IV. Describing and measuring pain

A problematic definition

Pain, according to the texts, is an unpleasant perception, a sad affection or a distressing feeling. We know how to recognize it when we experience it, but how can we define it precisely? Some physicians of the time felt that this was an impossible task. They nonetheless attempted to name the various painful sensations using an abundant lexicon.

In 17th-century writings, physical pain is often distinguished from sadness, or moral pain, which is a general feeling that involves the whole individual. However, the distinction between the two is not entirely clear or systematic. And physicians note that physical pain itself usually causes a state of sadness.

Physician Gerard van Swieten thus introduces his study of pain: “it is impossible to make clear using words alone what this feeling is in the soul; it is only known to him who suffers from painGerard van Swieten, Hermann Boerhaave, Aphorismes de chirurgie d’Hermann Boerhaave, commentés par Monsieur van Swieten, traduits du latin en français, Paris, Veuve Cavalier, t. I, 1753, p. 415. ”.

A controversial classification

There are a few recurrent criteria for characterizing body pain:

  • Intensity. Doctors regularly qualify pain as extreme, cruel, unbearable, even inexpressible. Patient testimonies and analyses by doctors generally focus on intense or persistent types of pain.

  • Duration. Pain may be continuous or discontinuous.

  • Location. Pain may be fixed (localized) or vague (diffuse). It may also be universal (generalized).

  • Quality. Physicians evoke four types of pain in particular –pricking pain (like a needle), tensive pain (resulting from relentless tension), heavy (with a feeling of weightiness) and pulsative (producing an unceasing and irritating throbbing). They can also be dull, biting or cutting. But these adjectives are sometimes contested, and no single classification of pain is unanimously agreed upon.

Marin Cureau de La Chambre - Pain: One Word, a Thousand Kinds of Pain

The faces of pain

These images, intended to be used by artists, distinguish between several different facial expressions of pain: “the pupils are hidden under the eyebrowsCharles Le Brun, Jean Audran, Expressions des passions de l’âme d’après les dessins de Le Brun [1619-1690], Paris, Jean Audran, 1727, p. 3.” and the mouth is slightly open with acute pain; the mouth is half-open and the eyebrows are slightly less raised with simple body pain; the corners of the mouth droop downwards and the eyelids are lowered with sadness.

Today, simplified graphic representations are used to help children describe their level of pain. Above is the Biéri scale, aimed at young patients, with the following instructions: “choose the face that shows how much pain you are in right now”. The faces represent only the degrees of intensity of pain. Doctors use a numerical scale from 0 to 10 on the back of the image.