Annals of Health Law
INTERVENING AT THE RIGHT POINT
Dickinson famously observed, pain defies definitions and straddles
categories.16 In a 2005 essay, anthropologist Jean Jackson found multiple
and competing (about ten) definitions of chronic pain in the clinical
literature.17 There are dozens of different kinds of pain, and because
experiences of pain are profoundly conditioned by the enormous variety of
human beings’ lived experiences,18 definitions of pain in one sociocultural
context may be inapplicable in others. Constructing even a crude
epidemiology of global pain therefore requires analysis of a hodgepodge of
local and regional studies. In a 2011 paper, Goldberg and McGee note the
Globally, twenty percent of adults suffer pain, and ten percent of
adults (sixty million people) have been diagnosed with chronic
Ten percent of adults are newly diagnosed each year;
Reliable estimates of pain prevalence in many countries and
regions hover around twenty to twenty-five percent;
Estimates of pain prevalence in the United States and Europe
range from between twelve and twenty-five percent and
approximately twenty percent, respectively.
Goldberg and McGee also note that pain severity and functional impairment
are crucial indicators of the burden of global pain, and cite evidence that
“moderate-to-severe pain is prevalent even in resource-rich settings, and
that the combination of persistent pain and comorbid psychological
disorders produce significant disability across the globe (as measured by
impairment of daily activities).”20 The recently released Global Burden of
Disease (“GBD”) Report, the product of a monumental effort of data
collection, synthesis, and interpretation, documents that musculoskeletal
disorders comprised the “large total” of six to eight percent of global
disability adjusted life years (“DALYs”), disorders which were themselves
largely composed of back pain (about 50%), neck pain (about 20%) and
osteoarthritis (about 10%).21
16. EMILY DICKINSON, PAIN HAS AN ELEMENT OF BLANK (1955) reprinted in THE
COMPLETE POEMS OF EMILY DICKINSON (Thomas H. Johnson ed., 1976).
17. Jean E. Jackson, Stigma, Liminality and Chronic Pain: Mind-body Borderlands, 32
AM. ETHNOLOGIST 332, 335-36 (2005).
18. This is generally undisputed within pain studies. See, e.g., Morris, supra note 3;
James Giordano, et al., Culture, Subjectivity, and the Ethics of Patient-Centered Pain Care,
18(1) CAMBRIDGE Q. HEALTHCARE ETHICS 47 (2009).
19. GOLDBERG & MCGEE, supra note 9 at 1-2.
20. Id. at 2.