Introduction

Pain is a major reason we seek healthcare. This may be the pain of a broken bone, the pain of a heart attack, the joy-filled pain of labor, or even the pain of appendicitis. Pain from events such as these and numerous others force us into the health care system asking for assistance. Back pain is the number two reason to miss work in the U.S., second only to a “cold.”

The International Association for the Study of Pain has defined “pain” as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”  This definition reflects that pain is a result of tissue damage as when the skin is lacerated or a bone is broken. The definition also indicates that pain may be the result of an unpleasant emotional experience in the absence of tissue damage. We all know this to be true as we find ourselves tolerating injury differently depending on our emotional well- being. If we are feeling well, the pain of a sprained ankle is far more tolerable, less painful, than a sprained ankle occurring at the funeral of one’s parent. The key concept to understand when discussing or considering the topic of pain is imprecision. There is no objective way anyone can assess the magnitude of someone else’s suffering.

Different cultures, different genders tolerate and accept pain differently and will manifest pain differently. There is no device that allows a third party to assess the magnitude of pain of an individual. This is readily apparent to parents who try to guess whether their infant is crying because of pain, hunger, or a wet diaper. The manifestation of all three is the same. Some manifest pain as facial grimacing, descriptive words; while others withdraw, say nothing, or isolate themselves. No one can say the pain of one is greater than the suffering of the other.

Pain as a term—as a concept—is imprecise and methods of assessing pain are imprecise as well. Presently, health care workers gauge pain by a verbal pain score, ranging from zero (no pain) to 10 (worst possible pain imaginable). However, this numeric scale is not exact enough to enable relating similar type of pain in different individuals. Pain as a term and the tools to assess its magnitude are imprecise.