The science, language, and many dimensions of pain

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“We have invented techniques to quantify and objectify pain,” says pain specialist Mark Sullivan. “Most famously, the zero-to-ten pain scale that everybody's had administered to them when they're in the doctor's office or in the hospital, and we have interpreted the right to pain relief in terms of that scale, as a right to a lower pain score.” Photo by Shutterstock.

Backache, migraines, a nail in the foot — physical pain can be overwhelming. Historically, some cultures have viewed pain as part of God’s plan — a message from the divine and a preparation for the afterlife. By the 17th century, French scientist René Descartes had theorized that pain was a kind of mechanical response born from a sensory source in our own bodies.   

Jonathan Bastian talks with University of Washington Professor of Psychiatry and Behavioral Sciences Mark D. Sullivan, co-author with Jane Ballantyne of “The Right to Pain Relief and Other Deep Roots of the Opioid Epidemic,” about his research into physical pain and how intensity and types of pain can vary — why, for example, a headache or toothache is very different from the visceral pain of a cut or a fall.  

Sullivan also explains how pain relief — from aspirin to oxycodone — has advanced. The opioid crisis, Sullivan says, shows that while opioids are great at providing short term relief, they’ve proven to be ineffectual and addictive in the long term. 

Sullivan explains that “intensity” is not the only measure of pain, and that the origins and experience of pain are often far more complex — particularly when it comes to chronic or unexplainable pain. In his view, the familiar “zero to ten” pain scale used by hospitals and medical practitioners should be abandoned. 

With a better understanding of the origins and nature of pain, he says, the focus will be less on a pharmaceutical fix and more on alternatives like acupuncture, physiotherapy, or psychotherapy. The opioid crisis, Sullivan explains, wasn’t just the result of unethical medical providers and greedy pharma, but a flawed model of physical pain and pain relief. 

“It's been easier, with policy, to reduce access to opioids than it has been to increase access to behavioral treatments for pain,” Sullivan explains. “But it's much harder to get funded for things like acupuncture, massage, physical therapy, psychotherapy — all sorts of things that have proven [to be] of benefit for people with chronic pain.”


Mark D. Sullivan, pictured here, argues that the familiar “zero to ten” pain scale used by hospitals and medical practitioners should be abandoned. Photo courtesy of the author.

How humans express pain can be as complex and challenging as treating it. Elaine Scarry, Walter M. Cabot Professor of Aesthetics and the General Theory of Value at Harvard University, specializes in analyzing physical suffering and its relation to great works of art, language, and vocabulary.  Scarry is author of “The Body in Pain: The Making and Unmaking of the World,” in which she describes the total and immense nature of pain. Other than letting out an explicative or a groan, language often fails us when there is physical agony. 

“When we have psychological pain, there are literally hundreds — hundreds — of great artworks that address the problem,” says Scarry. “But for physical pain, there's only a tiny number of works that take that on.”

Scarry says there are many dimensions to pain, and shares the significance of work by psychologists Ronald Melzack and Warren S. Torgerson in developing the 1975 McGill Pain Questionnaire, which is used throughout the world today. Scarry explains that when patients who are in pain are offered, as with the McGill Questionnaire, a kind of “menu” of adjectives from which to choose — words like flickering, quivering, pulsing, throbbing, beating — their choice of words and their selection “could help a physician diagnose the pain and might also help predict which painkiller which medicine might be most successful.” 


Elaine Scarry pictured here says there is a difference between voluntary and involuntary pain; “a key absolutely key feature of physical pain is the elimination of agency, the elimination of consent.” Photo courtesy of Elaine Scarry 


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Credits

Guests:

  • Mark D Sullivan - Author; Professor of Psychiatry and Behavioral Sciences, University of Washington; Adjunct professor of Anesthesiology and Pain Medicine
  • Elaine Scarry - Author; Walter M. Cabot Professor of Aesthetics and General Theory of Value, Harvard University

Producer:

Andrea Brody