What is the meaning of pain?

In 1996, pain was declared the “fifth vital sign,” ranking alongside blood pressure, pulse, respiratory rate, and body temperature when assessing a patient’s state of health. But this “fifth vital sign” was not declared by the surgeon general but by the American Pain Society, a group funded by “Big Pharma.” That organization went out of existence in 2019, faced with massive legal challenges.

Who is to blame for the American opioid crisis? Beth Macy’s 2018 bestselling book, Dopesick: Dealers, Doctors, and the Drug Company That Addicted America, aims its sights squarely at Purdue Pharma’s concerted effort to push OxyContin on doctors as “non-addictive” despite lacking any verifiable science for backing such a claim. A new exposé from The New York Times also documents how pharmaceutical middlemen helped facilitate the overprescription of opioids by discouraging restrictions that would have better-protected patients from future addiction.

Still, the consequences of opioid usage remain clear. Deaths from drug overdoses exceeded 100,000 in 2021, most of which involved the use of opioids. The full onslaught of fentanyl has only worsened what OxyContin began.

A deeper social pathology than corporate greed is at play here, however. The opioid crisis reveals a basic confusion about the nature and meaning of pain. Individuals who become hooked on painkillers are the front-line victims of a mentality that misuses medicine for ends that go beyond its proper place in society.

The antidote lies in what Farr Curlin and Christopher Tollefsen call the “Way of Medicine.” In their understanding, purely physical health is not the only goal of medicine and medical practice. Instead, doctors conduct themselves “in solidarity with the patient as a person,” seeking to align sick individuals with their ultimate ends as rational, spiritual beings created by God as much as they try to render them physically well. Medicine is to be holistically oriented and concerned with all aspects of the human person beyond the immediate presentation of illness. As they contend, “Health is not the absence of disease.”

It cannot be identified as the total absence of pain either. As those who exist in a fallen world, the frailty of the body and mind will never be completely cured on this side of eternity. Pain reminds image-bearers that their embodied selves are made for more than the uninterrupted self-actualization that the secular mindset cherishes above all else. Common grace offers many wonderful cures, but it will never offer the final solution to all of our ailments.

Grounding American medicine upon a far greater vision of human dignity and the ends for which humans ought to live their lives is vital. As rates of physician-assisted suicide continue to rise globally, helping people properly understand the purpose and place of their pain is vital for preserving the integrity of the human person. Expressive individualism’s promotion of individual self-determination as the supreme standard of evaluation renders pain a matter of personal opinion, making the intellectual wall between seeking immediate relief through opioids and choosing euthanasia for relief from life itself all quite thin. If I am stuck with this pain, is life worth living?

To recognize that some degree of pain is part of the human experience helps those who must confront it chronically realize that its presence alone does not demand extreme measures to address it. If we consider health and the management of pain as consisting of more than just a therapeutic sense of well-being, medicine can better align with its true mission not only in the medical establishment but also within the greater economy of the created order.

Pain, in the words of C.S. Lewis, is what God uses as a “megaphone to rouse a deaf world.” Sadly, the opioid crisis has been one long, grueling lesson in what happens when many, especially those professionally entrusted with caring for the unwell, choose to ignore it. A proper understanding of pain—and of modern medicine—reminds us to expect better.