Daniel Goldberg is an Associate Professor at the University of Colorado's Center for Bioethics and Humanities, and he has released a new paper "Pain, objectivity, and history: understanding pain stigma* which not only argues the importance of understanding historical context of chronic pain treatment, but helps place it there.
He is interviewed by Sara Zhang in this Atlantic article, I found it very worth the read.
One of the more salient points, to me, is the double-edged sword of medical objectivity especially related to imaging and testing technology. We want, in modern Western medicine, to be able to attribute Symptom A with Pathology A - and for many chronic pain patients, the subjective pain is very very real but the objective findings are elusive. The diagnoses backed up by tests or images carry greater legitimacy and therefore less likely to be stigmatised as some variation of 'malingering'.
This effects not only how pain sufferers are treated by other people, but how pain sufferers treat themselves.
From Zhang's interview:
“Patients want medical imaging, especially people dealing with contested illnesses. Why? Because seeing it confirms the truth of the matter for them. These are the people experiencing it—they don’t have the luxury of denying the reality of their own pain but they kind of do deny the legitimacy of it, especially when everyone else is denying the legitimacy of it.
That’s how stigma works. When everybody else is stigmatizing you for something—day after day, week after week, year after year, guess what? You tend to internalize it. Seeing the image, the pathology, the object confirms the truth of the matter to them.”
Unfortunately, even as the objective result can confirm the truth, an objective finding of 'nothing' from an accurate but not omniscient instrument can make the "truth" even more lonely, when someone suffers without "reason".
*(abstract here http://mh.bmj.com/content/early/2017/02/21/medhum-2016-011133; full text available through BMJ paywall)