The Pain Cluster
I study those who study pain. For most of the past decade, I have conducted an ethnographic study on the neuroscience of pain, conducting observations in neuroimaging pain labs and interviewing top pain scientists. The sum of these years has left me feeling surprisingly optimistic about our chances of solving the problem of pain.
When I tell people that I study pain, they often assume that I spend my days tucked away in a laboratory, peering through microscopes or systematically inducing pain in rats. I am not a bench scientist. I did not dedicate my career to investigating the biological, physical aspects of pain. I'm not trying to identify new interventions or illuminate the neurological mechanisms of pain. Instead, I'm collecting and analyzing qualitative data in order to understand the social aspects of pain. I'm hoping to make sense of how we're collectively thinking about what pain is and how it should be addressed. I am a sociologist of pain.
Believe it or not, until very recently, sociology largely ignored questions about pain. As is the case with many other health conditions, classical sociologists left the study of pain up to the bench scientists who are charged with studying the biological processes of the body. Pain was seen to be a physical problem, which meant that it was outside the purview of sociologists. We concern ourselves with social issues. If pain is biological, how could it also be social?
Only in the past handful of years, as the treatment of pain has become increasingly politicized, has pain's social life started to emerge in public discourse. Those who spend their time studying and treating pain have begun to attend to how pain is organized along social hierarchies and divisions. Increasingly, the gatekeepers of biomedicine are calling for a biopsychosocial approach to pain management.
The biopsychosocial model is based on the notion that the psychosocial components of illness should be considered alongside the biological. But while the bio-psycho-social model successfully articulates both the psychological and the biological aspects of illness, the sociological aspects are typically undertheorized. More often than not, the social components of being sick get confined to a consideration of a person's work environment or their social support network. This is especially true when it comes to pain, which has, until very recently, largely been considered strictly a biological or psychological condition. When pain experts diagram a biopsychosocial model of pain, they often use the patient's familial relationships as a proxy for what's social within pain management.
What's missing? What would it look like to expand our understanding of pain to include the social? How would we go about conceiving of a biopsychosocial model of pain that takes into consideration the sociological components of living in a body that hurts? Put simply: how is pain social?
Sociologists have grappled with for decades about the meaning of "the social" itself. At its most basic, "the social" has to do with things like: (1) how and why specific meanings get attached to a given object; (2) how power circulates through discourses and practices; and (3) the interplay between agency and structure. Anthropologists would add something about culture, and Neo-Marxists would object to my failure to privilege the means of production and economic capital. But when it comes to the ways in which I sociologically interrogate pain, meaning, power, and agency are the most salient considerations.
When expanding our understanding of a biopsychosocial approach to pain, then, we can begin to consider how pain is sociological in nature. Meanings matter. The experience of pain is mitigated by the meanings that we invest in that experience, and these meanings are collectively defined. The stories that we tell ourselves about what pain is and what should be done about it have bearing upon how we actually experience pain. For most of the 20th century, pain was not considered a symptom in and of itself, and many people accepted physical discomfort as a normal part of the human condition. In some parts of the world, going to a doctor to treat pain would be unheard of, especially before first consulting spiritual advisors. The cultural soup that we are all swimming in shapes the ways in which we interpret painful sensations, and in turn dictates how we intervene upon those sensations.
These collectively defined meanings are not neutral, but rather are invested with specific power arrangements that benefit some and not others. The opioid crisis garnered national attention only after it began impacting those inhabiting white bodies. Access to comprehensive pain management remains stratified, and evidence suggests that a substantial number of health care providers continue to believe that the biological experience of pain varies across racial lines, rendering some groups more deserving of pain management than others.
Pain sits directly at the center of an ongoing interplay between agency and structure. When considering the ways in which pain impacts the lived experience of those who endure it, it is important to recognize the traces of institutional logics upon individual care practices. Particularly as the self-management of pain is coming to replace pharmacotherapy, pain experts and policymakers would be wise to acknowledge how the structures of our society dictate our individual capacity to make choices about how we live with daily, ongoing pain.
So, what can we do with this expanded model of pain? We can ask more questions. We can try to identify some of the ways that meanings about pain are constructed in this given political, cultural, ideological moment. What are some of the stories that we collectively tell ourselves about pain? How does this vary across different groups, if at all? How inevitable is it that these discourses become the dominant paradigm for how we think about what pain is and how to treat it?
As I mentioned at the start, I am optimistic about our capacity to solve the problem of pain. An increasing number of bright, passionate individuals have dedicated their lives to improving the plight of those who suffer from chronic pain, continuously reaching outside the confines of traditional scientific meaning making to unpack some of the existential questions that surround and constrict our understanding of pain. I am encouraged to see federal agencies begin to call for big picture thinking around pain and its treatment. Sociologists of pain are proliferating in number, and in turn, the social life of pain is being articulated in increasingly nuanced and salient ways.
Sara Rubin studies the intersections between pain and addiction at the University of California, San Francisco. Her work has been published in Journal of Health and Social Behavior, Social Science and Medicine, and Sociology of Health and Illness. Her forthcoming book on the social meanings of pain will be released by Bloomsbury Press in 2021.
