Sullivan M D
Multidisciplinary Pain Center, University of Washington, Seattle 98195, USA.
Clin J Pain. 2001 Jun;17(2):146-56. doi: 10.1097/00002508-200106000-00007.
Physicians and patients alike find it easy to divide pain into mental pain and physical pain. But close examination of this distinction shows that it fails on clinical and philosophical grounds. The body is not a passive conduit for information about tissue damage. Nociception is modified and analyzed throughout the nervous system. The mind is not a central theater where pain is finally apprehended. Pain perception cannot be understood as the private observation of a pain sensation. Pain must have mental (e.g., aversion) and physical (e.g., location) elements if it is to qualify as pain. We understand our pain as well as the pain of others in terms of socially categorized pain behavior. Pain thus originates, not in mind or body, but between minds and bodies. The dualism of mental and physical pain cannot be overcome if the biological individual is considered in isolation. Mental and physical pain can only be reconciled if their common interpersonal roots are understood. This interpersonal view of pain can help clarify some clinical and moral dilemmas in the care of patients with pain.
