Deciphering chronic pain

Abstract

Chronic pain is a problematic reality at least for two reasons.First, pain is a person's private experience, to which no one else has direct access. Second, chronic pain is lasting proof of a failure that questions the validity of actions and explanations, both past and future, of all involved. Because pain is a private sensation that cannot be reduced by objectification, it cannot, ultimately, be stablised as an unquestionable fact that can serve as the basis of medical practice and thus organise relations between professional and lay persons. This fragile factuality increases the work a physician has to do to decipher a patient's pain. The aim of this paper is to examine how physicians specialising in pain medicine work at this deciphering. Because of these characteristics of pain, physicians are forced to work on the elusive information provided by patients so as to bring into being something called chronic pain. When doing this they tap various, nearly incompatible, resources. I shall study the way these multiple resources are put to use by physicians as they form judgements about cases. By using as a field experiment two pain centres with opposite conceptions and practices, it can be shown how physicians in each centre determine patients' pain situations and formulate advice to them, how the characteristics of this work involve physicians in specific systems of relations with patients, and how these systems are related to dimensions of this work: either to a justification of physicians' actions or else to a confirmation, or realignment, of the initial doctor-patient agreement.

Medical sociology, chronic illness and the body

“…For example, in recent years disorders like gall bladder disease, ulcers, back pain, stroke, and bronchitis pale into significance sociologically, compared to studies of AIDS/HIV (Field andWoodman 1990, Barbour andVan TeijHngen 1994). Even where writers have focused on the apparently physical, as in the case of pain, it is the cognitive mediation and interpretation of pain (Bendelow 1993, Kotarba 1983 or the ways in which professionals make sense of it (Baszanger 1992) which is of sociological interest, rather than the bodily experience of pain itself. That is, the meanings of pain are given precedence over its physical restrictions and discomforts -even though it is precisely these which have greatest weight in shaping interpretations and the attribution of meaning by sufferers.…”

A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain

“…However, the proliferation of studies exploring the experience of chronic non-malignant pain 97,140,206,214,250,261,296,327,342,343,348,363,379,385,427,433,[443][444][445][446][447][448][449][450][451][452][453][454][455][456][457][458][459][460] makes it difficult for clinicians and policy makes to use this knowledge to inform practice and policy, and increases the danger that these findings are 'doomed never to be visited'. 27 Research findings need to be accessible if they are to have an effect on care and policy.…”

Using Numbers Creates Value for Health Professionals: A Quantitative Study of Pain Management in Palliative Care

“…Pain management research stresses that chronic pain is a problematic area since pain is a personal experience. Hence, staff has to work with person-centered care to achieve high-quality care [50,51].…”

“…Age-related differences concerning staff skills and use of technical solutions, as well as funding, working conditions, etc., also need to be considered. Even though e-health offers opportunities for patients concerning pain management, the staff and managers must handle it with care [49][50][51][52].…”