Articles, Chapters, Books, 2008 - by Simon van Rysewyk
Brain, 2026
**Accepted** This letter critically examines the evidentiary and conceptual claims advanced in We... more **Accepted** This letter critically examines the evidentiary and conceptual claims advanced in Weisman et al.'s argument that nociception is necessary for pain. It challenges the constrained literature strategy, the asymmetric burden of proof, and the conflation of definitional and mechanistic aims. The International Association Study of Pain (IASP) definition of pain is defended as an open-textured, clinically robust framework safeguarding epistemic humility and ethical integrity in pain medicine.
Paediatric and Neonatal Pain, 2026
Healthcare disparities amplify vulnerabilities in infants and children. In the context of pain, v... more Healthcare disparities amplify vulnerabilities in infants and children. In the context of pain, vulnerable individuals are those whose pain often goes under-appreciated, -recognized, or -treated. Vulnerability to pain arises due to multiple and interacting sources including inherent vulnerability, situational vulnerability, and pathogenic vulnerability. Some groups are more vulnerable to pain than others, which will be the focus of this article: sick and preterm newborns, and children with intellectual disabilities and complex communication needs, including children with cerebral palsy. In this conceptual review, we highlight vulnerabilities to pain in these vulnerable populations and identify how we have obligations to minimize harm experienced by sick and preterm newborns, and children with developmental disabilities. Although pain is a universal experience, not everyone has equal and fair access to the necessary services for adequate pain management. This is particularly the case for sick and preterm babies who are exposed to large numbers of painful procedures during their hospitalization, and individuals with intellectual disability and complex communication needs, who have limited language and/or speech capacity to self-report pain. Therefore, explicit reflection on vulnerability reinforces a collective responsibility to provide effective assessment and management of pain in particularly vulnerable pediatric populations.
Korean Journal of Pain, 2026
My response to Cohen ML, Weisman A, Quintner JL. Paradoxes weaken the International Association f... more My response to Cohen ML, Weisman A, Quintner JL. Paradoxes weaken the International Association for the Study of Pain definition of pain. The Korean Journal of Pain. 2026 Jan 1;39(1):51-8.
Deconstructing the Body , 2026
** Accepted for publication in edited collection Deconstructing the Body (Routledge) ** Wittgenst... more ** Accepted for publication in edited collection Deconstructing the Body (Routledge) ** Wittgenstein proposes that the attribution of ‘pain’ is not directed towards a Cartesian immaterial soul, to the body or its parts, nor to a machine. Instead, it is ascribed to the ‘living human being.’ The ability to recognise another person as experiencing pain is inherently linked to how we respond to them, and this response is fundamentally connected to their being a certain type of living being. Within the human being, the face holds a distinct significance in prompting responses aimed at alleviating pain, with the eyes playing a particularly crucial role. Understanding another as a ‘living human being’ involves acknowledging the special importance of the face, especially the eyes, in expressing pain in a manner that is comprehensible. Wittgenstein argues that when we say, ‘I feel pain in my hand,’ our response is not to the hand itself, but to the living human being manifesting pain. He supports this by noting that our attention is naturally drawn to the living face. Facial grimaces, although incapable of directly ending the pain, evoke the intervention of others. When I observe your grimace, I do not merely see a physical movement; I perceive you, a living being, through your facial expression. Pain behaviours lack the unique power of facial expressions to convey the immediacy of an individual’s experience. Unlike behaviour, expression is not goal-oriented or dependent on specific circumstances. While facial expressions of pain can be somewhat controlled, involuntary changes reveal the individual as they truly are, beyond their ability to govern these expressions. Misinterpretation of behaviour is possible, but such errors are less likely with facial expressions.
Academia Medicine, 2024
This study aimed to determine the prevalence of unhelpful pain cognitions, such as catastrophizin... more This study aimed to determine the prevalence of unhelpful pain cognitions, such as catastrophizing and low self-efficacy, and the relationships between pain qualities (severity, interference, distress, and disability) and opioid use in patients with cancer. The study design included the linkage of collected self-report questionnaire responses sourced from the Electronic Persistent Pain Outcomes Collaboration (ePPOC) with medical records in cancer patients referred to a hospital-based pain clinic in Sydney, Australia, from January 2013 to June 2019. Of 267 patients with a history of cancer, 37 (13.8%) had pain attributable to cancer. The average pain intensity was moderate, but severe (≥7/10) in 12 (36%) patients. Unhelpful pain cognitions were common; average scores for pain self-efficacy and catastrophizing were moderate. At referral, most patients were on strong opioids, with many on high doses (>100 mg oral morphine equivalents (OME) per day). Despite higher doses of opioids, pain interference, depression, anxiety, self-efficacy, and catastrophizing scores were worse in patients with severe pain. Pain catastrophizing was significantly higher in the severe group. The correlation between opioid dose with catastrophizing and anxiety indicates that healthcare providers may have not assessed unhelpful pain cognitions, and opioids may have been used by patients to cope with psychological or spiritual distress rather than for analgesia.
British Journal of Pain, 2023
Background: Although multiple measures of the causes and consequences of chronic noncancer pain (... more Background: Although multiple measures of the causes and consequences of chronic noncancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom.
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
Pain Reports, 2018
Introduction: The definition of pain promulgated by the International Association for the Study o... more Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language. Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.
The clinical significance of non-credible responding lies not in adjudicating the reality of pain... more The clinical significance of non-credible responding lies not in adjudicating the reality of pain, but in guiding risk-sensitive clinical decision-making.
The patient need not attribute his or her pain experience to tissue damage; sincerity of expressi... more The patient need not attribute his or her pain experience to tissue damage; sincerity of expression is sufficient.
If clinical interventions that restore or clarify meaning can produce functional benefit for pati... more If clinical interventions that restore or clarify meaning can produce functional benefit for patients with chronic pain, then meaning is an outcome of clinical relevance.
Could we believe that 2 × 2 = 5? Wittgenstein's response is not that we would be universally mist... more Could we believe that 2 × 2 = 5? Wittgenstein's response is not that we would be universally mistaken, but that we could be describing a different mathematical practice.
It remains unclear why the removal of evil should be regarded as a divine obligation if the prima... more It remains unclear why the removal of evil should be regarded as a divine obligation if the primary purpose of God’s existence is not the promotion of human welfare.
How understanding lived pain experience can reshape social understanding beyond the clinic.
Published case evidence that meaning or interpretive context can influence pharmacological and no... more Published case evidence that meaning or interpretive context can influence pharmacological and non-pharmacological analgesia.
How adults respond to a child’s pain does more than soothe the moment, it helps constitute what p... more How adults respond to a child’s pain does more than soothe the moment, it helps constitute what pain is for the child. Calm, regulated, and sympathetic adult responses to the child’s pain help integrate pain into a shared symbolic system, where it can be named, interpreted, and acted upon without becoming catastrophic. By contrast, adult distress and overprotection amplify self-focused threat, narrowing the child’s regulatory capacities and entrenching pain as overwhelming and isolating. Language plays a decisive role: learning to say “it hurts” is not simply the expression of a private experience, but an initiation into a linguistic practice that enables understanding, care, and coordinated response. Pain is given a specific role in human interaction. Fostering regulated, meaning-rich responses to childhood pain can lay the groundwork for resilience, empathy, and adaptive coping across the lifespan.
"Efforts to replace or subordinate clinical judgement to explicit algorithms and rules mistakes h... more "Efforts to replace or subordinate clinical judgement to explicit algorithms and rules mistakes how rules function in practice."
Chronic pain can become central to a person's self-concept, shaping his or her behaviour, thought... more Chronic pain can become central to a person's self-concept, shaping his or her behaviour, thoughts, emotions, attitudes, social participation, and coping. How pain acquires personal meaning and becomes identity-defining are underexamined in contemporary pain research. In this post, I propose sample experimental questions, hypotheses, and predictions for studying this aspect of the meaning of pain.
Five fictional cases showing how the meaning a person gives to their pain can influence their out... more Five fictional cases showing how the meaning a person gives to their pain can influence their outcomes and treatment engagement.
Tapentadol shows short-to medium-term efficacy compared with other strong opioids. However, it re... more Tapentadol shows short-to medium-term efficacy compared with other strong opioids. However, it remains an opioid with dependence and respiratory-risk potential.
For Māori, the indigenous people of Aotearoa New Zealand, pain is not only physical or psychologi... more For Māori, the indigenous people of Aotearoa New Zealand, pain is not only physical or psychological, but relational: it is embedded in family, spirituality, and land.
Uploads
Articles, Chapters, Books, 2008 - by Simon van Rysewyk
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.