I actually don't think the well-recognized difficulty in defining pain makes it particularly difficult to design interventions. Being a devotee of later Wittgenstein, I tend to think we do not need definitions to make meaningful distinctions in our attitudes and practices about pain. We need to
have some idea of what we typically refer to when we discuss pain, but I don't think a definition consisting of necessary and sufficient conditions is either tenable or even desirable.
In any case, as I certainly don't wish to monopolize this Listserv with details of my own research, I will simply say that my intent is to contend that many of our policy approaches towards improving the undertreatment of pain, while well-intentioned, have little likelihood of meaningful long-term
impact, in no small part because they are typically disconnected from an analysis of the social and cultural factors that drive our imbalanced policies and practices to begin with. This reflects the general state of health policies in general, of course, at least in the U.S.
Those interested are invited to contact me individually for further details.
--dsg
-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Diana Liw
Sent: Monday, May 05, 2008 11:12 AM
To: [log in to unmask]
Subject: Re: [SDOH] People With Less Education And Lower Income Spend More Time In Pain, Study Finds
Thanks Daniel. I would be very interested to know what you find in your dissertation. I think that it's a very important subject, but very difficult to measure since it's very subjective. There is an increasing interest in the research and public health communities to look into chronic pain.
However, I think that the difficulty aside from coming up with a measurement for pain is the definition of pain. Perhaps lack of a "precise/concise" definition for "pain" is reason why it's hard to quantify. In addition, people may have different tolerance and treshold for pain. All of these
complicate the "public health intervention". How do we prevent the experiences of pain (physical, mental perhaps also social such as what people call as "heartaches"), and how do we reduce pain other than taking pain medication and other drugs to numb ourselves.
>>> "Goldberg, Daniel" <[log in to unmask]> 05/05/08 8:40 AM >>>
In case anyone cares, my disseration will be on pain, and, to the best of my knowledge, there is no good way to measure pain other than self-reporting. Of course, this means that certain populations have higher or lower rates of reporting pain e.g., elderly populations, which typically underreport
pain.
I think Diana's question is a good one, but I'm not sure we have any way of teasing apart the variables, given that the definitive measure of pain is in fact self-reporting. Chronic pain itself tends to promote silence, as Scarry's seminal text demonstrates (empirically confirmed by anthropologists
and other social scientists), so over the long run of experience with chronic pain, rates of self-reporting should go down.
I have seen little evidence to date that chronic pain is overreported, but quite a bit of evidence that such pain is underreported (for some of the reasons noted above). As such, I tend to think the estimates suggested by this study are probably conservative, or are at least consistent with much of
the empirical scholarship on pain.
-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of Diana Liw
Sent: Monday, May 05, 2008 10:30 AM
To: [log in to unmask]
Subject: Re: [SDOH] People With Less Education And Lower Income Spend More Time In Pain, Study Finds
"The researchers did not ask the survey participants to make a distinction between physical and mental pain because all pain, the researchers said, is subjective. Yet clearly, they said, many of the participants were reporting physical pain."
Not to minimize the importance of the study. I wonder how "pain" is measured. Based on self-report? Are people with less education and lower income spend more time in pain, or are they more likely to report pain?
I also "experience pain", and I would consider myself highly educated with decent income. Sometimes shoulder pain or eye strains from using the computer too much. But I doubt I would report them if I was surveyed. I also get tooth pain, and I take Excedrin for it.
>>> Carlos Quinonez <[log in to unmask]> 05/05/08 8:18 AM >>>
Is there any mention regarding the types of pain? I bet toothache is a good portion of this pain.
In the end, yet another way to prove that poverty is a significantly limiting factor to living a productive life.
CQ
On 5-May-08, at 10:54 AM, Zakaria Pezeshki wrote:
> http://www.sciencedaily.com/releases/2008/05/080502081604.htm
>
> Mohammad Zakaria Pezeshki, M.D., M.P.H.
> Socio_somatic Medicine Program
> Department of Community Medicine
> Tabriz Medical School, Tabriz, Iran
> Tel: ++98 411 336 46 73
> Fax: ++98 411 336 46 68
>
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