The paradox of pain: between subjectivity and measurement

Since the well-known 1996 campaign promoted by the American Pain Society, entitled “Pain: The 5th Vital Sign,” pain has progressively come to be recognized as the fifth vital sign of the human body. This initiative contributed to reinforcing the clinical obligation to systematically assess pain and provide appropriate treatment. Today, pain assessment is an integral component of clinical care pathways, from diagnosis to therapeutic monitoring and the evaluation of clinical outcomes and quality of life. Despite the availability of validated scales and standardized instruments – such as the Numeric Rating Scale (NRS), the Visual Analogue Scale (VAS), the Verbal Rating Scale (VRS), and multidimensional measures – pain assessment continues to face a structural limitation: pain remains a subjective experience that is neither immediately nor directly observable and can be accessed only indirectly through the patient’s account. Although clinically necessary, the measurement of pain does not fully capture the complexity of the lived experience, which is shaped by bodily, psychological, relational, and contextual factors. The aim of this paper is to analyze the tension between the clinical objectification of pain and the subjective dimension of painful experience, with particular attention to its ethical and decision-making implications. To this end, the paper draws on conceptual resources from the phenomenological and hermeneutic traditions, beginning with Edmund Husserl and Maurice Merleau-Ponty, who developed the distinction between the body as object and the lived body, emphasizing the embodied nature of perceptual experience. These reflections are complemented by contemporary contributions to the phenomenology of the body and pain, particularly those of Drew Leder, as well as by Elaine Scarry’s philosophical and literary analysis of pain as an experience that resists language. Rather than offering a purely theoretical reflection, we seek – through a closer examination of the concepts of total pain and narrative medicine, as developed by Cecily Saunders and Rita Charon – to propose an interpretive framework relevant to clinical practice. Recognizing the intrinsically subjective dimension of pain may strengthen active listening, foster the therapeutic alliance, and support more proportionate and personalized decision-making.