06 Dec

Pain: A Sociological Introduction

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Whenever I mention that I have written a book on the sociology of pain the most common reaction is “What is the connection between sociology and pain?” This was also the initial reaction of many students whom I taught on pain management programmes and courses, which was one of the reasons that I decided that a book that views pain through a sociological lens was timely. People tend to be familiar with biomedical and maybe also psychological explanations of pain, but do not immediately see the relevance of sociology. The aim of the book is to deconstruct the supposed objectivity of the dominant medical model of pain, and to use existing sociological literature to give voice to those who experience pain and who use the health and care services available to manage it. The role of sociology is to explore and challenge dominant ways of seeing the world and to unpack ideas that we trend to take for granted, which makes it a useful discipline for a concept such as pain, one of the most pressing public health issues of the twenty first century.

In my research on women’s experience of endometriosis over the past 15 years I have heard at first hand the problems faced by people living with a painful condition, and the ways in which they live with it. What struck me then, and continues to do so, is how similar many stories are, but paradoxically also how diverse. There were many common themes running through my research, and also through the wider pain literature, which provide the structure for my book and inform the arguments I make in advocating a sociological analysis of pain. This I contend is as valuable as the more usually encountered biomedical and psychological models.

Much pain is experienced as short lived, and self-limiting or easily treated, but for those individuals who live with long term and intractable pain it can cause disruption of life as it is currently lived and alter their expectations of the future. This disruption may well extend to wider family and significant others. Although pain is a private experience, no one can truly know the extent of another’s pain, structural factors such as age, gender, and educational attainment all impact on the way pain is experienced, and on encounters with the health professionals who manage it. Sociological research has, for example, shown how men and women approach and experience pain differently, seeking to explain why women more than men report more long term and disabling pain than men. A strength of a sociological understanding of pain is that it encompasses both the interpretive perspective of the person in pain and the structural factors that influence this, offering an explanation of the way that these intersect.

One way in which this is manifest is in an exploration of contested illness or unexplained pain. For patients, their significant others and health professionals a diagnosis provides entry into the sick role, and an acknowledgment that pain is genuine. For individuals without this acknowledgment being believed becomes difficult, and many describe their struggle to gain acceptance that their pain is genuine. Although some people will disengage with mainstream health services and look for alternative explanations and remedies for their pain, in most instances people do not reject the biomedical model but rather attempt to live up to its expectations. They work at being seen as credible in order to gain legitimation of their pain. One reason that pain is disbelieved is that it may be commonly experienced short term in the wider population, and there is suspicion when for some people it becomes long term and disabling. So, for example back pain is a common and usually self-limiting complaint, and those whose back pain is so debilitating that it causes time off work and multiple GP or hospital visits frequently find themselves accused of malingering or hypochondria.

So in this book I tease out these and other issues using sociological themes and concepts to gain insight and make sense of the complex and nuanced world of pain.

Elaine Denny is Emeritus Professor of Health Sociology at Birmingham City University. She is co-editor of Sociology for Nurses (Polity, 2016), now in its third edition. Her new book, Pain: A Sociological Introduction, is the latest addition to the Key Themes in Health and Social Care series and is now available from Polity.