Pain vs. Suffering
June 14, 2019 / Reid M. Jacobs, APHSW-C, MSW
Not everyone with pain suffers and not all those who suffer have pain. That sounds wrong, doesn’t it? The nature of pain and suffering seem almost identical, and the terms are often used interchangeably. However, there are some important distinctions between the two.
Pain has many aspects beyond the physical sensation, all of which can contribute to a sense of suffering. Pain is typically defined as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (International Association for the Study of Pain). In palliative and hospice care we often focus on total pain which is the suffering that encompasses all of a person’s physical, psychological, social, spiritual, and practical struggles.
Still, suffering isn’t a universal experience for pain. Suffering is a subjective experience that is unique to the individual and can change over time. Several factors like culture, religion, and personal beliefs, can change a person’s response to and perception of pain.
Pain can also take on meaning. For example, a person with cancer may experience severe pain from the tumor or the cancer treatments. Feeling the pain from cancer can make someone think that a tumor is growing and the cancer advancing. Someone else may feel the same pain, but take it as a sign that the treatment is working. It’s a signal that their body is fighting, and the cancer is dying. These two different experiences of pain greatly influence the perception of suffering that the person experiences.
For some people, pain becomes a religious experience. They may see the pain as atonement for sins or wrongdoings earlier in their life. For others, it becomes a closer connection to God. One of my clients explained, “my Jesus suffered. Am I any better than Him that I shouldn’t suffer?” She did use the term suffer, but her experience transcended the suffering. She recounted the suffering inflicted on Christ in the days leading up to and including crucifixion. Through her suffering, she felt closer to God and could better appreciate the sacrifice Christ made.
So, do we let people stay in pain if they aren’t suffering? Well, this gets to the heart of the palliative and hospice philosophy. Our goal is to take a patient-centered approach to manage pain, symptoms, and improve quality of life. This means that we look to the patient to understand their priorities. Most people want pain relief. For these patients, we work hard to get rid of the pain, and we’re good at doing that.
If someone does not want to treat the pain, however, we will focus on other ways to support them. This may include emotional and spiritual support to help them make sense of the pain, address suffering, and cope with their situation. We may seek to understand why the person doesn’t want to treat the pain, to ensure they aren’t being coerced into refusing pain medications or misunderstanding the treatment options.
Still, there are some patients who want pain control, but want to avoid using opioid medications. We have good alternatives for these situations too, such as mindfulness meditation, guided imagery, music therapy and other complementary therapies.
The focus of palliative and hospice care is to reduce suffering and improve quality of life. One way we do this is by relieving pain, but it’s not the only way. We tailor our interventions to each person, their unique needs, and their goals. We will champion our patients’ decisions for pain management and all aspects of care. And if they change their mind, we will support them with that as well.