The meaning of pain expressions and pain communication

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes

Facing others in pain : why context matters

Judging pain in another is challenging, largely because pain is a subjective phenomenon to which observers have no direct access. Despite this ambiguity, inferences often are made that can drive important clinical decisions, such as estimating another’s pain intensity, with significant implications for patient treatment and outcomes. This chapter focuses upon the influence of the context upon observer cognitive, emotional, and behavioral responses toward others in pain. In doing so, we consider context in its broadest form: characteristics of the patient/person in pain, the observer, and the situation, as well as elements of the reported pain experience, itself. Despite the increased understanding of and appreciation for the role of context in observer judgments, knowledge of how context, judgment, and treatment outcomes interact remains sketchy and in need of translational research. Such research is needed if we are to build our current base of knowledge and translate that knowledge into improved approaches to the assessment and treatment of patients in pain

On the overlap between physical and social pain

When asked to name their most negative life events, people often cite an event of loss such as the dissolution of a valued relationship or the death of a loved one. Curiously, such events are often experienced and described as painful. Curiously, the overlap between physical pain and distressing social experiences does not end there. This chapter explores a growing body of social neuroscience and experimental laboratory research that demonstrates a fascinating, dynamic interplay between distressing social experiences such as exclusion and ostracism, and the experience of physical pain.edition: 1ststatus: publishe