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A conceptual framework for "updating the definition of pain" Reply
... For Cassell, "the canons of science that have held medicine in thrall for much of the twentieth century do not have a place for the phenomenon of suffering" ( [2], 276). The failure of diagnosis and thus of the treatment of suffering does not only come from the increasing use of technology, from the emotional boundary that caregivers impose on themselves with patients ("the requirement of parsimony" as coined by the French psychiatrist Jean-Jacques Kress; Ricoeur [6], 69) or caregivers' ignorance of their own subjectivity and personal suffering, their "feelings, intuition, and even the input of their senses -that would be necessary to detect suffering in their patients" ( [2], 276). For Cassell, "the fact that suffering, like pain, is subjective and cannot be measured may be an important reason" ( [2], 276). ...
... [...] what is missing in the word 'unpleasant' is the misery, anguish, desperation, and urgency that are part of some pain experiences". It is therefore remarkable that consensual theoretical classifications and clinical practice omit to include the associated suffering, preventing a real conceptual renewal of the notion of pain, and that in the light of recent years inflamed debates calling to update its official definition [67][68][69][70]. To avoid further amalgams both in science and medicine regarding suffering in general and in relation to pain requires to focus on: 1) identifying suffering at the end of life (palliative care, terminal diseases) versus persistent suffering (pain and chronic diseases); 2) being precise and distinguish between suffering in general and pain-related suffering; 3) renewing the consideration of suffering as an extended form of the pain's unpleasantness; 4) educating professionals not to confuse between suffering and pain. ...
Eric Cassell introduced his demand that physicians be more attentive to assessing the suffering of their patients as one of the fundamental goals of medicine. This call was indeed taken into account by health professionals but remained difficult to satisfy in the absence of appropriate measures. In addition, the focus on end-of-life suffering in palliative care has excluded, in the vast majority of cases, patients with chronic medical conditions like chronic pain whose on-going suffering is part of everyday life. To fill this gap, my integrative approach relies on both philosophical, psychobiological and clinical concepts seeking to provide a measure accompanied by an interpretation of the person’s suffering. The practical goal is to provide a simple and effective clinical tool to assess the degree of suffering related to pain and to characterize its specific nature in each patient, allowing a more precise diagnosis and more individualized management of chronic patients. In specifically answering the question « Can we measure Pain- related Suffering? », this article addresses the main issues, both conceptual and methodological, attached to the diagnosis of suffering using pain as a study case in order to instruct the development of an illness-related suffering assessment tool for medical use.
Keywords: Human Suffering; Chronic Pain; Measurement; Meaning; Suffering Assessment Tool; Chronic Illnesses; Philosophy; Experimental Studies; Clinical Studies
November 2015 marks the 50th anniversary of the 1965 Science publication “Pain Mechanisms: A New Theory” by Ronald Melzack and Patrick D Wall, in which the authors introduced the gate control theory of pain that has since revolutionized our under-standing of pain mechanisms and management. The brilliance, creativity and critical thought that went into the formulation and explication of the gate control theory of pain can best be appreciated by reading the original article. Fifty years later, having become part of our scientific history and accepted as common knowledge, the essence of the theory is often conveyed by the familiar diagram in Figure 1.
Introduction 86 Pain and suffering: what are they? 87 Classification excess: the multiplicity of pain and suffering 90 Understanding: the matrix of biology and culture 92 The ethics of pain and suffering: narrative analysis 93 References 95 The International Association for the Study of Pain (IASP) definition of pain is valid, but flexible.
Physical activity is beneficial in chronic pain rehabilitation. However, due to psychological anxieties about pain and the percevied risk of injury, physical activity is often avoided by people with chronic pain. This avoidance is expressed through self protective body movement aimed at avoiding strain, particularly in painful areas. The detection of protective behaviour is crucial for effective rehabilitation advice and to enable a more normal lifestyle. Current technology to motivate physical activity in rehabilitation contexts does not address these psychological barriers. In this paper, we investigate the automatic recognition of a specific form of protective behaviour, guarding, common in people with chronic lower back pain. We trained ensembles of decision trees, Random Forests, on posture and velocity based features from motion capture and electromyographic data. Results show overall out of bag F1-classification scores of 0.81 and 0.73 for sitting to standing and one leg stand exercises respectively.