TIME Magazine: Living With Pain – An Aristotelian Perspective

By | March 2, 2011

Aristotle's multifaceted theory of causation points out the difficulty in making a diagnosis and developing rational treatment plans.

In the first chronic pain case dealing with her own mother, Ms. Suddath describes the onset of low back pain symptoms as occurring two days after moving a concrete flower pot from the living room to the patio. This illustrates an extremely common problem in most pain cases, differentiating between causation and chronological happenstance. In this case the putative causal link between the flowerpot and the patient’s subsequent symptoms, however tantalizing, remains unproven and unprovable. One cannot run time backwards and tell the woman not to move that pot, but perhaps a smaller and lighter one.

Even if for the sake of argument, one were to accept a causal relationship, one would still be left with a difficult philosophical problem and a frequent clinical roadblock best explained in terms of Aristotle’s four components of causation: material, formal, efficient and final. Leaving aside for a moment the question of final causation, which is rarely important medically, moving the plant may or may not have constituted the efficient cause of this woman’s spinal problems. As we said above we cannot go back in time and tell her not to move the flow pot. Furthermore the question of efficient causation is almost certainly the least important of the remaining questions, since in the end it would have mattered little if the injury had been caused by moving a flower pot, a garbage can or even some grocery bags. In a similar vein, while one or more of the 13 damaged or herniated disks in her spine are likely to be the formal cause of her pain, focusing on the anatomy leaves unanswered the more important question of material causation.

I have seen many patients with extensive lumbar and thoracic disk disease, although not quite as bad as this. The important point however, is to differentiate them from the more common problem of one or two level disk protrusions or herniation. When this many discs are affected the real problem is not the nature of the trauma leading to deformity of the disc or the exact anatomical location and extent of the deformity, but rather the underlying weakness in the disks which predisposed them to degeneration. I have instituted numerous workups looking for such underlying causes and must confess that given the current state of medical knowledge most of these searches lead to inconclusive answers. They are important nevertheless. In some cases treatable conditions are found and in others the patient at least has the peace of mind that comes from knowing which diseases or conditions they do not have.


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