The Pain-Suffering Association, A Review

David A. Fishbain, John E. Lewis, Jinrun Gao

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations


Objective: This review wished to determine the reported prevalence of suffering in various patient diagnostic groups and examine the evidence for the association of pain and suffering. Design/Setting: Twenty-four studies fulfilled inclusion-exclusion criteria. They were divided into the following groups: advanced cancer/terminal illness/hospice patients (AC/TI/H) (7 studies); hastened death/assisted suicide/euthanasia patients (HD/AS/E) (14 studies); noncancer (NC) patients (3 studies). No chronic nonmalignant pain (CNMP) suffering studies fulfilled inclusion-exclusion criteria of this review. The reported prevalence of suffering for each study was abstracted and the overall percentage of sufferers in each grouping calculated. For those studies that provided a statistical relationship between pain and suffering information was abstracted for whether these studies supported/did not support the association of pain and suffering. A vote counting method was utilized to determine the overall percentage of studies supporting/not supporting this association. The consistency of this data for supporting this association was then rated by Agency for Health Care Research and Quality guidelines. Results: The prevalence of suffering in each grouping was as follows: AC/IT/H 45.7%; HD/AS/E 81.9%; NC 19.2%; and all groupings combined 59.9%. AC/TI/H and all groupings combined received an A rating (consistent evidence multiple studies for a statistical relationship between suffering and pain). HD/AS/E received a C (evidence which is inconsistent). For NC there were not enough studies for a consistency rating. Conclusions: The above results indicate a consistent association between suffering and pain in some patient groups. Studies addressing suffering are needed in CNPM patients.

Original languageEnglish (US)
Pages (from-to)1057-1072
Number of pages16
JournalPain Medicine (United States)
Issue number6
StatePublished - Jun 1 2015
Externally publishedYes


  • Acute Pain
  • Acute Pain Patients
  • Assisted Suicide
  • Cancer
  • Chronic Pain
  • Chronic Pain Patients
  • Euthanasia
  • Existential Suffering
  • Hastened Death
  • Mental Defect
  • Mental Pain
  • Pain
  • Psychological Pain
  • Review
  • Suffering
  • Terminal Illness

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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