Articles, Chapters, Books, 2008 - by Simon van Rysewyk
Academia Medicine, 2024
This study aimed to determine the prevalence of unhelpful pain cognitions, such as catastrophizin... more This study aimed to determine the prevalence of unhelpful pain cognitions, such as catastrophizing and low self-efficacy, and the relationships between pain qualities (severity, interference, distress, and disability) and opioid use in patients with cancer. The study design included the linkage of collected self-report questionnaire responses sourced from the Electronic Persistent Pain Outcomes Collaboration (ePPOC) with medical records in cancer patients referred to a hospital-based pain clinic in Sydney, Australia, from January 2013 to June 2019. Of 267 patients with a history of cancer, 37 (13.8%) had pain attributable to cancer. The average pain intensity was moderate, but severe (≥7/10) in 12 (36%) patients. Unhelpful pain cognitions were common; average scores for pain self-efficacy and catastrophizing were moderate. At referral, most patients were on strong opioids, with many on high doses (>100 mg oral morphine equivalents (OME) per day). Despite higher doses of opioids, pain interference, depression, anxiety, self-efficacy, and catastrophizing scores were worse in patients with severe pain. Pain catastrophizing was significantly higher in the severe group. The correlation between opioid dose with catastrophizing and anxiety indicates that healthcare providers may have not assessed unhelpful pain cognitions, and opioids may have been used by patients to cope with psychological or spiritual distress rather than for analgesia.
British Journal of Pain, 2023
Background: Although multiple measures of the causes and consequences of chronic noncancer pain (... more Background: Although multiple measures of the causes and consequences of chronic noncancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom.
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
Frontiers in Pain Research, 2024
Edited by Mark I. Johnson, James Woodall, Emmanouil Georgiadis, and Antonio Bonacaro
This Resear... more Edited by Mark I. Johnson, James Woodall, Emmanouil Georgiadis, and Antonio Bonacaro
This Research Topic acknowledges that the biomedical paradigm does not provide a
complete understanding of pain by focussing attention upstream towards the role of the
environment in fashioning the experience and impact of pain on health. Research
methodologies from non-biomedical disciplines can explore social, cultural, economic,
political, and environmental conditions that influence the living experience of pain in
the modern era. Investigating the phenomenon of pain using socio-ecological
frameworks provide opportunities to shift perspectives and open-up new avenues for
exploration, including innovative strategies to reduce the burden of pain on society.
Pain Reports, 2018
Introduction: The definition of pain promulgated by the International Association for the Study o... more Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language. Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.
simonpetervanrysewyk.com, 2025
I focus on religious and spiritual meanings of cancer pain through fictional case studies, highli... more I focus on religious and spiritual meanings of cancer pain through fictional case studies, highlighting pathways of positive clinical care.
I review five common meanings of cancer-pain, the effects of these meanings on patients, and pote... more I review five common meanings of cancer-pain, the effects of these meanings on patients, and potential meaning-based treatments.
Sorrow has an object, pain a cause; but both influence what we think.
Does the inability to make facial expressions impair recognition of emotional faces? Moebius Synd... more Does the inability to make facial expressions impair recognition of emotional faces? Moebius Syndrome invites us to rethink emotion recognition.
Malingering seems to be strong evidence for the privacy of pain. Put simply, the difference betwe... more Malingering seems to be strong evidence for the privacy of pain. Put simply, the difference between genuine pain and malingering is that the private, mental state of pain is present in genuine pain, but not in malingering. Malingering is differentiated from pain by the conscious choice to dissemble. Pain and malingering have the same behavioural manifestation, but different mental states. In this article, I will argue that this simple view is mistaken: malingering is intended to look like real pain, but the wider patterns in which they belong are different, even if they partially overlap.
Assessing another person for the presence of pain is a case of decision-making in uncertainty. Th... more Assessing another person for the presence of pain is a case of decision-making in uncertainty. The difficulty of pain assessment lies in the strong feeling we have that the attending observer must try to 'peer inside' another person to verify the presence of pain. Ideally, the clinician would deploy a simple instrument to read a patient's mind, scan for his or her current mental state, and, using the output, advise on clinical action (Prkachin et al. 2007). For patient ratings of pain, the sensation, feelings, and thoughts about pain are most relevant, including social and cultural norms for expressing pain experience in behaviour; factors that influence observer pain judgements are observer sensitivity, knowledge, beliefs on the nature of pain, and beliefs about the patient (Prkachin et al. 2007).
Unlike pain behaviour, pain expression individuates the sufferer and makes pain personal and imme... more Unlike pain behaviour, pain expression individuates the sufferer and makes pain personal and immediate.
simonpetervanrysewyk.substack.com, 2024
Even if we grant that a community is irrational in adhering to its practices, does this mean that... more Even if we grant that a community is irrational in adhering to its practices, does this mean that the community must discontinue them?
According to Wittgenstein, doubt about personal pain is excluded, not because pain is a private e... more According to Wittgenstein, doubt about personal pain is excluded, not because pain is a private experience, but because the individual has the role of expressing pain. These expressions include a range of verbal and non-verbal pain behaviours. In the swing and play of real life, we normally treat these behaviours as sincere or authentic. To introduce doubt here would alter the meaning of pain; crucially, it would undermine our concept of the person.
simonpetervanrysewyk.substack.com, 2024
Human behaviour is not always decoded through inference.
simonpetervanrysewyk.substack.com, 2024
The Gospels narrate the life, death and resurrection of Jesus, and invite the reader to believe. ... more The Gospels narrate the life, death and resurrection of Jesus, and invite the reader to believe. Believing the Gospels is the certainty that I will be saved by Jesus. This attitude we can call ‘faith in Jesus Christ’.
medthority.com, 2024
Migraine frequency and severity increase during perimenopause. Menstruation, and consequently men... more Migraine frequency and severity increase during perimenopause. Menstruation, and consequently menstrual migraine, is more frequent as the cycle length shortens. Women with migraine face increased risk of vasomotor symptoms, anxiety, depression, and sleep disturbance. Post menopause, migraine prevalence without aura declines from the last menstrual period.
medthority.com, 2024
Exercise can reduce the risk of developing PD, improve motor symptoms associated with the disease... more Exercise can reduce the risk of developing PD, improve motor symptoms associated with the disease, and could extend the life of living dopamine-producing neurons that can degenerate. Exercise is an intervention available to almost every individual, and amenable for integration into PD treatment plans. Could it be a medical panacea for neurodegenerative diseases?
medthority.com, 2024
At ISTH 2024, Jordan Schaefer (Rogel Cancer Center, Ann Arbor, Michigan, USA) presented the findi... more At ISTH 2024, Jordan Schaefer (Rogel Cancer Center, Ann Arbor, Michigan, USA) presented the findings of a study that he conducted with his colleagues, which compared bleeding rates after DOAC initiation for non-valvular atrial fibrillation (AF) and venous thromboembolism (VTE).
medthority.com, 2024
At the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Dr J... more At the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Dr Joseph Greer (Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Boston, USA) presented outcome data from the large-scale REACH PC trial, which compared the effectiveness of early palliative care delivered through video with in-person care for patients with advanced NSCLC.
medthority.com, 2024
LAURA clinical trial takeaways Osimertinib after chemoradiotherapy showed a statistically signifi... more LAURA clinical trial takeaways Osimertinib after chemoradiotherapy showed a statistically significant improvement in progression free-survival (PFS) for EGFR-mutated unresectable stage 3 non-small cell lung cancer (NSCLC). There were no unexpected safety signals.
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Articles, Chapters, Books, 2008 - by Simon van Rysewyk
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
This Research Topic acknowledges that the biomedical paradigm does not provide a
complete understanding of pain by focussing attention upstream towards the role of the
environment in fashioning the experience and impact of pain on health. Research
methodologies from non-biomedical disciplines can explore social, cultural, economic,
political, and environmental conditions that influence the living experience of pain in
the modern era. Investigating the phenomenon of pain using socio-ecological
frameworks provide opportunities to shift perspectives and open-up new avenues for
exploration, including innovative strategies to reduce the burden of pain on society.
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
This Research Topic acknowledges that the biomedical paradigm does not provide a
complete understanding of pain by focussing attention upstream towards the role of the
environment in fashioning the experience and impact of pain on health. Research
methodologies from non-biomedical disciplines can explore social, cultural, economic,
political, and environmental conditions that influence the living experience of pain in
the modern era. Investigating the phenomenon of pain using socio-ecological
frameworks provide opportunities to shift perspectives and open-up new avenues for
exploration, including innovative strategies to reduce the burden of pain on society.
The IASP identified older persons, infants and young children, individuals with cognitive impairments or psychiatric disorders, and pain in survivors of torture, as “belonging to the most vulnerable”. The selection of this group was guided by expertise within the task force.
Today, I want to explore conceptual connections between vulnerability and pain and related concepts such as harm, exploitation, and autonomy. I also sketch out a taxonomy of sources of vulnerability to pain.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Overview: Let’s discuss what it means to cope with chronic pain – this is not a data presentation. Instead, I attempt to create a sense of enquiry and self-reflection on how to take the meaning of coping with chronic pain and apply it in the clinic. Thinking about what we do, and what the doing represents in the clinic, can be rewarding.
During pain, body-parts are subject to massive involuntary transformations. But the involuntary transformations revealed in the face are more meaningful than in other body-parts. This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. When I observe another’s pain facial expression, I am not perceiving a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face. A person may be perceived by his arm, but not in his arm. The most meaningful features in displays of pain are the eyes, followed by brows, eyelids, mouth, head, forehead, and then other body-parts. Intentional control of pain through facial movements is normally judged by observers to be an insincere expression of pain, and open to doubt. Thus, involuntary facial changes show the person with pain "as he really is" because he does not fully control them, and observers are more obliged to offer help when movements are most involuntary.
The loss of voluntary control over my body during pain, and its dominion over me, create the compelling sense, for me and for others, of an "incarnate" person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person with pain feel answerable for what he or she experiences. The expression on a face is an offering in the world of mutual responsibilities: it projects into our inter-personal relations a particular person’s "being there". As soon as I notice pain in another person's face, my responsibilities are engaged. Facial expressions of pain call on you to respond to me. The face has this meaning for us because it is the boundary at which the other appears, offering "this person" as one in need of help. This feature is perhaps at the heart of what it means to treat and monitor pain.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Simon van Rysewyk, adjunct researcher
Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart 7001, Australia
[email protected] | +61 4 8899 7823
https://simonvanrysewyk.com/ | https://utas.academia.edu/SimonvanRysewyk
Methods: This presentation briefly analyses the historical development of the IASP definition, and some of the commentaries and suggested modifications to it over almost 40 years. Common factors of pain that patients experience are described, together with theoretical insights from philosophy and biology.
Results: Major problems with the IASP definition of pain include: (i) the stance of the observer is privileged over that of the experiencer of pain; (ii) the obligatory linking with "tissue damage" focuses attention on the body as distinct from the person; and (iii) the validity of the experience when there is no obvious "cause" is questioned. A revised definition of pain is offered: Pain is a mutually recognisable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.
Conclusion: This definition integrates the subjectivity or “first-person” level of experience of pain, and the challenge for the “second-person” of clinical evaluation (if not also intervention) towards objective “third-person” goals. This redefinition of pain is compatible with that of the IASP but more philosophically sound, biologically relevant, clinically applicable, and meaningful for people experiencing pain and for health care professionals who engage with them.
researcher have been influenced by a triple level spinal fracture and a C6 radiculopathy."
The congenital absence of facial expression and the inability to imitate facially the expressions of other persons may result in profound changes in the way a person is perceived by others and in a subsequent loss of affiliation. These experiences reveal not merely the importance of perceiving feelings and the capacity for imitating others for the maintenance of human relationships, but also the extent to which adults with a condition such as Möbius Syndrome may have difficulty in engaging in a shared form of life with others. These limitations are partial rather than absolute, however, and people with Möbius may yet maintain social coordination through their other channels of expression; through prosody of voice, gesture, clothes, enriched vocabulary, and so on.
Keywords: Wittgenstein, mimicry, Möbius Syndrome, rapport, form of life