On the meaning of pain – guilt in chronic sufferers: does pain mean punishment?

Introduction: The meaning of the word “pain” has an intrinsic component of punishment, penalty, sanction, suffering and torment. Objective: To investigate if pain is perceived by chronic pain patients as a punishment and thus associated with a feeling of guilt. For that purpose, an inventory to detect and quantify guilt was applied to subjects with chronic pain, to individuals with chronic tinnitus and to healthy controls, and results were compared. Method: Through a cross-sectional study (n=136) pain and tinnitus groups were evaluated with validated scales regarding the intensity of pain and tinnitus, and the three groups regarding levels of anxiety, depression, guilt and religiousness. Results: Anxiety and depression levels were the same between groups chronic pain versus chronic tinnitus (p = 0.790; p = 0.938), but different between groups chronic pain versus healthy controls (p < 0.001) and chronic tinnitus versus healthy controls (p <0.001). Guilty feelings showed no differences between group chronic pain versus chronic tinnitus (p = 0.155) and chronic pain versus healthy controls (p = 0.065), though they were greater for group chronic tinnitus as compared with healthy controls (p =0.004). Religiosity indexes were not different among groups. Conclusion: The study demonstrated that chronic pain was not associated with feelings of guilt and thus, at least nowadays and in the population studied, dissociated of the meaning of punishment.