The Negotiation of Pain and Suffering

Diminished advocacy for people with pain exists for several reasons, including debate, frustration, lack of trust, and fear of regulatory scrutiny. Since 2000, priorities have shifted with respect to whether there are differences in patients with cancer-related pain and those with noncancerous-related pain, with some being deemed worthy of maintaining access to opioid analgesics and others not. Much of the advocacy for pain management in people with cancer-related pain set the stage for designating pain as the 5th vital sign in 2000. There was a sense that “pain is pain,” regardless of the underlying pathophysiology. At the time, there was a groundswell of support for improved pain treatment regardless of its cause. That changed with the ensuing overdose epidemic. As the previous chapter mentioned, there is often a lack of consensus with respect to the definition of pain. Despite the fact that pain and suffering are often referred to together, there may even be a greater lack of agreement on the definition of suffering. This chapter will explore the relationship between pain and suffering, and how negotiation of pain and suffering has the potential to significantly impact a person’s quality of life regardless of whether it is cancer or noncancer-related pain. Additionally, this chapter will differentiate between the biomedical and biopsychosocial approaches to managing pain with the intention of clarifying their relationship and appropriateness for caring for people with acute or chronic pain.