REVIEW   Free access

Minerva Anestesiologica 2021 November;87(11):1255-67

DOI: 10.23736/S0375-9393.21.15920-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Pain, the unknown: epistemological issues and related clinical implications

Enrico FACCO ^{1, 2} ✉

¹ Studium Patavinum, Department of Neurosciences, University of Padua, Padua, Italy; ² F. Granone Institute, Italian Center of Clinical and Experimental Hypnosis (CIICS), Turin, Italy

Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. The intensity and tolerability of pain and suffering also depend on what the pain means to the patient. The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient’s centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The plethora of available data suggests the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient’s inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.

KEY WORDS: Pain; Biopsychosocial models; Knowledge; Placebo effect; Nocebo effect; Hypnosis