Chronic Pain and Time – A Theoretical Analysis

Abstract

Background

When theoretically discussing pain, the distinction between acute and chronic pain is not always taken into consideration. By contrast, informed by the pain medicine distinction between acute and chronic pain, the present theoretical paper analyses the phenomena of chronicity and chronification in the pain setting.

Methods

Philosopher Fredrik Svenaeus and his paper The phenomenology of chronic pain: embodiment and alienation (Continental Philosophy Review 2015;48:107–122) is used as a dialogue partner.

Results

Three aspects, relevant for clinicians, are discussed: (1) the distinction between emotion and mood, arguing that the process of chronification entails pain evolving from the former to the latter; (2) chronification as a process in which the pain patient becomes aware of his/her temporality, both the past and the future coming to the fore (as opposed to severe acute pain in which only the present counts, ie, getting rid of the pain now); (3) the acquisition of a pain-related narrative identity, interdisciplinary pain rehabilitation programs being described as helping patients regain a narrative identity that is not dominated by pain or by a fruitless chase after pain relief.

Conclusion

Chronic pain reminds us of our temporality and of the narrative character of our lives.

Plain Language Summary

It is important to distinguish acute pain from chronic pain. When pain is discussed by philosophers of medicine, this distinction is not always made. In the present paper, the phenomenon of chronic pain is analysed. It is argued that chronic pain reminds us of the fact that human beings are subject to time and that our lives can be viewed as a story unfolding in time. When pain persists, both past and future come to the fore. This contrasts with severe acute pain in which only the present counts, ie, getting rid of the pain now. This has practical and clinical implications, and it is argued that one of the potential benefits of interdisciplinary pain rehabilitation programs is to help patients reclaim the story of their lives from the dominion of pain and a fruitless chase after pain relief.

Keywords:

• chronic
• chronification
• narrative
• pain
• temporality
• time

Acknowledgments

I would like to thank Professor Kristin Zeiler, director of the Centre for Medical Humanities and Bioethics (CMHB) at Linköping university, for valuable comments on an earlier version of the manuscript. Thanks also to the participants of a seminar at CMHB where the views expressed in this paper were discussed. Among other things, the participants rightly commented that the importance of context in the experience of pain is underdeveloped in this text. I do agree about the importance of context. As aptly expressed by historian Joanna Bourke, “the body is never pure soma”.²⁵ I acknowledge that I am writing as a Scandinavian academic in 2023 (hence situated in that particular context), and the influence of different sociocultural, historical, and religious views on the interpretation of temporality in the chronic pain setting would indeed be an interesting area to explore. However, such a discussion falls outside the scope of the present paper.

Disclosure

The author declares that there is no conflict of interest.

Additional information

Funding

ALF Research Grants, Region Östergötland. NEURO Sweden.