Suffering in Chronic Pain: Addressing Own Mental & Psychological Associations

  • What is the source of suffering?  Is it pain?  Is it disability? Or maybe it is a loss of self-worth?  We are confronted with suffering on a daily basis, yet we struggle to comprehend the intricate relationship between the disease, person, and suffering. Years back, a phrase in Dr. Dean Ornish's book, Love and Survival, captured my attention, "Pain is not suffering; suffering is the perception of pain."  In the first part, the writer is saying that to be in pain does not necessarily mean that one is suffering. In the second part, the writer adds that suffering comes from the understanding, knowledge, or awareness of pain.

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    How does one perceive pain? Usually, the pain takes on a certain amount of meaning. For some, pain might mean that the end of life is near. For others, pain might mean that work or happiness will cease. For each individual, pain will have a different meaning. And within this significance of pain is the source of suffering for each individual. Everyone has a different understanding of what pain means to him/her. In turn, everyone will have a different level of suffering. "Pain is not suffering; suffering is the perception of pain."


    In The Nature of Suffering and the Goals of Medicine, Dr. Eric Cassel defines suffering as the "state of severe distress associated with events that threaten the intactness of person."  A person in pain will perceive an impending destruction of life as they know it. A person with chronic pain can sense a threat to the intactness of life, love, and the pursuit of happiness. When this awareness arises, suffering begins with an overwhelming fear of uncertainty as life spins out of control, seemingly without end.  Meanings, threats, fear, and loss of control are all at the core of suffering.


    The primary goal of medicine is to end suffering.   No matter how far the science of medicine progresses, the art of medicine will still have to deal with the incurable nature of individuality and uncertainty.  How can we end suffering?  Dr. Cassel suggests that suffering eases when one is "living entirely in the present".  One of my 80 year old patients was distressed because she could not walk as quickly as she used to.  I asked her not to live in the past.  She smiled because it was a familiar phrase.  The past is a source of comparison, while the future is a source of fear.  And fear is the greatest amplifier of pain.   Instead of pushing up the dosages, sometimes it is best to address the source of suffering.  Guiding someone towards adaptation and acceptance can be a tipping point.  A flexible patient will be able to find a new interest that compensates for the loss.  Finding different ways to perform tasks is another way to regain control and ease suffering.   Alternative ways of accomplishing the unavoidable daily living activities can greatly improve someone's quality of life. Sometimes, a patient may be unwilling to concentrate on the present and unwilling to adapt.  In those cases, merely the quiet, strong supporting presence of a friend, spouse, or healthcare worker is the best way to begin to end suffering. Let's all resolve to end suffering.


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    "To end suffering one must give up desire.  To give up desire one must surrender the enchantment of the future."                                                         E. Cassel


Published On: December 29, 2009