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Quick Takes

There’s a code for pain, but what’s the code for suffering?

(A piece I wrote for KevinMD 3 years ago)

Hans Duvefelt, MD

Sep 11, 2023

Opiates relieve pain and can transport people to their apparent happy place. So does marijuana. Lyrica, the seizure-turned-pain medication, caused enough of a buzz in early study participants that it became a controlled substance. The anesthetic ketamine is now used for treatment-resistant depression. So there is an example of anesthesia relieving not only pain, but also suffering.

Years ago, we had to be very specific about the location and classification of our patients’ pain. When pain then became a self-reported vital sign and chronic opioid therapy seemed legitimate for a number of years, it seemed more or less irrelevant where or why people hurt.

Now the only classification of pain in some areas, for example, on prescriptions, is whether it is acute or chronic, while on the other hand, our understanding of its underlying mechanisms is continuing to evolve. I guess this is not the only area of medicine where two opposite forces coexist: Differentiation and individualization on the one hand and unifying theories of disease mechanisms on the other.

The inevitably obvious question must then be what the difference really is between pain and suffering, neurologically, and biochemically.