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Taj Taher

Honors 222 C
29 April 2015
Seminar 5 Thought Piece
There is one passage from Kleinman, Brodwin, Good, and Goods Pain as Human
Experience: An Introduction that I found to be surprisingly enlightening. It reads: The patient
often experiences pain as an intrusive foreign agent: an unwelcome force producing great
physical distress as well as moral and spiritual dilemmas. Others, however, see the patient as the
agent, who somehow produces pain as a response to social and psychological conditions. This
approach implies that pain is at least partially willful, voluntary, and hence under the patients
control, (6). This passage was particularly striking because in the past few weeks that I have
been introduced to the idea of chronic pain, I have begun to perceive it as an experience
absolutely separate from any other disease. However, the notion that pain is a foreign entity in
the body is similar to when one is sick with the flu. There is an expectation of transiency: that
whatever one feels now, eventually it will be overcome and there will be a return to the norm. It
has been stated before that chronic pain reaches a point where it becomes its own disease, and
based on that fact and the passage, what I found so enlightening was that chronic pain is the
elusive and frustrating dilemma that it is because it is contradictory in nature.
Chronic pain produces in patients the experience associated with any other disease, and
yet chronic pain has no physical etiology and consequently any possible physical treatment. But
the greater contradiction of chronic pain lies in what Kleinman et al reveal in their observation:
even though we know that pain is a subjective experience that we could not hope to quantify or
understand, the patient perceives it subjectively but conceptualizes the pain as an objective
entity. This creates a major roadblock in pain management because the patient now has the
expectation that there is an objective solution to their subjective problem. This produces a

vicious example of circular reasoning in which those responsible for treatment cannot utilize the
only tools at their disposal (objective means).
This begs the question: should we even bother treating chronic pain? To answer no is
an absolutely horrific and inhumane prospect, especially for me since I consider my future role
as a primary care provider as one that establishes the highest quality of life for my future
patients. However, to what point does that goal extend? Should not our responsibilities only lie
within the scope of what we can feasibly accomplish? Isnt that inherent to the definition of
responsibility? These questions tie into an aspect of the Turk, Wilson, and Cahana analysis of the
various treatment methods available for pain management. In their conclusion, they say In the
absence of a cure, there is a need to maximize symptom relief so that patients are able to lead the
highest quality of life possible, (2233). Quality of life is an unquestionable ideal ubiquitous
throughout any discussion of chronic pain, and yet there has never been a discussion of what
these treatments would cure. How can we cure a natural experience? This notion sounds as
nonsensical as curing a patient of 20/20 vision. Pain is a natural process that works at a primal
level as a warning system. We assume that because acute pain is transient, chronic pains
longevity is an aberrance. However, what if chronic pain is natural? What if chronic pains
endurance is because it is warning the body of an issue of equal endurance? There is ample
evidence to show that those suffering from chronic pain have numerous reasons for their bodies
to be warning them of something awry or amiss in their lives (not corporeally alone). As such,
might chronic pain be a condition not appropriate to medically address? I would like to discuss
this notion in class despite its ostensibly obvious answer.