DO DOCTORS UNDERTREAT PAIN

Routinely, physicians discount patients' pain reports and provide too little analgesia too late. Critics call them callous, sadistic, and Pu ritanical, but the causes of these clinical practices are different - namely, a psychological need to distance themselves from the pain they encounter and inflict, and more subtly, a peculiar concept of pain ac quired in medical training. Physicians learn to think of pain as a sym ptom to observe and explore in diagnosing and monitoring disease - not as a complaint to relieve quickly or fully. Moreover, pain-relief is regarded as subordinate to, and competing with efforts to cure or main tain the life of a patient. This training, I suggest, gives physicians a new, clinical concept of pain al odds with their prior, lay concept of pain whose manifestations standardly call for sympathetic efforts at relief The conceptual nature of this difference is obscured by thin king of pain as a solely private sensation, rather than as a sensation with public and social aspects (ci la Wittgenstein). Although suppres sed in certain clinical circumstances, these standard public and socia l aspects are shown in the very tests used in clinical pain research. This clinical pain concept is rooted in Medicine conceived as preemine ntly curative and life-prolonging. Physicians are, however, themselves undermining this professional self-definition (by treating AIDS and A lzeimer's patients; by no longer pressing their patients to 'fight to the end'; by collaborating with non-medical healers). Accordingly, pai n-relief may gain greater therapeutic status, and, so too, the ordinar y concept of pain that medical training has suppressed.