Pain cannot (just) be whatever the person says: A critique of a dogma

Abstract

McCaffery's definition of pain has proven to be one of the most consequential in nursing and healthcare more generally. She put forward this definition in response to the persistent undertreatment of pain. However, despite raising her definition to the status of a dogma, the undertreatment remains a real problem. This essay explores the contention that McCaffery's definition of pain elides critical aspects of it, aspects that demand consideration when treating pain. In section I, I set the stage. I discuss how McCaffery's definition and her understanding of pain science interrelate. In section II, I raise three problems for this understanding. In section III, I argue that these problems stem from an incoherency in her definition. Finally, in section IV, I draw from hospice nursing as well as philosophy and the social sciences to redefine ‘pain’ so that an intersubjective feature of it is foregrounded. I also briefly discuss one implication this redefinition has for pain management.

Entangled brains and the experience of pains

“…In the scientific literature, there has been at least the suggestion that there are no underlying mechanisms specific to the experience of pain, nor any clear pattern of activity for it across the brain. Even from science's point of view, it appears more likely than not that pains are not a natural kind (although Bateu, 2020 andDjordjevic, 2023 suggest a different perspective).…”

Finding a meaning for pain: Definitions, sense‐making, and philosophical health

“…14 Conversely, if the metric is independent of the subject, then empirical, ethical, and conceptual problems emerge. 15 Empirically, several authors have pointed out that the reliance on an independent intensity metric inexorably forces a subject to collapse a *A reviewer insightfully pointed out that a prior draft of this paper's use of Gadamer's hermeneutics was too quick and struggled to harmonize Gadamer with my more 'analytic' approach. To overcome these difficulties, I now draw exclusively from Rorty's more 'analytic' account of hermeneutics.…”

Editorial preface: The role of subjectivity, intersubjectivity, and power relations in the delivery of humane nursing care

“…They consider tacit knowledge as interpretative narratives and learning attitudes that reflect interaction with others. Djordjevic (2023) questions the connotation that the immediacy of experiencing pain allows the individual to lay claim to a pure and genuine understanding of the pain that enables the individual to communicate it fully to others via pain scales. Hence, the idea that pain is whatever the patient says cannot hold ground.…”

“…Hence, the idea that pain is whatever the patient says cannot hold ground. Djordjevic (2023) argues that pain experience is relational and partly shaped by others, including the process of learning to use the pain scales. The meaning-making and communication processes of pain experiences are mediated by and created from the very process of articulating and describing the experience through language.…”

“…They argue that the relational interactions of persons, health and environment are fundamentally more important for nursing practice than the conceptual entities of persons, health and environment. Moreover, Pesut and Thorne (2023), like Djordjevic (2023), suggest that conceptual entities are (re)shaped by relational interactions and eventually affect the ideas and values nurses hold about the conceptual entities and the overall relational interactions. They focus on relational interactions to analyse how nurses think about death within the medical assistance in the dying framework, whereby physical death is not morally neutral but socially conditioned.…”