Objective Assessment and Disease Models of Chronic Pain: Ethical Considerations for Stigma

Abstract: Chronic pain is an individual and subjective condition that is often refractory to objective assessment. Chronic pain is also highly stigmatized, causing people who live with chronic pain to be disbelieved, ignored, or undertreated, perpetuating health inequities. Advocates argue that chronic pain should be considered a disease, not just a symptom of another condition, to legitimize the experience of chronic pain and reduce stigma. Research on the neuroscience of chronic pain, tools such as Artificial Intelligence (AI), and the recent changes to the ICD-11 that classifies chronic primary pain as a disease in itself, are reinforcing a disease model. However, as the history of medicalization demonstrates, disease models can increase some aspects of stigma (e.g., fear) while reducing others (e.g., blame). This panel will explore the ethical implications of disease explanations of chronic pain on stigma from clinical and population-level ethics perspectives. The panel brings together four speakers with diverse content expertise in stigma studies, bioethics, public health ethics, philosophy, artificial intelligence, and the history of medicine. Panelists will discuss the issue of pain stigma and contestable notions of objectivity from population-level and historical perspectives, how predictive analytics that prioritizes quantification in diagnosis and prognosis neglects embodied knowledge that is necessary for ethically appropriate pain management, findings from an empirical bioethics study on attitudes toward brain disease models of chronic pain on stigma, and how the presumed existence of objective measures of chronic pain may intensify epistemic injustices for people in pain from marginalized communities.