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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 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
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.
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.
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.
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.
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.
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.
Bustan et al. manuscript in preparation.
Price D. Psychological and neural mechanisms of pain. New York: Raven Press; 1988. 241 p.
Bush FM, Whitehill JM, Martelli M. Pain assessment in temporomandibular disorders. Cranio. 1989;7:137–43.
Wade JB, Dougherty LM, Archer CR, Price DD. Assessing the stages of pain processing: a multivariate analytical approach. Pain. 1996;68:157–67.
Wade JB, Hart RP. Attention and the stages of pain processing. Pain Med. 2002;3:30–8.
Fishbain DA, Lewis JE, Gao J. The pain suffering association, a review. Pain Med. 2015;16:1057–72.
Bustan S. Suffering. Mafte’akh. 2011;3:151–178. Available from: http://din-online.info/pdf/mft3.pdf.
Bustan S. Suffering – a premise for the social and political thought. Zeitschrift für kritische Sozialtheorie und Philosophie. 2015;3(2):379–417.
Loeser JD. Perspectives on pain. In: Clinical pharmacology and therapeutics. Turner P, Padgham C, Hedges A, editors. Macmillan: Palgrave; 1980. p. 313–316.
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.
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.
Fordyce WE. Pain and suffering: a reappraisal. Am Psychol. 1988;43(4):276.
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.
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.
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.
Bueno-Gómez N. Conceptualizing suffering and pain. Philos Ethics Human Med. 2017;12(1):7.
Cassell EJ. The nature of suffering and the goals of medicine. New York: Oxford University Press; 1991. 336 p.
Jansen LA, Sulmasy DP. Proportionality, terminal suffering and the restorative goals of medicine. Theor Med Bioeth. 2002;23(4–5):321–37.
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.
Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–45.
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.
Krikorian A, Limonero JT. An integrated view of suffering in palliative care. J Palliat Care. 2012;28(1):41.
Krikorian A, Limonero JT, Maté J. Suffering and distress at the end-of-life. Psychooncology. 2012;21(8):799–808.
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.
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.
Cassell EJ, Rich BA. Intractable end-of-life suffering and the ethics of palliative sedation. Pain Med. 2010;11(3):435–8.
Chapman CR, Garvin J. Suffering and its relationship to pain. J Palliat Care. 1993;9(2):5–13.
Loeser JD. Pain and suffering. Clin J Pain. 2000;16(2):S2–6.
Loeser JD, Melzack R. Pain: an overview. Lancet. 1999;353(9164):1607–9.
Marchand S. The phenomenon of pain. Seattle: IASP Press; 2012. p. 14.
Price DD, Barrell J. Inner experience and neuroscience – merging both perspectives. Boston, MA: MIT Press; 2012. p. 159–81.
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.
Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5(2):168–95.
Kleinman A, Das V, Lock M, Lock MM, editors. Social suffering. Berkeley: University of California Press; 1997. 434 p.
Fields HL. Pain: an unpleasant topic. Pain. 1999;82:S61–9.
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.
Melzack R, Wall PD. Challenge of pain. New York: Basic Books; 1983. 368 p.
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.
McCracken LM. Anger, injustice, and the continuing search for psychological mechanisms of pain, suffering, and disability. Pain. 2013;154(9):1495–6.
Price D. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000;288:1769–72.
Price D. Central neural mechanisms that interrelate sensory and affective dimensions of pain. Mol Interv. 2002;2:392–403.
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.
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.
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.
Chapman CR, Gavrin J. Suffering: the contributions of persistent pain. Lancet. 1999;353(9171):2233–7.
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.
Fordyce WE. Pain and suffering: what is the unit? Qual Life Res. 1994;3:S51–6.
Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods. 2004;36(4):717–31.
Masten CL, Morelli SA, Eisenberger NI. An fMRI investigation of empathy for ‘social pain’ and subsequent prosocial behavior. NeuroImage. 2011;55(1):381–8.
Jollant F, Olié E. La douleur psychologique [Psychological Pain]. Douleur et Analgésie. 2018;31(3):122–8.
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.
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.
Orbach I. Mental pain and suicide. Isr J Psychiatry Relat Sci. 2003;40(3):191.
Saunders C. The symptomatic treatment of incurable malignant disease. Prescr J. 1964;4(4):68–73.
Saunders C, Baines M. Living with dying: the management of terminal disease. Oxford: Oxford University Press; 1983. 80 p.
Baines MJ. Cancer pain. Postgrad Med J. 1984;60(710):852.
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.
Merleau-Ponty M. Phenomenology of perception. Smith C, translator. London: Routledge; 1995/1945. 544 p.
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.
Mccormick P, Elliston F. Husserl Shorter Works. Notre Dame, Indiana: A University of Notre Dame Press; 1981. 440 p.
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.
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.
Correll D. Chronic postoperative pain: recent findings in understanding and management. F1000Res. 2017;6:1054.
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.
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.
Participant n. 47, PASCON working package 1, Luxembourg; 2013.
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.
Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988. 304 p.
Canguilhem G. The normal and the pathological. Fawcett CR, Cohen RS, translators. New York: Zone Books; 1991. 336 p.
Lefève C. La philosophie du soin [The philosophy of care]. La Matière et l’esprit. 2006;4:25–34.
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.
Canguilhem G. Le statut épistémologique de la médecine [The epistemological Status of Medicine]. History Philos Life Sci. 1988;10(Suppl):22–3.
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
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
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
DOI: https://doi.org/10.1007/978-3-030-24154-4_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-24153-7
Online ISBN: 978-3-030-24154-4
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)