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IN CONCLUSION | MOSKOVITZ A Theory of Suffering BY PETER A. MOSKOVITZ, MD I present here a personal theory of suffering. It differs from previous efforts to understand suffering by proposing that the nature of suffering is evolutionary and neurobiological, rather than metaphysical, phenomenological, or linguistic. In this theory I argue six interrelated premises: 1. Persistent grief or fear evokes distinct bodily disturbances (somatic markers) that are experienced as suffering; 2. When pain evokes fear and grief, it has the same effect on the maps in the brain’s body-sensing regions as do fear and grief alone; 3. Suffering is not an emotion, but it is an “emotionally competent stimulus,” capable of evoking emotions; 4. The neural substrate for the experience of suffering requires, in part, the anterior cingulate cortex; 5. The evolution of suffering is essential to the com munication of emotion and to mammalian nurturing; and 6. The capacity for suffering is the experiential precursor of empathy and altruism, which are the components of natural morality. CRPS as the Quintessential Maldynic Pain Disorder James Giordano used the term maldynia to address and describe the trajectory of chronic pain and stated that maldynia “… evokes considerable suffering, but the (direct) cause of this is pain qua [as] illness (1).” “Pain” and “suffering” are distinct experiences; suffering has causes other than pain. The suffering of grief, for example, is often severe and some At Right 30”x40” oil on board. Matt Sesow is an independent American artist residing in Washington, DC. Visit his website at www.sesow.com 74 | T H E PA I N P R A C T I T I O N E R | S P R I N G 2 0 0 6 T H E PA I N P R A C T I T I O N E R | V O L U M E 16 , N U M B E R 1 | 74
T H E PA I N P R A C T I T I O N E R | V O L U M E 16 , N U M B E R 1 | 75
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EDITORS’ CORNER | COMPLEX REGIONA
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COMMENTARY | GIORDANO Comprehending
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FEATURE | BROATCH RSDSA: Expanding
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FEATURE | PATIENT PROFILE PEOPLE WI
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Page 42 and 43: INTERVIEW | COVINGTON Q. Have any s
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Page 47 and 48: with depression. However, they foun
Page 49 and 50: It is common for patients in pain i
Page 51 and 52: There are multiple forms of amplifi
Page 53 and 54: Okay for Vegas. Not your Practice.
Page 55 and 56: especially opioids. Opioids should
Page 57 and 58: Subscribe to Currents Today! The Ac
Page 59 and 60: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 61 and 62: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 63 and 64: ZICONOTIDE: Promising New Treatment
Page 65 and 66: UNRIVALED INDEPENDENCE COMING SOON
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Page 69 and 70: SCS as Part of the CRPS Treatment A
Page 72 and 73: OPINION | GETSON The Use of Thermog
Page 76 and 77: IN CONCLUSION | MOSKOVITZ even thin
Page 78 and 79: IN CONCLUSION | MOSKOVITZ Comorbidi
Page 80 and 81: IN CONCLUSION | MOSKOVITZ empathy e
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Page 86 and 87: RESOURCES | CRPS RESOURCES FOR CRPS
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