On Suffering: Pathways to Healing and Health

2. Suffering Is Not Pain: The Evidence

2 * Suffering Is Not Pain the evidence Science promised answers to all the mysteries of life, and postmodern society is the recipient of many of the wonders revealed and described by science. Unfortunately , contemporary society seems to have forgotten the revelations achieved through art and intuition. Consequently, in the attempt to conquer disease, many in medicine have forgotten that often it is not the disease that is the patient’s real problem but rather the experience of illness. Suffering is not a disease, but it may well be the prime cause of the patient’s experience of illness. Academic pundits may argue about the definitions of physical pain, psychic pain, and emotional pain, and these arguments have value because they stimulate creative thought, but in everyday life, those who suffer because of chronic illness or disability may require a more pragmatic approach. Clinically, it is critical to understand the nature and origins of individuals’ beliefs about the nature of suffering. It is not useful to combine suffering and pain as one entity. We know that some individuals who suffer experience little pain, and others who experience considerable pain report little suffering. The most useful understanding of suffering in medical practice is to acknowledge that suffering is a perception of threat to an individual’s idea of self and personhood. Pain, whether physical, emotional, or psychic, is simply only one of many factors that may contribute to the experience of suffering. The purpose of this chapter is to provide research evidence that shows that suffering , as defined above, and pain are separate and only sometimes related entities. The focus is on the relationship between (a) suffering and pain intensity in various diseases; (b) total suffering scores and pain intensity obtained from patients assessed using a self-administered, valid, and reliable questionnaire (masq); and (c) pain intensity and total pain scores in a group of patients with chronic illnesses such as arthritis, epilepsy, migraine headache, and spinal cord injury. Analyses of these data will show that some people who experience considerable suffering have low pain scores, while others with high pain scores have low suffering scores. These findings support the argument that if pain is eliminated, suffering does not always abate. The chapter concludes with a discussion that focuses on the significance of incorporating these research findings on suffering into clinical practice. The example given explores the relationship between suffering and monetary compensation in chronic illness or injuries. Emphasis is on cases of litigation involving tort law. 26 Suffering: What Man Has Made of Man Research Evidence Background Considerable controversy exists about the ability to objectively identify those patients who experience suffering. Proponents of the argument for objective measures argue that universal characteristics of suffering such as a threat to idea of self and personhood, loss of central purpose, self-conflict, and impaired interpersonal relationships can be identified (1–3). Those against objective assessment argue that the experience is idiosyncratic and cannot be objectively evaluated (4–6). Our research team adopts the view that the characteristics of suffering are universal and measurable and it is only the expression of the experience that is idiosyncratic. Based on this theory, a self-administered questionnaire, the Measurement and­ Assessment of Suffering Questionnaire (masq), was designed and validated. Details of the items evaluated and results of statistical analyses relating to the validity and reliability of the questionnaire are reported in more detail in chapter 8. The hypothesis that suffering and pain are separate entities that are only sometimes related was tested on 381 patients who had chronic illnesses and who were attending either a hospital outpatient day program or were attending outpatient clinics. Seventy-nine patients had migraine headache, 113 people had epilepsy, 23 had spinal cord injuries and 166 persons with arthritis were assessed. There were 66 females and 12 males in the migraine headache group with a mean age of 42.77 ± 12.22 years. Illness duration was 20.51 ± 11.98 years. The epilepsy group consisted of 58 females and 55 males with a mean age of 41.56 ± 11.42 years and the illness duration was 22.88 ± 12.96 years. The spinal cord injury group was considerably younger, with a mean age of 46.21 ± 8.54 years and an illness duration of 10.95 ± 11.91 years. There were 9 females in the group. The arthritis group consisted of 127 females and 39 males with a mean age of 60.31 ± 14.23 years. Illness duration was 10.95 ± 11...