Is “Chronic Pain” a Meaningful Diagnosis?

  • Milton CohenEmail author
  • John Quintner



“Chronic pain” and “chronic primary pain” in particular are both about to appear in the international taxonomy, ICD-11. While this is likely to have great utility at administrative and possibly clinical levels, the question arises as to whether people experiencing chronic pain also will benefit.


The definitions (denotations) of “chronic pain” as symptom, disease and diagnosis are refracted through the constraints of language, especially figures of speech, in order to ascertain if “meaning” is possible.


“Chronic (primary) pain” as a taxonomic entity remains tied to the definitional link of “pain” itself to actual or apprehended tissue damage. This situation does not assist the plight of those experiencers of pain in whom tissue damage cannot be demonstrated.


While the definition of pain itself is constrained by the link to tissue damage, there can be no satisfactory denotation of “chronic pain” for those who live with that experience. As such, meaning remains elusive.

Clinical Implications

“Chronic pain” and “chronic primary pain” in particular are about to appear in the international taxonomy, ICD-11. While this is a welcome development towards the recognition of chronic pain as a societal and clinical problem, with positive diagnostic, therapeutic and administrative implications, the question also arises, whether this “entity” carries meaning for those who experience it. This article argues that, while pain itself is defined as being linked to tissue damage, there can be no satisfactory denotation of “chronic pain” for those who live with that experience. As such, meaning remains elusive.


Chronic pain Taxonomy Meaning 


  1. 1.
    Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. The IASP taskforce for the classification of chronic pain. The IASP classification of chronic pain for ICD-11: chronic primary. Pain. 2019;160(1):28–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Mill JS. A system of logic, ratiocinative and inductive. In: Robson JM, editor. The collected works of John Stuart Mill, vol. 2. London: University of Toronto Press; 1843. p. 5.Google Scholar
  4. 4.
    Cohen M, Quintner J, van Rysewyk S. Reconsidering the IASP definition of pain. Pain Rep. 2018;3(2):e634.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Derbyshire SWG. The IASP definition captures the essence of the pain experience. Pain Forum. 1999;8(2):106–9.CrossRefGoogle Scholar
  6. 6.
    Williams ACC, Craig KD. Updating the definition of pain. Pain. 2016;157:2420–3.CrossRefGoogle Scholar
  7. 7.
    Merskey H, Bogduk N, editors. Classification of chronic pain: descriptions of chronic pain syndromes and definition of pain terms. 2nd ed. Seattle: IASP Press; 1994. 222 p.Google Scholar
  8. 8.
    Bonica JJ. The management of pain. Philadelphia: Lea and Febirger; 1953. 592 p.Google Scholar
  9. 9.
    Tallis R. Hippocratic oaths: medicine and its discontents. London: Atlantic Books; 2004. p. 43–73.Google Scholar
  10. 10.
    Young ME, Brookes L, Norman GR. Found in translation: the impact of familiar symptom descriptions on diagnosis in novices. Med Educ. 2007;14:1146–51.CrossRefGoogle Scholar
  11. 11.
    Peters A, McEwan BS, Friston K. Uncertainty and stress: why it causes diseases and how it is mastered by the brain. Prog Neurobiol. 2017;156:164–88. Scholar
  12. 12.
    Baumeister RE, Landau MJ. Finding the meaning of meaning: emerging insights from four grand questions. Rev Gen Psychol. 2018;22(1):1–10.CrossRefGoogle Scholar
  13. 13.
    Ogden CK, Richards IA, editors. The meaning of meaning. 8th ed. New York: Harcourt, Brace and World, Inc.; 1946. 363 p.Google Scholar
  14. 14.
    Wittgenstein L. Philosophical investigations. Anscombe GEM, Hacker PMS, Schulte J, translators. Oxford: Blackwell; 2009. 246 p.Google Scholar
  15. 15.
    Ruthrof H. Language, Vorstellung, and meaning as use. Linguist Philos Invest. 2011;10:60–92.Google Scholar
  16. 16.
    Luis-Flores H. The imagination’s piano in Wittgenstein’s Philosophische Untersuchungen. In: Wittgenstein and the future of philosophy. A reassessment after 30 years. Papers of the 24th international Wittgenstein-symposium. Kirchberg am Wechsel: Austrian Ludwig Wittgenstein Society; 2001. p. 218–23.Google Scholar
  17. 17.
    Jackendoff R. A user’s guide to thought and meaning. Oxford: Oxford University Press; 2012. 274 p.Google Scholar
  18. 18.
    Ruthrof H. The body in language, vol. 7. London: Cassell; 2000. 193 p.Google Scholar
  19. 19.
    Ruthrof R. Semantics and the body: meaning from Frege to the postmodern. Toronto: University of Toronto Press; 1997. 321 p.CrossRefGoogle Scholar
  20. 20.
    Ruthrof H. Language and imaginability. Newcastle Upon Tyne: Cambridge Scholar Publishing; 2014. 270 p.Google Scholar
  21. 21.
    Bowen JL. Educational strategies to promote clinical diagnostic reasoning. NEJM. 2006;355:2217–25.PubMedCrossRefGoogle Scholar
  22. 22.
    Temkin O. The Double Face of Janus. Baltimore: The Johns Hopkins University Press, 1977. p. 419–40. Google Scholar
  23. 23.
    King LS. Medical thinking: a historical preface. Princeton: Princeton University Press; 1982. p. 91–104.Google Scholar
  24. 24.
    Nessa J. About signs and symptoms: can semiotics expand the view of clinical medicine? Theor Med Bioethics. 1996;17:363–77.CrossRefGoogle Scholar
  25. 25.
    Eriksen TE, Risør MB. What is called symptom? Med Health Care Phil. 2014;17(1):89–102.CrossRefGoogle Scholar
  26. 26.
    Semino E. Descriptions of pain, metaphor and embodied simulation. Metaphor Symbol. 2010;25(4):205–26.CrossRefGoogle Scholar
  27. 27.
    Stein E. On the problem of empathy. Stein W, transl. Washington: ICS Publications; 1989. 135 p.CrossRefGoogle Scholar
  28. 28.
    Periyakoil VS. Using metaphors in medicine. J Palliat Care. 2008;11(6):842–4.Google Scholar
  29. 29.
    Masukume G, Zumla A. Analogies and metaphors in clinical medicine. Clin Med. 2012;12:55–6.CrossRefGoogle Scholar
  30. 30.
    Miller FG, Colloca L. Semiotics and the placebo effect. Perspect Biol Med. 2010;53:509–16.PubMedCrossRefGoogle Scholar
  31. 31.
    Bonica JJ. Introduction to the first world congress on pain. In: Bonica JJ, Albe-Fessard DG, editors. Advances in pain research and therapy, vol. 1. New York: Raven Press; 1976. p. xxvii–xix.Google Scholar
  32. 32.
    Quintner JL, Buchanan D, Cohen ML, Katz J, Williamson O. Pain medicine and its models: helping or hindering. Pain Med. 2008;9:824–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Dorland W. Dorland’s illustrated medical dictionary. 31st ed. Philadelphia: WB Saunders Company; 2007. 535 p.Google Scholar
  34. 34.
    Rosenberg CE. The tyranny of diagnosis: specific entities and individual experience. Milbank Q. 2002;80:237–60.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Body R, Foex B. On the philosophy of diagnosis: is doing more good than harm better than “primum non nocere”? Emerg Med J. 2009;26:238–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Cohen ML, Quintner JL, Buchanan DA. Is chronic pain a disease? Pain Med. 2013;14:1284–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Quintner J, Bove G, Cohen M. A critical evaluation of the “trigger point” phenomenon. Rheumatology. 2015;54:392–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg. 2004;99:510–20.PubMedCrossRefGoogle Scholar
  39. 39.
    Kleisiaris CF, Sfakianakis C, Papathanasious IV. Health care practices in ancient Greece: the hippocratic ideal. J Med Ethics Hist Med. 2014;7:6.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Crookshank FG. The importance of a theory of signs and a critique of language in the study of Medicine. In: Ogden CK, Richards IA, editors. The meaning of meaning. 8th ed. New York: Harcourt, Brace and World; 1946. p. 337–55.Google Scholar
  41. 41.
    Bichat X. Anatomie générale appliquée à la physiologie et à medicine, vol. 3. Paris: Broson, Gabon et Cie; 1825.Google Scholar
  42. 42.
    Hanne M. Diagnosis and metaphor. Perspect Biol Med. 2015;58:35–52.PubMedCrossRefGoogle Scholar
  43. 43.
    Jutel A. Sociology of diagnosis: a preliminary review. Sociol Health Ill. 2009;31:278–99.CrossRefGoogle Scholar
  44. 44.
    Carr DB, Bradshaw YS. Time to flip the pain curriculum? Anesthesiol. 2014;120:12–4.CrossRefGoogle Scholar
  45. 45.
    Sullivan M. The problem of pain in the clinicopathological method. Clin J Pain. 1998;14(3):197–201.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.St Vincent’s Clinic & UNSWDarlinghurstAustralia
  2. 2.Arthritis and Osteoporosis WAShenton ParkAustralia

Personalised recommendations