At the edge of being: the aporia of pain

Despite the enlightening advances in conceptualising pain and the humanitarian responses of many health practitioners working in this area, it is still universally acknowledged that idiopathic pain, often termed chronic pain syndrome or pain for which there is no established physical pathology, is one of the most complex and difficult aspects of modern healthcare. The inadequacies of biomedicine to comprehend fully the complex phenomenon of pain has provided the impetus for this conference. This volume provides vivid and compelling accounts of the attempts to imaginatively link subjective pain experiences to current healthcare practice which were presented at the conference by practitioners, researchers and theorists across a wide range of disciplines A major theme of Part One of the volume was to gain deeper insight into the complex phenomenon of pain by addressing some of the limitations and barriers within current treatments and understandings. In the first chapter, Fink articulately addresses the philosophical and ethical lacunae within medical science ' of the pain experience. Beginning with the IASP definition, he questions a science of pain which fails to recognise the 'natural origins' and is unable to unite subjective and objective components which influence its expression, its meaning and its moulding. Next, Cohen and Quintner present the profoundly sensitive reflections of pain practitioners who recognise the reductionism of the models they are working within which inevitably result in marginalisation of the sufferer. They propose that clinicians have a moral and ethical obligation to engage in the aporia of pain, to allow the 'third space' of self-referentiality to emerge within the clinical encounter. Kalman and Scheman develop the subjectivity of interpersonal space further, using a range of examples to demonstrate the process of inflecting pain, whether in clinical or more personal settings. Finally Dubin's compassionate case studies of the highly stigmatising chronic pain trajectory vividly illustrate the multi-faceted nature of total pain as coined by Saunders 12, with its drastic financial and legal implications in addition to the mind-body-spiritual elements. In Part Two of the volume, experience of pain is again the key, but here the focus is more explicitly on the narration of chronic pain in a variety of contexts, where believability, self-identity, emotional distress and narrative restitution all play a part. Flaherty's chapter charts the linkage of social identity to the use of both licit and illicit intoxicating substances as a means of alleviating emotional pain amongst the GLBTQ community in Sydney. Nielsen uses a Goffmanesque - labelling theory inspired framework to investigate in-depth the relationship between chronic pain and stigma, and Buchinger Bodwell offers a sophisticated analysis of the crucial role that illness narratives play for those involved in treating chronic pain, as well as those who suffer from it. Finally McKenzie's empathetic case studies of emotion management by cancer survivors illustrate dramatically how enmeshed are mind, body and society in the phenomenological experience of pain.