Conceptualizing suffering and pain

BACKGROUND This article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them (the mind-body dichotomy, Cassel's idea of persons as "intact beings") are critically discussed with such purpose. METHODS A philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are found as better definitions of suffering and pain. RESULTS Pain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one's own attachment to the world (including personal management, or the cultural and social influences which shape it). An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person's life, and the self is the ever-changing sum of these (and other) experiences. CONCLUSIONS The provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain.