Pain

Pain is a complex, multidimensional phenomenon. The understanding of this phenomenon is evolving as scientists from many disciplines conduct research. Increased knowledge provides health care professionals with many strategies for pain management. Pain is defined as whatever the person experiencing the pain says it is, existing whenever the person says it does. This clinical definition recognizes pain as a personal private experience.

Scientists at the International Association for the Study of Pain (IASP) have proposed another definition. This definition states that pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or it is described in terms of such damage.

In considering the IASP definition, it is important to note that not all potentially tissue-damaging stimuli result in pain. Nociception is the activation of the primary afferent nerves with peripheral terminals that respond differently to noxious stimuli. Nociceptors function primarily to sense and transmit pain signals. Nociception may or may not be perceived as pain, depending on a complex interaction within the nociceptive pathways. If nociceptive stimuli are blocked, pain is not perceived. Finally, it is important to distinguish pain, or nociception, from suffering. Suffering is the state of severe distress associated with events that threaten the intactness of the person. Suffering is an emotion. Pain and suffering are not the same phenomenon.

The person who complained of pain in the heart because of the death of a loved one is suffering rather than experiencing pain as it is defined by the IASP. It is clear that three conditions could exist: 1) suffering occurs in the presence of pain,2) suffering occurs when pain is not present, and 3) pain occurs when suffering is not present. For example, the woman awaiting breast biopsy may suffer because of anticipated loss of her breast. After the biopsy, she may have pain without suffering if the biopsy is negative or pain with suffering if the biopsy is positive for malignancy. Interventions aimed at relieving pain and suffering may have some commonalities, but clearly some interventions for suffering will be inadequate for pain just as some interventions for pain are inadequate for suffering.