Pain & Suffering by Dr. Alisa Johnson

Below is an interesting piece written by Dr. Alisa Johnson, post-doctoral researcher at PRICE, for IASP 2018 World Congress on Pain PRF Correspondents Blog

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” —Viktor Frankl

It has been said that “pain is inevitable, suffering is optional.” What is suffering? When we ask about pain unpleasantness are we capturing the full meaning of suffering? Probably not. In a timely and poignant presentation, Smadar Bustan, Herta Flor, and Pierre Rainville presented the case for a more comprehensive view and assessment of pain that will ultimately improve patient care and pain outcomes

During the session, the audience was challenged to reconsider the current practice of assessing pain intensity and unpleasantness and assuming suffering is captured by these primary sensory and affective dimensions. Instead, suffering needs to be assessed separate from unpleasantness. As Smadar Bustan explained, suffering is a secondary affective process of pain that affects multiple dimensions of human existence, including the physical, mental, psychological, existential, emotional, and social self

Herta Flor presented findings that suggest it may be possible to induce some suffering in experimental settings, though it is recognized this type of suffering cannot fully capture the suffering that is inherent to chronic pain. Evidence suggests that suffering is in fact distinct from pain unpleasantness and that individuals are able to conceptualize suffering apart from unpleasantness, as demonstrated in four separate studies measuring self-reported pain intensity, pain unpleasantness, and suffering.

Pierre Rainville finished the session by presenting fascinating fMRI data on the pain responses, or lack thereof, of highly trained Zen meditators, once again challenging long-held conceptualizations of pain. Taken together, the talks by all three presenters provide sufficient evidence to question the current measurement practices of pain in research and clinical settings. As was so beautifully illustrated, chronic pain invokes suffering, and that suffering occurs in multiple ways and multiple dimensions

Moving forward, it is crucial that both researchers and clinicians recognize suffering as a distinct concept from pain unpleasantness. Only in this way will we be able to better understand the individual differences in pain experiences. 


photoAlisa Johnson, PHD Postdoctoral Research Associate, University of Florida, Gainesville, US.