Author, professor introduces book about pain relief at lecture
If you ask 100 different authorities for the definition of “pain,” they would give 100 different answers, said anesthesiologist John Bonica 40 years ago.
This idea was cited multiple times during “Pain: A Political History,” a seminar held yesterday at the Institute for Health, Health Care Policy and Aging Research in New Brunswick downtown. The seminar was meant to show the intersubjectivity of pain and the complexities surrounding the policies of pain relief.
Keith Wailoo, vice dean and the Townsend Martin Professor of History and Public Affairs at the Woodrow Wilson School of Public and International Affairs, spoke at the seminar. His book, “Pain: A Political History,” delves into the history of pain relief and its definition in relation to cultural, historical, political and legal standards.
Carol Boyer, associate director of the Institute for Health, Health Care Policy and Aging Research, said the department wanted to bring Wailoo to Rutgers because his recent work touches on several key areas the faculty has interest in.
“I’m always so impressed with the depth of his analyses,” Boyer said. “I think it has a lot to do with him being a historian, so he goes deep into the papers.”
Wailoo, who taught at Rutgers for nine years, said his book was inspired by the work he did on his 2001 book, “Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health.” In that work, Wailoo examined the disease and the factors surrounding it in Southern black communities.
Speaking to a Memphis-based physician about the disease revealed that no unified agreement exists on the level of pain treatment for it, he said.
Patients were denied treatment due to suspicion of exaggerating symptoms to obtain drugs.
“What I found interesting is how a change in cultural climate in time could create new kinds of challenges,” Wailoo said.
Race, public welfare, drug addiction and the rising cost of disease management all factor into the skepticisms behind why patients are denied pain relief, Wailoo said.
To illustrate race as a factor in the administration of anesthesia, Wailoo brought up the statistic that Hispanic people with extremity fractures are less likely to receive analgesics than white people.
This could stem from different factors like the cultural difference in expression of pain, the doctor’s understanding of expressions or physician bias, he said.
The presentation dealt with the issue of where to draw the line in treatment, he said. This includes the lines between pain relief and pleasure, euthanasia and acceptable treatment that can hasten death and “real” physical pain versus psychologically exacerbated pain.
Wailoo addressed the “take home” message of his book.
“What began for me as a project about medicine, about clinical practice [and] about disease, became a book about politics, how you judge, and this was a big surprise about law.”
Wailoo said courts determine who is in pain and what level of relief they deserve. There is a political divide involving “liberal trends” and “conservative impulses.”
Individual relief, compassion and intersubjective understanding define liberal trends, while conservative impulses are concerned with malingering, addiction and the social consequences of indulgence, he said.
Libby Luth, a graduate student in the Department of Sociology at Rutgers, read Wailoo’s book and attended the seminar in order to gain insight for a research project on pain education in medical schools.
“I think what was really interesting about this particular book and the presentation is how he ties together the social, the political, what is going on in the court system and the cultural, not just in terms of the culture of society, but the culture of medicine,” Luth said.
Stephen Crystal, associate director for health services research at the Institute For Health, Health Care Policy and Aging Research, said Wailoo is a wonderful scholar. Crystal’s expectations were met in terms of gaining insight into an important issue.
“It’s intensely relevant to issues about how to handle the medical relief of pain and policies about prescribing opiates,” Crystal said. “It’s a very difficult and complex problem, but [the presentation] is one of the most comprehensive and thoughtful discussions of the whole complicated context of this problem that I’ve heard.”