Smadar Bustan

This chapter shows that phenomenology may be critical to diagnose human suffering in science and medicine, significantly improving patients’ well-being, while providing a more thorough understanding and adequate management of on-going suffering in the context of chronic pain and other major illnesses. Historical and contemporary references from philosophy, medicine, and science explain why, to date, there is no golden rule or consensual definition of suffering. As a solution, the paper calls for a paradigmatic conceptual shift, explaining the fundamental principles, and how they are translated into an experimentally and clinically tested “Pain-related Suffering assessment tool,” as demonstrated by Bustan’s Fan Models. The tool is tailored for individual use for enhancing personalized care. And while reviving George Canghuilem’s important historical message about individuality in medicine, it seeks to combine impersonal knowledge and personal knowledge to improve medical science and practice.Clinical Implications: The demand from physicians to be more attentive in assessing the suffering of their patients was introduced by Eric Cassell as one of the fundamental aims of medicine. This concern, taken into account by health professionals, is difficult to fulfill in the absence of appropriate measures. In addition, the focus on end-of-life suffering has excluded, in the vast majority of cases, patients with chronic pathologies and in particular those with chronic pain whose suffering is part of everyday life. This chapter therefore presents the conceptual shift necessary for the development and validation of a simple and effective clinical tool to diagnose suffering, allowing a more precise assessment and individualized care for chronic pain patients, applicable to other chronic illnesses.

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.