The word suffering is sometimes used in the strict sense of physical pain, but more often it refers to psychological pain, or more often it refers to pain in a broad sense, that is, to any unpleasant feeling, emotion, or sensation. Pain is an overwhelming, all-consuming experience, and even pain of low or moderate intensity can cause extreme suffering because it interferes with daily life and personal relationships or makes the patient wonder why that pain and suffering are deserved. Pain can be described in neurological terms, but cognitive awareness, interpretation and behavioral provisions, as well as cultural and educational factors, have a decisive influence on the perception of pain. It is proposed to define suffering as an unpleasant or even distressing experience, which seriously affects a person at a psychophysical and existential level.
Pain and suffering are considered unpleasant. However, the definitions provided do not include the idea that pain and suffering can attack and even destroy the self or the idea that they can expand it constructively; both perspectives can be equally useful in controlling pain and suffering, but they are not defining characteristics of the self. The inclusion of the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one's attachment to the world (including personal management or the cultural and social influences that shape it).An understanding of life experiences of pain and suffering is proposed, meaning that they are considered aspects of a person's life, and the self is the constantly changing sum of these (and other) experiences. When pain intensifies and becomes widespread over time, it becomes suffering.
Suffering is the repeated inability to act successfully based on pain's natural motivation to do something that heals, repairs, or improves. This article will begin by explaining the conceptions of pain and person used by classical evidence-based medicine and its Cartesian roots, followed by a critical discussion of the contributions of the humanist turn (represented by Cassell) and, finally, the phenomenological and narrative conceptions of the self and the person. Therefore, in an additional step, we summarize them in 22 “descriptors” (2 to 4) for each dimension that allow a quick understanding of the 8 dimensions and should be more useful for developing future operationalizations of pain-related suffering. Social problems such as poverty, social exclusion, forced social inclusion (such as peer pressure), forced displacement and uprooting; existential and personal problems such as pain and stress; conditions such as nausea, paraesthesia, a painless illness, anxiety or fear can also be a cause of suffering.
Instead, Baines and Norlander4 measured pain-related suffering by directly asking patients to indicate the extent of their own suffering in different areas (such as spiritual distress or concern for loved ones). We developed a systematic procedure to manually extract and analyze the data from the selected articles, with the objective of identifying the aspects and dimensions that define the different conceptualizations of suffering related to pain. However, this time, we used the verbatim quotes and the keywords that were extracted to answer another conceptual question from our data extraction form (“What dimensions or types of suffering are different? ). Medicine can pay more attention to the above-mentioned subjective and symbolic dimensions of suffering and pain, and doctors can be trained to be more empathetic to sick people and more sensitive to their real needs.
In the second step, a manual and systematic extraction of verbatim citation data was carried out with information relevant to the conceptualization of pain-related suffering. (we systematically search existing literature for conceptualizations of pain-related suffering), (we use manual qualitative research methods to synthesize the literature into an integrative definition and develop a multidimensional conceptual framework of pain-related suffering) and, finally (we use a machine learning approach to cross-validate both the conceptual framework and the integrative definition).However, while summaries of 58 keywords on the background and consequences of suffering provide a systematic overview of the conceptualizations of the literature and are useful for specifying in detail the dimensions of pain-related suffering, in order to create an accessible and ready-to-use framework for construction on a future scale, their level of detail is too complex.