When pain overwhelms the self: A phenomenological study of a new mode of suffering, based on adults' recollections of their worst pain episodes.
The journal of pain – May 02, 2025
Source: PubMed
Summary
During intense pain episodes, people can experience a profound disruption of their basic sense of self - losing connection with time, body, and identity. Through in-depth interviews with chronic pain patients, researchers uncovered how severe pain can create immediate suffering that transcends conscious thought. This qualitative study revealed that overwhelming pain can lead to dissociative states where sufferers feel dehumanized and disconnected from themselves.
Abstract
Suffering is a foundational yet understudied construct within the field of pain. There is general agreement that pain-related suffering involves disruption to one's sense of self. The selfhood literature characterizes two inter-related modes of self-experience. One mode entails in-the-moment experiences that shape one's stream of consciousness; another involves self-reflective thoughts about the past or expected future, related to self-narratives and identity. The field's current conceptualization of pain-related suffering is exclusively anchored to the latter, self-reflective mode of experience. Our past work argues that this framing fails to account for pain's immediate, disruptive impact and denies the potential for suffering among individuals without self-reflective capacities (e.g. infants). The purpose of this theoretically-informed, phenomenological study was to explore a new potential way by which people living with pain can suffer. We conducted in-depth, qualitative interviews with 12 adults across Canada living with various pain conditions. Interviews focused on understanding the moment-to-moment experiences of their worst episodes of pain. Results revealed important accounts of pain that overwhelmed thoughts and self-reflective capacities and disrupted foundational aspects of self-experience, including senses of agency, bodily ownership and time. Participants reported that these experiences were incapacitating, dehumanizing and dissociating. The findings are remarkably similar to first-hand accounts of torture and support a new mode of pain-related suffering that does not require self-reflection and is characterized by an immediate, disruptive impact on one's sense of self. Findings will inform the development of the first theoretically-informed and evidence-based definition of pain-related suffering and help advance pain theory and practice. PERSPECTIVE: This qualitative phenomenological study characterizes how pain can radically transform one's in-the-moment sense of self. Results reveal a new mode of pain-related suffering that does not require self-reflection. This supports the expansion of traditional understandings of suffering, exclusively anchored to self-reflection, to now include two inter-related modes of pain-related suffering.