This definition, advanced by JCAHO and other organizations seeks to demand that physicians somewhat uncritically accept patient claims of pain, and mandates treatment.

It then becomes hard to fault a physician who is something of a seive in treating pain. Certainly he must document each visit and prescription and record some scaled pain score the patient reports. Patients quickly learn the critical threshold for how they should report their pain, as external organizations have decreed a 7 to be unacceptable and must be treated. Never mind that any number a patient reports cannot be considered comparable to the same number reported by any other patient. That is, patients do not use the 0 to 10 scale in precisely the same way. It allows somewhat stoic people to suffer, especially if they are not aware of critical cut-off points that will produce differing prescribing.

We need to come up with a more rational definition of pain. Pain is what the patient and the physician together determine it to be. It includes the patient’s subjective report of the noxious stimulus itself, as well as detailed descriptions of the effect of both non-pharmacologic and pharmacologic interventions, the impact on various daily activities including work, sleep, sex, and mood, the objective assessment of the physician’s physical exam and their interpretation of how this patient’s experience is judged against the population of patients with chronic pain.

The patient approaches their condition with an intimate understanding of the impact, but only an N of 1. The physician approaches the condition with only the understanding that the patient can communicate, but an N of dozens, hundreds, or thousands. The experience of each must be considered. Not just the single pain number that JCAHO wishes us to jump for.