What Does Pain Hurt?

Anxiety and Chronic Pain Opioids in Cancer Pain Coping with Pain “Thank you for giving me my life back.” Through frustration and failure, the promise of hearing these words sustains those who treat pain sufferers. The first time I heard them I felt great pride. With time, however, I came to understand that my efforts and my patients’ gratitude were manifestations of a much larger process. This issue of Pain: Clinical Updates examines that bigger process and attempts to tie together some threads from my 15-year stewardship of this newsletter. As a valedictory reflection by its founding editor, it focuses upon the unique role that moral education—particularly through low-tech, social means such as conversation and personal example—plays in sustaining the “pain community” of researchers and clinicians, and the value of Pain: Clinical Updates in this enterprise. Concern for pain relief reflects human instincts for fairness and empathy in the face of suffering. Pain research, education, and care are therefore intertwined with attitudes and ethics to a degree nearly unique among biomedical fields. Given pain’s moral dimension, pain-related educational tools that merely convey factual information often fall flat. Such resources— culminating in quantitative distillations of clinical evidence—typically fail to engage health care providers. We are now just beginning to understand the mechanisms through which social and cultural influences shape unconscious perceptions and attitudes toward people in pain. Interactions based upon shared narrative, dialogue, tutoring, and admiration have great persuasive power.