Dave Stonor

Pain and pleasure affect us all. Knowing this with empathy, and acting upon it, civilises us. Without such empathy, pain can become a means of domination and injustice. Moreover, pain is expressed and responded to in all social contexts, and the word “pain” has diverse meanings, depending on the associated activities. To observe various ways in which we say that it hurts, and the many meanings of pain, I follow ordinary-language philosophy, particularly Ludwig Wittgenstein and John L Austin, and I consider a range of social and historical contexts, from the closest intimacy, everyday chatter, the clinic, and beyond, to the domain of public policy and human rights. This addresses our verbal expressions of pain, their lived contexts and effects, within relationships and among social groups, altering mutual obligations, eliciting actions and reactions, and thence creating moral, legal and political norms. My aim, then, is to consider the social and political implications of ordinary performative pain-talk, in particular regarding the relationship between pain and justice, public policy, human rights and law.Clinical Implications: Clinicians’ roles in disability assessment and pain management are often affected by extrinsic concerns such as financial incentives and the risks of substance abuse. This chapter addresses those complex issues, illustrating how they have arisen in particular historical circumstances, and with political and economic causes and consequences. While unable to provide ready-to-hand clinical solutions, a pragmatic ordinary-language approach to conversations and disagreements about pain helps to chart the grounds on which these matters are debated.

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers.

The English word ‘pain’ is commonly used by lay people in a ‘messy’ life-world of imprecise meanings. It has a complex etymology, including legal and political uses as ‘punishment’. Understandings of pain in the political theory of Hobbes and Bentham are summarized. This wider historical and philosophical account of the uses of ‘pain’ means the IASP definition can be seen in relation to medical history and to present-day clinical challenges. We can consider the misunderstandings that may occur between clinicians and pain sufferers, and the ways in which ‘pain’, although ‘subjective’, is inescapably a political concern. Using Wittgenstein’s approach to meaning, however, we can envisage a context-sensitive and flexible approach to communication about pain.