Pain

Indispensable and elusive, pain marks the limit of medicine’s semiotic capacities. At this limit, where access to another’s experience is most desirable and most difficult, the discursiveness of caring for suffering becomes inescapably manifest. Health care’s struggle with the representation of pain emerges clearly in a recent definitional shift by the International Association for the Study of Pain (IASP; medical- and US-based) from “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” to an “experience associated with, or resembling that associated with… tissue damage.” This change eliminates the activity of description. The amendment is well intentioned, stemming from a fear that the original might be “interpreted as excluding infants, elderly people, and others—even animals—who could not verbally articulate their pain” (IASP 2017). But without representation, the definition is circular: we associate pain with tissue damage, and pain both is and resembles experience associated with tissue damage. The passive voice shuts down communicability further. (Who is “we”? Those in pain? Those who define, evaluate, or manage it?) In their concern about those whose pain may not find the right words (we might add those whose language the clinician doesn’t understand or those who are ignored or demented or sedated), the IASP does away with communicability. For description is not necessarily verbal and articulate. Pain may be (descriptively) enacted without words; to reach beyond the self, we can describe our pain with screams, grimaces, curses, as well as precise histological metaphors.