Is “Chronic Pain” a Meaningful Diagnosis?

Abstract

Introduction: “Chronic pain” and “chronic primary pain” in particular are both about to appear in the international taxonomy, ICD-11. While this is likely to have great utility at administrative and possibly clinical levels, the question arises as to whether people experiencing chronic pain also will benefit. Methods: The definitions (denotations) of “chronic pain” as symptom, disease and diagnosis are refracted through the constraints of language, especially figures of speech, in order to ascertain if “meaning” is possible. Results: “Chronic (primary) pain” as a taxonomic entity remains tied to the definitional link of “pain” itself to actual or apprehended tissue damage. This situation does not assist the plight of those experiencers of pain in whom tissue damage cannot be demonstrated. Conclusion: While the definition of pain itself is constrained by the link to tissue damage, there can be no satisfactory denotation of “chronic pain” for those who live with that experience. As such, meaning remains elusive. Clinical Implications: “Chronic pain” and “chronic primary pain” in particular are about to appear in the international taxonomy, ICD-11. While this is a welcome development towards the recognition of chronic pain as a societal and clinical problem, with positive diagnostic, therapeutic and administrative implications, the question also arises, whether this “entity” carries meaning for those who experience it. This article argues that, while pain itself is defined as being linked to tissue damage, there can be no satisfactory denotation of “chronic pain” for those who live with that experience. As such, meaning remains elusive.