The word, pain, is derived from a Greek word, poine’ (ποινή), which means penalty. The Latin, poena, means punishment. While these concepts may have had value in the past, I’ve gleaned a better definition from a variety of sources. It seems well suited to describe what we mean by “pain” in today’s world.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain motivates us to withdraw from damaging or potentially damaging situations.

Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or pathology.While we all have a good sense about what pain is in our life, we would be hard pressed to describe it accurately to another person.

Over the years, health workers have attempted to create an objective pain scale, something that would inform them about the level of pain their patients were experiencing. I presume that another part of their agenda was to establish objective criteria for treating pain. For example, a pain level of “X” would be treated with “drug Y” in a specific dose. While valiant, all of these efforts have failed at accurately describing exactly how much pain a person was experiencing. The best they have been able to do is to establish whether a particular person was experiencing more or less pain than they were experiencing the last time they were checked.

The sensation of pain is physical and emotional – and it is highly subjective. These elements mingle in varying amounts. For example, think of a person who is working alone and smashes his thumb with a hammer. After the initial expletive, he might grimace, but is not likely to continue screaming about the injury. What if, however, he’s hammering at home and his wife is nearby? After smashing the thumb and the initial expletive, it would not be unusual for the man to stretch out the response to the pain. Part of the pain relief can come from the attention paid by the nearby spouse – “Oh you poor dear, etc.” In these cases, the response to pain can be influenced by the desire for emotional solace.

This same subjectivity comes into play during the interaction between a person with pain and someone who is trying to determine just how much pain is present. I’m sure you can arrive at dozens of examples where an identical painful stimulus can elicit different reports of intensity in different people – and even in the same person at different time (and different circumstances).

Regardless of advances in technology, the objective measurement of pain will continue to elude us. The best we can do is to evaluate relative levels of pain in an individual – “compare your pain today with how it felt yesterday”, for example.

We’re back to subjectivity again.

This means that pain treatment must be provided to people on an individual basis with a goal of relieving the level of pain that individual is experiencing. Since there will probably never be a clear, objective measure for pain, how is a health provider supposed to understand her patient’s needs and prescribe treatments that offer complete relief? (Yes, complete relief is possible.) The only answer is to “ask the patient” and act accordingly.

This requires honesty and trust – two important elements that are becoming ever rarer in today’s health care environments. Doctors must believe their patients and patients must trust that their doctor will offer them the correct treatment to treat their pain in a manner that meets their personal needs. No legitimate caregiver should ever say that his or her patient should learn to live with the pain because there isn’t anything else that can be done. There is always something more – and all of the objections to adequate pain relief have been met and debunked.

The only way I can know how much pain you have is to ask you.

SUBJECTIVITY: judgment based on individual personal impressions and feelings and opinions rather than external facts.

OBJECTIVITY: judgment based on observable phenomena and uninfluenced by emotions or personal prejudices