The Meaning of Pain Expressions and Pain Communication

Abstract

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “body-centric” kind of way, while another thinks of pain in a much more “mind-centric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate-dividing sensory/cognitive/affective factors-needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes. Clinical Implications: First, by making a subject’s tacit beliefs about pain explicit it will be possible to create a more open, shared space for pain communication (particularly between clinicians and patients) and support a move away from purely quantitative measures of pain towards more discursive pain narratives. Secondly, the polyeidic view might provide a mechanism for predicting who will do well or badly from cognitive interventions for pain management, allowing more efficient use of healthcare resources. Finally, the polyeidic approach might also contribute to the creation of more nuanced cognitive interventions by elucidating the pre-conscious beliefs that influence a subject’s experience of pain.