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Taj Taher

Honors 222 C
15 April 2015
Seminar 3 Thought Piece
My initial reaction to an epidemiological approach to pain was “What’s the point?” If
we’ve established anything so far, it’s that pain is a highly subjective experience. For the team of
Torrance, Smith, Bennett, and Lee to claim that “This information is vital in order to understand
the distribution, etiology, and natural history of this type of chronic pain” seemed somewhat
nonsensical given the multitude of factors that give rise to chronic pain in any one individual, let
alone the hundreds they would be surveying. How could a broad survey hope to elucidate the
physiological mechanisms behind chronic pain? How would one participant’s pain report be
comparable to another’s? For any study to be of value, there must be some common denominator
within the form of measurement in order to make connections among discrete data points. The
only definitive fact tying together individuals with chronic pain is the presence of chronic pain.
I discovered through the course of the readings, however, that this fact is actually quite
useful. Given how difficult it has been to find exactly why chronic pain occurs in any one
individual, it may be beneficial to see where and in what kinds of individuals it does occur.
Boivie establishes this in “Central Pain” given that four out of five of his proposed directions for
future research do not seek the mechanisms by which pain operates, but rather the “factors that
determine whether or not a patient will develop central pain”, how patients at a high risk of
developing pain can be identified, and how the development of that pain can be prevented. This
is interesting in that Boivie treats pain less like a symptom restricted to an individual and instead
like a disease that can affect anyone. Indeed, this is reminiscent of an assertion made in a reading
from a prior week that at a certain point, chronic pain becomes its own illness.
If this is the case, then it should be approached as such. For most illnesses, the best
medicine is prevention; this is why primary care physicians emphasize eating properly and

maintaining a healthy body weight so that the onset of diseases like diabetes or coronary artery
disease can be minimized or even avoided. And this is why epidemiological research is so
important in the study of pain. If we can identify a subset of individuals who are more
susceptible to chronic pain, we can look for the signs that it could arise and better prepare
ourselves to address the issue if it should. We may not know why it occurs, but we can take the
steps to minimize its impact upon arrival or prevent its arrival altogether.
There is this sense of helplessness associated with pain, not just for those that suffer from
it but those responsible for making it go away. When we do not know exactly why chronic pain
occurs or do not have an effective way of treating it, it is only natural to cynically ask “What’s
the point?” But this sense of helplessness and frustration arises from the inability to properly
characterize what it is we are dealing with; if epidemiological research has shown anything
though, that need not be the case. This form of research may not give a straightforward answer as
to the origins of pain, but throughout the course of the readings and as I have reflected upon it in
this Thought Piece, it has given me hope. Epidemiological studies can give a face to the faceless,
a vague understanding of a specific issue but an understanding nonetheless. Suddenly, the pain
ceases to seem insurmountable, for as Sun Tzu once said “If you know the enemy and know
yourself you need not fear the results of a hundred battles”.