Chronische pijn, het kruis van de geneeskunde

textabstractThe title of this study refers to the thesis that chronic or intractable pain is experienced as such a burden for medicine itself that it may be seen as the cross of medicine (crux medicorum). In dealing with patients whosuffer from chronic, intractable or 'inexplicable' pain, medicine seems to be confronted with the limits of its own theory and practice. Metaphorically, we may speak of the 'pain' of medicine in view of its inability to successfully treat these patients. This problem is analyzed further in this study as a contribution to a broader understanding of pain and the management of patients with pain. In medicine pain is usually seen as a symptom, an adjunct or secondary product of a disease (Chapter 1). The problem is that pain is a subjective phenomenon. If the physician is able to get clear answers from the patient on the questions he poses, the symptom can be objectified and a diagnosis can be made. Pain as a sensation seems to have the function of a warning signal. So called chronic pain appears to have no function at all (Chapter 2). It is considered, both by patients and physicians, as a meaningless sensation of which we must get rid of. In such cases the pain is seen as a disease in its own right. In the treatment of this "disease" pain is considered as an entity that can be cut out of the body. In those patients who complain about pain and in whom no underlying lesion or known syndrome can be uncovered, the pain is called psychesomatic or psychogenic. This partial analytical medical approach to pain and the ill person bas been criticised, among others, by Illich, Buytendijk and Metz. From an anthropological point of view, pain is a specific state of existence, which poses specific questions about life. Furthermore, they state that the physician, as a fellow human person in relation to the patient, has bis own task in alleviating the sufferin