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The Bioethics of Pain Management: Beyond Opioids
  1. Joanna Bourke
  1. Correspondence to Professor Joanna Bourke, Department of History, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK; columba.quigley{at}

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Daniel S Goldberg. Published by Routledge, 2014, hardback, 164 pages. ISBN 978-0415746731, £84.99.

Emily Dickinson, that great nineteenth century American poet, knew about suffering. Chronic pain, oedema and agoraphobia blighted her life. She also understood the power of language—how to shape words into almost visceral evocations of illness, amputation, blindness, anorexia and madness. One of her most famous poems, though, is about pain itself. In words that echo those of pain sufferers throughout time, Dickinson claimed Pain – has an Element of Blank – It cannot recollect When it began – or if there were A time when it was not – It has no Future – but itself – Its Infinite Contain Its Past – enlightened to perceive New Periods – of Pain.

It was a profound depiction of what it means to live in chronic pain: its timelessness, the way it alienates people from each other, its suffocating presence as an enemy that is simultaneously located inside and outside the self and the way it consumes worlds.

In his new book, bioethicist, philosopher and historian Daniel Goldberg reminds us that there is another sense in which pain has ‘an Element of Blank’. Pain is invisible. It cannot be captured in a clinic, laboratory or inside an MRI scanner. The most compassionate physician may be forced to acknowledge defeat in the presence of pain that is both incontrovertibly tangible and yet strangely amorphous. As distinguished pain surgeon René Leriche admitted in 1939, a surgeon often found himself reaching out to patients, sympathetically touching the ‘region of pain’, only to be ‘surprised that you can feel nothing, and yet at times, by your touch, even exciting dreadful recurrent spasms of pain’. There was simply ‘nothing to be seen’. Even the most intimate knowledge of physiology paired with the liveliest imagination failed to provide clinical observers with a way out of the abyss in …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.