner M, Löffler M, Flor H, et al. Suffering as an independent component of the experience of pain. Eur J Pain. 2015;19(7):1035–48.

    Article  CAS  PubMed  Google Scholar 

  4. Brunner M, Löffler M, Kamping S, Bustan S, Gonzalez-Roldan AM, Anton F, et al. Assessing suffering in experimental pain models. Z Psychol. 2017;225(1):45–53.

    Google Scholar 

  5. Löffler M, Brunner M, Kamping S, Kleinböhl D, Bustan S, Anton F, et al. The impact of controllability on pain and suffering. Pain Reports. 2018;3(6):1–10.

    Article  Google Scholar 

  6. Bustan S. Peut-on mesurer la souffrance liée à la douleur? [Can we measure pain-related suffering?]. Douleur et Analgésie. 2017;30(4):230–8.

    Article  Google Scholar 

  7. Bustan et al. manuscript in preparation.

    Google Scholar 

  8. Price D. Psychological and neural mechanisms of pain. New York: Raven Press; 1988. 241 p.

    Google Scholar 

  9. Bush FM, Whitehill JM, Martelli M. Pain assessment in temporomandibular disorders. Cranio. 1989;7:137–43.

    Article  CAS  PubMed  Google Scholar 

  10. Wade JB, Dougherty LM, Archer CR, Price DD. Assessing the stages of pain processing: a multivariate analytical approach. Pain. 1996;68:157–67.

    Article  CAS  PubMed  Google Scholar 

  11. Wade JB, Hart RP. Attention and the stages of pain processing. Pain Med. 2002;3:30–8.

    Article  PubMed  Google Scholar 

  12. Fishbain DA, Lewis JE, Gao J. The pain suffering association, a review. Pain Med. 2015;16:1057–72.

    Article  PubMed  Google Scholar 

  13. Bustan S. Suffering. Mafte’akh. 2011;3:151–178. Available from: http://din-online.info/pdf/mft3.pdf.

  14. Bustan S. Suffering – a premise for the social and political thought. Zeitschrift für kritische Sozialtheorie und Philosophie. 2015;3(2):379–417.

    Google Scholar 

  15. Loeser JD. Perspectives on pain. In: Clinical pharmacology and therapeutics. Turner P, Padgham C, Hedges A, editors. Macmillan: Palgrave; 1980. p. 313–316.

    Chapter  Google Scholar 

  16. Clark WC, Carroll JD, Yang JC, Janal MN. Multidimensional scaling reveals two dimensions of thermal pain. J Exp Psychol Hum Percept Perform. 1986;12:103–7.

    Article  CAS  PubMed  Google Scholar 

  17. Clark WC, Ferrer-Brechner T, Janal MN, Carroll JD, Yang JC. The dimensions of pain: a multidimensional scaling comparison of cancer patients and healthy volunteers. Pain. 1989;37:25–32.

    Article  Google Scholar 

  18. Fordyce WE. Pain and suffering: a reappraisal. Am Psychol. 1988;43(4):276.

    Article  CAS  PubMed  Google Scholar 

  19. Wade JB, Dougherty LM, Hart RP, Rafii A, Price DD. A canonical correlation analysis of the influence of neuroticism and extraversion on chronic pain, suffering, and pain behavior. Pain. 1992;51(1):67–73.

    Article  CAS  PubMed  Google Scholar 

  20. Krikorian A, Limonero JT, Román JP, Vargas JJ, Palacio C. Predictors of suffering in advanced cancer. Am J Hosp Palliat Med. 2014;31(5):534–42.

    Article  Google Scholar 

  21. Büchi S, Sensky T, Sharpe L, Timberlake N. Graphic representation of illness: a novel method of measuring patient’s perceptions of the impact of illness. Psychother Psychosom. 1998;67:222–5.

    Article  PubMed  Google Scholar 

  22. Bueno-Gómez N. Conceptualizing suffering and pain. Philos Ethics Human Med. 2017;12(1):7.

    Article  Google Scholar 

  23. Cassell EJ. The nature of suffering and the goals of medicine. New York: Oxford University Press; 1991. 336 p.

    Google Scholar 

  24. Jansen LA, Sulmasy DP. Proportionality, terminal suffering and the restorative goals of medicine. Theor Med Bioeth. 2002;23(4–5):321–37.

    Article  PubMed  Google Scholar 

  25. Botbol-Baum M. Peut-on répondre à la souffrance d’un point de vue médical? [Can we reply to suffering from a medical point of view?]. In: Traité de bioéthique. Toulouse: ERES; 2010. p. 469–79.

    Google Scholar 

  26. Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–45.

    Article  Google Scholar 

  27. Ruijs CD, Onwuteaka-Philipsen BD, van der Wal G, Kerkhof AJ. Unbearability of suffering at the end of life: the development of a new measuring device, the SOS-V. BMC Palliat Care. 2009;8(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Krikorian A, Limonero JT. An integrated view of suffering in palliative care. J Palliat Care. 2012;28(1):41.

    Article  PubMed  Google Scholar 

  29. Krikorian A, Limonero JT, Maté J. Suffering and distress at the end-of-life. Psychooncology. 2012;21(8):799–808.

    Article  PubMed  Google Scholar 

  30. Krikorian A, Limonero JT, Corey MT. Suffering assessment: a review of available instruments for use in palliative care. J Palliat Med. 2013;16(2):130–42.

    Article  PubMed  Google Scholar 

  31. Quill TE, Byock IR. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Ann Inter Med. 2000;132(5):408–14.

    Article  CAS  Google Scholar 

  32. Cassell EJ, Rich BA. Intractable end-of-life suffering and the ethics of palliative sedation. Pain Med. 2010;11(3):435–8.

    Article  PubMed  Google Scholar 

  33. Chapman CR, Garvin J. Suffering and its relationship to pain. J Palliat Care. 1993;9(2):5–13.

    Article  CAS  PubMed  Google Scholar 

  34. Loeser JD. Pain and suffering. Clin J Pain. 2000;16(2):S2–6.

    Article  CAS  PubMed  Google Scholar 

  35. Loeser JD, Melzack R. Pain: an overview. Lancet. 1999;353(9164):1607–9.

    Article  CAS  PubMed  Google Scholar 

  36. Marchand S. The phenomenon of pain. Seattle: IASP Press; 2012. p. 14.

    Google Scholar 

  37. Price DD, Barrell J. Inner experience and neuroscience – merging both perspectives. Boston, MA: MIT Press; 2012. p. 159–81.

    Google Scholar 

  38. Vélez MC, Palacio C, Moreno AI, Krikorian A. Psychological and family-related facts of suffering in patients with chronic diseases. Tech Reg Anesth Pain Manag. 2013;17(1):7–10.

    Article  Google Scholar 

  39. Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5(2):168–95.

    Article  CAS  PubMed  Google Scholar 

  40. Kleinman A, Das V, Lock M, Lock MM, editors. Social suffering. Berkeley: University of California Press; 1997. 434 p.

    Google Scholar 

  41. Fields HL. Pain: an unpleasant topic. Pain. 1999;82:S61–9.

    Article  Google Scholar 

  42. Clark WC, Janal MN, Carroll JD. Multidimensional pain requires multidimensional scaling. In: Loeser JD, Chapman CR, editors. Issues in pain measurement. New York: Raven Press; 1989. p. 285–326.

    Google Scholar 

  43. Melzack R, Wall PD. Challenge of pain. New York: Basic Books; 1983. 368 p.

    Google Scholar 

  44. Scott W, Trost Z, Bernier E, Sullivan MJ. Anger differentially mediates the relationship between perceived injustice and chronic pain outcomes. Pain. 2013;154(9):1691–8.

    Article  PubMed  Google Scholar 

  45. McCracken LM. Anger, injustice, and the continuing search for psychological mechanisms of pain, suffering, and disability. Pain. 2013;154(9):1495–6.

    Article  PubMed  Google Scholar 

  46. Price D. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000;288:1769–72.

    Article  CAS  PubMed  Google Scholar 

  47. Price D. Central neural mechanisms that interrelate sensory and affective dimensions of pain. Mol Interv. 2002;2:392–403.

    Article  PubMed  Google Scholar 

  48. Krikorian A, Limonero JT, Vargas JJ, Palacio C. Assessing suffering in advanced cancer patients using pictorial representation of illness and self-measure (PRISM), preliminary validation of the Spanish version in a Latin American population. Support Care Cancer. 2013;21(12):3327–36.

    Article  PubMed  Google Scholar 

  49. Ricoeur P. La souffrance n’est pas la douleur [Suffering is not pain]. In: Von Kaenel JM, editor. Souffrances corps et âme, épreuves partagées [Suffering body and soul, shared hardships]. Autrement. 1994;2:58–69.

    Google Scholar 

  50. Wissler RL, Evans DL, Hart AJ, Morry MM, Saks MJ. Explaining pain and suffering awards: the role of injury characteristics and fault attributions. Law Hum Behav. 1997;21(2):181.

    Article  CAS  PubMed  Google Scholar 

  51. Chapman CR, Gavrin J. Suffering: the contributions of persistent pain. Lancet. 1999;353(9171):2233–7.

    Article  CAS  PubMed  Google Scholar 

  52. Gómez Sancho M, Grau JA. Dolor y sufrimiento al final de la vida pain and suffering at the end of life [Pain and suffering at the end of life]. Madrid: Aran; 2006.

    Google Scholar 

  53. Fordyce WE. Pain and suffering: what is the unit? Qual Life Res. 1994;3:S51–6.

    Article  PubMed  Google Scholar 

  54. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods. 2004;36(4):717–31.

    Article  Google Scholar 

  55. Masten CL, Morelli SA, Eisenberger NI. An fMRI investigation of empathy for ‘social pain’ and subsequent prosocial behavior. NeuroImage. 2011;55(1):381–8.

    Article  PubMed  Google Scholar 

  56. Jollant F, Olié E. La douleur psychologique [Psychological Pain]. Douleur et Analgésie. 2018;31(3):122–8.

    Article  Google Scholar 

  57. Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003;33(3):219–30.

    Article  PubMed  Google Scholar 

  58. Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P. Mental pain and its relationship to suicidality and life meaning. Suicide Life Threat Behav. 2003;33(3):231–41.

    Article  PubMed  Google Scholar 

  59. Orbach I. Mental pain and suicide. Isr J Psychiatry Relat Sci. 2003;40(3):191.

    PubMed  Google Scholar 

  60. Saunders C. The symptomatic treatment of incurable malignant disease. Prescr J. 1964;4(4):68–73.

    Google Scholar 

  61. Saunders C, Baines M. Living with dying: the management of terminal disease. Oxford: Oxford University Press; 1983. 80 p.

    Google Scholar 

  62. Baines MJ. Cancer pain. Postgrad Med J. 1984;60(710):852.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Clark D. Total pain, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Soc Sci Med. 1999;49(6):727–36.

    Article  CAS  PubMed  Google Scholar 

  64. Merleau-Ponty M. Phenomenology of perception. Smith C, translator. London: Routledge; 1995/1945. 544 p.

    Google Scholar 

  65. Dahlberg K. The essence of essences – the search for meaning structures in phenomenological analysis of lifeworld phenomena. Int J Qual Stud Health Well Being. 2009;1(1):11–9.

    Article  Google Scholar 

  66. Mccormick P, Elliston F. Husserl Shorter Works. Notre Dame, Indiana: A University of Notre Dame Press; 1981. 440 p.

    Google Scholar 

  67. Bustan S. On the limits of knowing suffering and pain. In: Fernandes I, editor. Creative Dialogues: narrative and medicine. Newcastle upon Tune: Cambridge Scholars Publishing; 2015. p. 259–73.

    Google Scholar 

  68. Bustan S. Voicing pain and suffering through linguistic agents: Nuancing Elaine Scarry’s view on the inability to express pain. Subjectivity. 2016;9(4):363–80.

    Article  Google Scholar 

  69. Correll D. Chronic postoperative pain: recent findings in understanding and management. F1000Res. 2017;6:1054.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Moryl N, Carver A, Foley K. Suffering in the patient, family, and physician. In: Kufe DW, Pollock RE, Weichselbaum RR, editors. Holland-frei cancer medicine cloth. Hamilton: BC Decker; 2003. 2008 p.

    Google Scholar 

  71. Melzack R, Casey KL. Sensory, motivational, and central control determinants of pain: a new conceptual model. In: Kenshalo D, editor. The skin senses. Springfield, IL: Thomas; 1968. p. 423–43.

    Google Scholar 

  72. Participant n. 47, PASCON working package 1, Luxembourg; 2013.

    Google Scholar 

  73. Bustan S, Gonzalez-Roldan A, Odero A, Baumann M, Kamping S, Flor H, et al. The generation of suffering-related items: a process integrating consensus experts and Sorensen’s similarity analysis. 2019, under review.

    Google Scholar 

  74. Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988. 304 p.

    Google Scholar 

  75. Canguilhem G. The normal and the pathological. Fawcett CR, Cohen RS, translators. New York: Zone Books; 1991. 336 p.

    Google Scholar 

  76. Lefève C. La philosophie du soin [The philosophy of care]. La Matière et l’esprit. 2006;4:25–34.

    Google Scholar 

  77. Lefève C. De la philosophie de la médecine de Georges Canguilhem à la philosophie du soin médical [From the philosophy of medicine of Georges Canguilhem to the philosophy of medical care]. Rev Metaphys Morale. 2014;2:197–221.

    Google Scholar 

  78. Canguilhem G. Le statut épistémologique de la médecine [The epistemological Status of Medicine]. History Philos Life Sci. 1988;10(Suppl):22–3.

    Google Scholar 

Download references

Acknowledgments

I wish to thank Javier Escartin for his kind help in revising this paper and to Simon van Rysewyk for his editing.

Author information

Authors and Affiliations

  1. University of Paris Diderot, Institut Humanités, Sciences et Sociétés (IHSS), Paris, France

    Smadar Bustan

Authors
  1. Smadar Bustan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. School of Humanities, Department of Philosophy and Gender Studies, University of Tasmania, Hobart, TAS, Australia

    Simon van Rysewyk

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bustan, S. (2019). Diagnosing Human Suffering and Pain: Integrating Phenomenology in Science and Medicine. In: van Rysewyk, S. (eds) Meanings of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-24154-4_3

Download citation

Publish with us

Policies and ethics

Search

Navigation