The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models

Philosophy, Ethics, and Humanities in Medicine

Egberto Ribeiro Turato³  Vera Lucia Pereira Alves¹  Daniela Dantas Lima² 

[1] Av. Julio de Mesquita 536 ap. 32 Cambuí, Campinas CEP 13025-061, SP, Brasil;Rua Presidente Bernardes 1293 ap.43 Jd. Flamboyant, Campinas CEP 13091-160, SP, Brasil;Departamento de Psicologia Médica e Psiquiatria FCM/UNICAMP, Caixa Postal 6111, CEP 13083-970 Campinas, SP, Brasil

关键词: Social environment;    Psychological stress;    Hospital out patient clinic;    Psychosomatic;    Intractable pain;   

Others  :  816377
DOI  :  10.1186/1747-5341-9-2

 received in 2012-08-30, accepted in 2013-12-13,  发布年份 2014

【 摘 要 】

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain.

【 授权许可】

   
2014 Lima et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lima M, Trad L: Lima MAG, Trad L. Dor crônica: objeto insubordinado. História, Ciências, Saúde–Manguinhos 2008, 15(1):117-133.
• [2]Traverso-Yépez M: A interface psicologia social e saúde: perspectivas e desafios. Psicologia em Estudo 2001, 6:2.
• [3]IASP: Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1979, 6(3):249-252.
• [4]Lobato O: O problema da dor. In Psicossomática hoje. Edited by Mello Filho J. Porto Alegre: Artmed; 1992:165-178.
• [5]Guimarães SS: Introdução ao estudo da dor. In Dor, um estudo mutidisciplinar. Edited by Carvalho MMMJ. São Paulo: Summus Editorial; 1999:13-30.
• [6]Wall P, Melzack R: Textbook of pain. 2nd edition. New York: Churchill Livingstone; 1989.
• [7]Bonica JJ: The managemente of pain, vol. 1, 2nd edn. Malvern: Lea & Febiger; 1990.
• [8]Melzack R: Pain: past, present and future. Can J Exp Psychol 1993, 47(4):615-629.
• [9]Teixeira MJ, Marcon EM, Rocha RO, Figueiró JAB: Epidemiologia da dor. In Dor: epidemiologia, fisiopatologia, avaliação, síndromes dolorosas e tratamento. Edited by Teixeira MJ. São Paulo: Grupo Editorial Moreira Jr; 2001:1-7.
• [10]Korff M, Dunn K: Chronic pain reconsidered. Pain 2008, 138:267-276.
• [11]Straub RO: Health psychology. 3rd edition. New York: Worth Publishers; 2012.
• [12]Lack S: Total pain. Clin Oncol 1984, 3(1):33-44.
• [13]Mcgrath PA: Pain in children: nature, assessment & treatment. New York: Guilford; 1990.
• [14]Turk DC, Melzack R: The measurement of pain and assessment of people experiencing pain. In Handbook of pain assessment. Edited by Turk DC, Melzack R. Nova York: Guilford; 1992:3-12.
• [15]Craig KD: Emotional aspects of pain. In Textbook of pain. 3rd edition. Edited by Wall PD, Melzack R. Edinburgh: Churchill Livingstone; 1994:261-274.
• [16]Apkarian AV, Baliki MN, Geha PY: Towards a theory of chronic pain. Prog Neurobiol 2009, 87(2):81-97.
• [17]IASP TFoT: Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Edited by Merskey H, Bogduk N. Seattle: IASP Press; 1994:209-214.
• [18]Chou R, Loeser JD, Owens DK, Rosenquis TRW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, et al.: Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009, 34(10):1066-1077.
• [19]Thomsen AB, Sørensen J, Sjøgren P, Eriksen J: Chronic non-malignant pain patients and health economic consequences. Eur J Pain 2002, 6:341-352.
• [20]Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM: Psychological aspects of persistent pain: current state of the science. J Pain 2004, 5(4):195-211.
• [21]Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006, 10:287-333.
• [22]Salvetti MG, Pimenta CAM: Dor crônica e a crença de auto-eficácia. Revista da Escola de Enfermagem da USP 2007, 41:135-140.
• [23]Gooberman-Hill R, Heathcote C, Reid CM, Horwood J, Beswick AD, Williams S, Ridd MJ: Professional experience guides opioid prescribing for chronic joint pain in primary care. Fam Pract 2011, 28(1):102-109.
• [24]Fine PG: Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med 2011, 12(7):996-1004.
• [25]Hackney R: The sports hernia: a cause of chronic groin pain. Br J Sports Med 1993, 27(1):58-62.
• [26]Ducic I, West J, Maxted W: Management of chronic postoperative groin pain. Ann Plast Surg 2008, 60:294-298.
• [27]Bright E, Reddy VM, Wallace D, Garcea G, Dennison AR: The incidence and success of treatment for severe chronic groin pain after open, transabdominal preperitoneal, and totally extraperitoneal hernia repair. World J Surg 2010, 34:692-696.
• [28]Cherny NI, Portenoy RK: Cancer pain: principles of assessment and syndromes. In Textbook of pain. 3rd edition. Edited by Wall DP, Melzack R. London: Churchill Livingstone; 2004:787-823.
• [29]Teixeira MJ: Síndromes dolorosas. In Dor, um estudo mutidisciplinar. Edited by Carvalho MMMJ. São Paulo: Summus Editorial; 1999:77-86.
• [30]Cousins M: Back Pain in the Workplace Management of Disability in Nonspecific Conditions Task Force Report, vol. ix. Seattle: IASP Press; 1995.
• [31]Arnstein P: The mediation of disability by self efficacy in different samples of chronic pain patients. Disabil Rehabil 2000, 22(17):794-801.
• [32]Rey R: The history of pain. Cambridge: Harvard University Press; 1998.
• [33]Hernández DPD: Una visión sucinta de la enseñanza de la medicina a lo largo de la historia: I. Desde el Antiguo Imperio Egipcio hasta el siglo XVII. Iatreia 2001, 24(1):90-96.
• [34]Gadamer H: El Estado Oculto de la Salud. Madrid: Editorial Gedisa; 2001.
• [35]Cataldo Neto A, Antonello I, Lopes MHI: O estudante de medicina e o paciente: uma aproximação à prática médica. 2nd edition. Poto Alegre: EDPUCRS; 2007.
• [36]Bonica JJ: History of pain concepts and pain therapy. Mt Sinai J Med 1991, 58(3):191-202.
• [37]Gimenes MGG: Definição, foco de estudo e intervenção. In Introdução à psiconcologia. Edited by Carvalho MMMJ. Campinas: Livro Pleno; 2003:35-56.
• [38]Gordon R: The Alarming History of Medicine. New York: St. Matin’s Griffin; 2002.
• [39]Miceli AVP: Dor crônica e subjetividade em oncologia. Revista Brasileira de Cancerologia 2002, 48(3):363-373.
• [40]Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977, 196:129-136.
• [41]Leventhal H: Behavioral medicine: psychology in health care. In Handbook of health, health care and the health care professions. Edited by Mechanic D. New York: The Free Press; 1983:709-743.
• [42]Sarafino EP: Health psychology: biopsychosocial interaction. 6th edition. New York: John Wiley & Sons; 2008.
• [43]Scheper-Hughes N, Lock M: The mindful body: a prolegomenon to future work in medical anthropology. Med Anthropol Q 1987, 1(1):6-41.
• [44]Hoyos M, Ochoa D, Londoño C: Revisión crítica del concepto psicosomático a la luz del dualismo mente-cuerpo. Pensam psicol 2008, 10(4):137-147.
• [45]Descartes R: A discourse on the method of correctly conducting one’s reason and seeking truth in the sciences. Oxford: Oxford University Press; 2008.
• [46]Schwartz M, Wiggins O: Psychosomatic medicine and the philosophy of life. Philos Ethics Humanit Med 2010, 5(1):2. BioMed Central Full Text
• [47]Leder D: The tale of two bodies: the cartesian corpse and the lived body. In The body in medical thought and practice. Edited by Leder D. Dordrecht: Kluwer Academic Publishers; 1992:17-35.
• [48]Novy D, Nelson D, Francis D, Turk D: Perspectives of chronic pain: an evaluative comparison of restrictive and comprehensive models. Psychol Bull 1995, 118(2):238-247.
• [49]Melzack R, Wall DP: Pain mechanisms: a new theory. Science 1965, 150:971-979.
• [50]Melzack R, Wall DP: The challenge of pain. 2nd edition. London: Penguin; 1991.
• [51]Turk DC, Okifuji A, Scharff L: Chronic pain and depression–role of perceived impact and perceived control in different age cohorts. Pain 1995, 61:93-101.
• [52]Campos T: Psicologia Hospitalar. A atuação do psicólogo em hospitais gerais. São Paulo: EPU; 1995.
• [53]Capitao C, Carvalho E: Psicossomática: duas abordagens de um mesmo problema. Psic 2006, 7(2):21-29.
• [54]Aisenstein M: Beyond the dualism of psyche and soma. J Am Acad Psychoanal Dyn Psychiatr 2008, 36(1):103-123.
• [55]Lyketsos CG, Huyse FJ, Glitin DF, Levenson JL: Psychosomatic medicine: a new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine. Eur J Psychiat 2006, 20(3):165-171.
• [56]Perestrello DA: Medicina da Pessoa. Rio de Janeiro e São Paulo: Livraria Atheneu; 1989.
• [57]Alexander F: Psychosomatic Medicine: Its Principles and Applications. 2nd edition. New York: Norton; 1987.
• [58]Turato ER: Tratado da metodologia da pesquisa clínico-qualitativa. 3rd edition. Petrópolis: Editora Vozes; 2008.
• [59]Kelly D: Somatic sensory system IV: Central representations of pain and analgesia. In Principles of Neural Science. Edited by Schwartz ERKJH. New York: Elsevier; 1981:199-204.
• [60]Harding G, Campbell J, Parsons S, Rahman A, Underwood M: British pain clinic practitioners’ recognition and use of the bio-psychosocial pain management model for patients when physical interventions are ineffective or inappropriate: results of a qualitative study. BMC Musculoskelet Disord 2010, 18(11):51.
• [61]Pereira MG: A perspectiva biopsicossocial na avaliação em psicologia da saúde: modelo interdependente. Psicologia, Teoria, Investigação e Prática 2002, 7(2):183-191.
• [62]Murray M, Chamberlain K: Health psychology and qualitative research. In Qualitative Health Psychology Theories & Methods. Edited by Chamberlain MMK. London: Sage; 1999:3-15.
• [63]Stam H: Theorizing health and illness: functionalism, subjectivity and reflexivity. J Health Psychol 2000, 5(3):273-283.
• [64]Brentano F: Psychology from an Empirical Standpoint. London: Routledge; 1973.
• [65]Dartigues A: Qu’est-ce que la phenomenologie?. Toulouse: Privat; 1972.
• [66]Moreira V: Fundamentos filosóficos das psicoterapias de base humanista. Revista de Psicologia Fortaleza 11, 12(1,2):111-123. 1993/94
• [67]Moreira V: Más allá de la Persona: Hacia uma Psicoterapia Fenomenológica Mundana. Santiago de Chile: Editoral Universidad de Santiago; 2001.
• [68]Merleau-Ponty M: Fenomenologia da percepção. 3rd edition. São Paulo: Martins Fontes; 2006.
• [69]Leder D: The dys-appearing body. In The absent body. Edited by Leder D. Chicago: The University of Chicago Press; 1990:69-99.
• [70]Baron R: An introduction to medical phenomenology: I can’t hear you while I’m listening. Ann Intern Med 1985, 103:606-611.
• [71]Madjar I: The lived experience of pain in the contexto of clinical practice. In Handbook of phenomenology and medicine. Edited by Toombs S. Dordrecht: Kluwer Academic Publishers; 2011:263-277.
• [72]Toombs S: Handbook of phenomenology and medicine. Dordrecht: Kluwer Academic Publishers; 2001.
• [73]Svenaeus F: Naturalistic and phenomenological theories of health: distinctions and connections. R Inst Philos Suppl 2013, 72:221-238.
• [74]Lima M, Trad L: A dor crônica sob o olhar médico: modelo biomédico e prática clínica. Cad Saude Publica 2007, 23(11):2672-2680.
• [75]Wall P: Pain: the science of suffering. London: Weidenfeld & Nicolson; 1999.
• [76]Scarry E: The body in pain. New York: Oxford University Press; 1985.