When, How, and Why Did “Pain” Become Subjective?
Beecher, Operationalization, and Its Problems
DOI:
https://doi.org/10.5195/pom.2023.146Keywords:
pain-assessment, subjectivity of pain, operationalization, Henry BeecherAbstract
The pain-assessment literature often claims that pain is subjective. However, the meaning and implications of this claim are left to the reader’s imagination. This paper attempts to make sense of the claim and its problems from the history and philosophy of science perspective. It examines the work of Henry Beecher, the first person to operationalize “pain” in terms of subjective measurements. First, I reconstruct Beecher’s operationalization of “pain.” Next, I argue this operationalization fails. Third, I salvage Beecher’s insights by repositioning them in an intersubjective account. Finally, I connect these insights to current pain-assessment approaches, showing that they enrich each other.References
Abdelhady, Ahmed, Rawan Alshahrani , Rawabi Asaheimi, Amani Alamrani, Mohammed Alqahtani, Abdulelah Asiri, Yousef Alharthi, et al. 2021. “Review: Clinical Pain Assessment Scoring Systems and Practice Essentials in Acute and Chronic Pain. Journal of Healthcare Sciences 1, no. 3: 50–56. http://dx.doi.org/10.52533/JOHS.2021.1107.
Asad, Talal. 2003. Formations of the Secular: Christianity, Islam and Modernity. Redwood City: Stanford University Press.
Ayer, Alfred Jules. 1952. Language, Truth, and Logic. New York: Dover Publications.
Bain, David. 2017. “Evaluativist Accounts of Pain’s Unpleasantness.” In The Routledge Handbook of Philosophy of Pain, edited by Jennifer Corns, 40–49. New York: Routledge.
Ball, C. and R.N. Westhorpe. 2011. “The History of Pain Measurement.: Anesthesia and Intensive Care 39, no. 4: 529. https://doi.org/10.1177/0310057x1103900401.
Beecher, Henry K. 1945. “Anesthesia for Men Wounded in Battle.” Annals of Surgery 122, no. 5: 807–819. https://doi.org/10.1097%2F00000658-194511000-00004.
———. 1948. “Pain in Men Wounded in Battle.” Annals of Surgery 123, no. 1: 96–105. https://doi.org/10.1097/00000658-194601000-00008.
———. 1952. “Experimental Pharmacology and the Measurement of the Subjective Response.” Science 116, no. 3007: 157–162. https://doi.org/10.1126/science.116.3007.157.
———. 1956a. “Limiting Factors in Experimental Pain.” Journal of Chronic Diseases 4, no. 1: 11–21. https://doi.org/10.1016/0021-9681(56)90004-2.
———. 1956b. “The Subjective Response and Reaction to Sensation: The Reaction Phase as the Effective Site for Drug Action.” American Journal of Medicine 20, no. 1: 107–113. https://doi.org/10.1016/0002-9343(56)90178-4.
———. 1957. “The Measurement of Pain: Prototype for the Quantitative Study of Subjective Responses.” Pharmacological Reviews 9, no. 1: 59–209. https://pubmed.ncbi.nlm.nih.gov/13431416/.
———. 1959a. “Generalization from Pain of Various Types and Diverse Origins.” Science 130, no. 3370: 267–268. https://doi.org/10.1126/science.130.3370.267.
———. 1959b. Measurement of Subjective Responses: Quantitative Effects of Drugs. Oxford: Oxford University Press.
———. 1961. “Surgery as a Placebo: A Quantitative Study of Bias.” Journal of the American Medical Association 176, no. 13: 1102–1107. https://doi.org/10.1001/jama.1961.63040260007008.
———. 1962. “The Bengue Memorial Award Lecture, 1961: Nonspecific Forces Surrounding Disease and the Treatment of Disease.” Journal of the Royal Institute of Public Health and Hygiene 25, no. 1: 147–152. https://pubmed.ncbi.nlm.nih.gov/13866496/.
———. 1963. “Pain.” Surgical Clinics of North America 43, no. 1: 609–618. https://doi.org/10.1016/s0039-6109(16)36979-1.
———. 1966. “Pain: One Mystery Solved.” Science 151, no. 3712: 840–841. https://doi.org/10.1126/science.151.3712.840.
———. 1969. “Anxiety and Pain.” Journal of the American Medical Association 209, no. 7: 1080. https://doi.org/10.1001/jama.1969.03160200044014.
Blackburn, Lisa M., Kathy Burns, Elizabeth DiGiannantoni, Karen Meade, Colleen O’Leary, and Rita Stiles. 2018. “Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients with Cancer.” Clinical Journal of Oncology Nursing 22, no. 6: 643–648. https://doi.org/10.1188/18.cjon.643-648.
Brandom, Robert B. 2019. A Spirit of Trust: A Reading of Hegel’s Phenomenology. Harvard: Belknap Press.
Bridgman, Percy Williams. 1927. The Logic of Modern Physics. New York: Macmillan.
Carnap, Rudolf. 1936. “Testability and Meaning.” Philosophy of Science 3, no. 4: 419–471. https://doi.org/10.1086/286432.
———. 1959. “Psychology in a Physical Language.” Logical Positivism edited by A.J. Ayer, 165–198. New York: The Free Press.
Cartwright, Nancy. 1983. How the Laws of Physics Lie. Oxford: Clarendon Press.
Cavell, Stanley. 1979. The Claim of Reason: Wittgenstein, Skepticism, Morality and Tragedy. Oxford: Oxford University Press.
———. 2002. Must We Mean What We Say? Cambridge: Cambridge University Press.
Chang, Hasok. 2007. Inventing Temperature: Measurement and Scientific Progress. Oxford: Oxford University Press.
Cowan, Marjorie Kelly and Heidi Smith. 2022. Microbiology Fundamentals: A Clinical Approach. 4th edition. New York: McGraw Hill.
Dewey, John. 1896. “The Reflex Arc Concept in Psychology.” Psychology Review 3, no. 4: 357–370. https://psycnet.apa.org/doi/10.1037/h0070405.
Dreyfus, Hubert. 1991. Being-in-the-World: A Commentary on Heidegger’s Being and Time, Division I. Cambridge: MIT Press.
Dunkley, Cara R., Craig D. Henshaw, Saira K. Henshaw, and Lori A. Brotto. 2020. “Physical Pain as Pleasure: A Theoretical Perspective.” Journal of Sex Research 57, no. 4: 421–437. https://doi.org/10.1080/00224499.2019.1605328.
Dutton, Donald G. and Arthur P. Aron. 1974. “Some Evidence for Heightened Sexual Attraction under Conditions of High Anxiety.” Journal of Personality and Social Psychology 30, no. 4: 510–517. http://dx.doi.org/10.1037/h0037031.
Edemekong, Peter F., Deb L. Bomgaars, Sukesh Sukumaran, and Caroline Schoo. 2022. “Activities of Daily Living (ADLs).” National Library of Medicine. Florida: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470404/.
Foucault, Michel. 1973. The Birth of the Clinic: An Archeology of Medical Perception. New York: Vintage Press.
Fricker, Miranda. 2007. Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford
University Press.
Glucklich, Ariel. 2017. “Sacred Pain: The Use of Self-inflicted Pain in Religion.” In The Routledge Handbook of Philosophy of Pain, edited by Jennifer Corns, 279–287. New York: Routledge.
Goldberg, Daniel S. 2017. The Bioethics of Pain Management: Beyond Opioids. New York: Routledge.
Hardy, James D. 1956. “The Nature of Pain.” Journal of Chronic Diseases 4, no. 1: 22–51. https://doi.org/10.1016/0021-9681(56)90005-4.
Hegel, G.W.F. 1977. Phenomenology of Spirit. Oxford: Oxford University Press.
Heidegger, Martin. 1962. Being and Time. New York: Harper and Row.
Horwich, Paul. 2012. Wittgenstein’s Metaphilosophy. Oxford: Oxford University Press.
IASP (International Association for the Study of Pain). 2011. Classification of Chronic Pain. 2nd revised edition. https://www.iasp-pain.org/publications/free-ebooks/classification-of-chronic-pain-second-edition-revised/.
Katz, Joel and Ronald Melzack. 1999. “Measurement of Pain.” Surgical Clinics of North America 79, no. 2: 231–252. https://doi.org/10.1016/s0039-6109(05)70381-9.
Kuhn, Thomas. 2012. The Structure of Scientific Revolutions. Chicago: University of Chicago Press.
McCaffery, Margo. 1968. Nursing Practice Theories Related to Cognition, Bodily Pain, and Man-
Environment Interactions. Los Angeles: University of California Press.
———. 1997. Pain: Clinical Manual. 2nd edition. New York: Mosby.
McCaffery, Margo and Christine L. Pasero. 1997. “Pain Ratings: The Fifth Vital Sign.” American Journal of Nursing 97, no. 2: 15–16. https://doi.org/10.1097/00000446-199702000-00010.
McDowell, John. 1998. Mind, Value, and Reality. Cambridge: Harvard University Press.
McPeek, Bucknam. 2007. “Pain and Subjective Responses.” International Anesthesiology Clinics 45, no. 4: 25–33. https://doi.org/10.1097/aia.0b013e318142c8bc.
Meghani, Salimah H., Eeeseung Byun, and Rollin M. Gallagher. 2012. “Time to Take Stock: A Meta-analysis and Systematic Review of Analgesic Discrepancies for Pain in the United States.” Pain Medicine 13, no. 2: 150–174. https://doi.org/10.1111/j.1526-4637.2011.01310.x.
Noble, Bill, David Clark, Marcia Meldrum, Henk ten Have, Jane Seymour, Michelle Winslow, and Silvia Paz. 2005. “The Measurement of Pain, 1945–2000.” Journal of Pain and Symptom Management 29, no. 1: 14–21. https://doi.org/10.1016/j.jpainsymman.2004.08.007.
Olatoye, Oludare O. 2019. “The Dreaded Pain-Scale.” Mayoclinic.org, 26 June. https://connect.mayoclinic.org/blog/adult-pain-medicine/newsfeed-post/what-to-expect-at-my-pain-medicine-appointment/.
Pain Management Task Force. 2010. Final Report. Office of the Army Surgeon General. https://www.dvcipm.org/site/assets/files/1070/pain-task-force-final-report-may-2010.pdf.
Putnam, H. 1963. “Brains and Behavior.” In Analytical Philosophy: Second Series, edited by Ronald Butler, 25–36. New York: Blackwell.
Rieder, Travis. 2019. In Pain: A Bioethicist’s Personal Struggle with Opioids. New York: Harper.
Scarry, Elaine. 1985. The Body in Pain: The Making and Unmaking of the World. Oxford: Oxford University Press.
Schiavenato, Martin and Kenneth D. Craig. 2010. “Pain Assessment as a Social Transaction: Beyond the ‘Gold Standard’.” Clinical Pain Journal 26, no. 8: 667–676. https://doi.org/10.1097/AJP.0b013e3181e72507.
Schiffer, Stephen. 2003. The Things We Mean. Oxford: Clarendon Press. https://doi.org/10.1093/0199257760.001.0001.
Sellars, Wilfrid. 1997. Empiricism and the Philosophy of Mind. Cambridge: Harvard University Press.
Stevens, Stanley. 1957. “On the Psychophysical Law.” Psychological Review 64, no. 3: 153–181. https://doi.org/10.1037/h0046162.
Taylor, Charles. 1971. “Interpretation and the Science of Man.” Review of Metaphysics 25, no. 1: 3–51. http://www.jstor.org/stable/20125928.
Tomasello, Michael. 2019. Becoming Human: A Theory of Ontogeny. Cambridge: Belknap Press.
Voepel-Lewis, Terri, Ronald J. Piscotty Jr., Ann Annis, and Bea Kalisch. 2012. “Empirical Review Supporting the Application of ‘Pain Assessment as a Social Transition’ Model in Pediatrics.” Journal of Pain and Symptom Management 44, no. 3: 446–457. https://doi.org/10.1016/j.jpainsymman.2011.09.005.
Wittgenstein, Ludwig. 2009. Philosophical Investigations. Oxford: Wiley-Blackwell.
Wright, Andrew. 2017. “An Introduction to the IASP’s Definition of Pain.” In The Routledge Handbook of Philosophy of Pain, edited by Jennifer Corns, 367–377. New York: Routledge.
Zanotti Joan M. 2018. “Handle with Care: Caring for Children with Autism Spectrum Disorder in the ED.” Nursing 48, no. 2: 50–55. https://doi.org/10.1097/01.nurse.0000529808.13784.bc.
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