Epistemic Injustice and Chronic Pain Reports

This post is by Veronica de Souza Campos and Daniel De Luca-Noronha who recently published a paper in the Journal of Applied Philosophy, entitled: Misunderstanding Epistemic Injustice: The Case of Chronic Pain Reports.

Migraine

Our article critiques the prevalent tendency to interpret inadequate medical responses to chronic pain reports primarily through the frameworks of testimonial and hermeneutical injustice. While these approaches—drawn largely from Miranda Fricker’s influential work—illuminate important aspects of the problem, they overlook a crucial dimension: what we term inquisitive inertia. 

Inquisitive inertia refers to the failure of healthcare professionals to actively investigate patients’ reports of chronic pain, defaulting instead to prescribing analgesics and dismissing the case. As we argue, this constitutes a form of distributive epistemic injustice, in which patients are denied access to a vital epistemic good: the right to a thorough and sustained inquiry into their condition.

Our article opens with first-person accounts of chronic pain sufferers who report years of misdiagnosis, dismissal, or inadequate treatment. Many scholars interpret such cases as instances of testimonial injustice (where a speaker is discredited due to prejudice) or hermeneutical injustice (where gaps in collective interpretive resources render certain experiences unintelligible). While these forms of injustice are undoubtedly present, the authors contend that they are insufficient to fully explain the epistemic harms experienced by chronic pain patients.

Testimonial injustice certainly plays a role, particularly for women and racial minorities, who are disproportionately undertreated due to implicit bias. However, chronic pain poses distinctive epistemic challenges that go beyond identity-based credibility deficits. Chronic pain often lacks clear aetiology, resists objective measurement, and disrupts narrative coherence. This makes it difficult to describe, even for patients who are believed, because the phenomenon itself strains linguistic expression. As such, even an attentive and impartial listener may fail to grasp the full significance of the patient’s testimony.

Back pain

Hermeneutical injustice also falls short in some respects. Although the development of richer conceptual resources for pain is important, this alone does not resolve the expressive limitations inherent in chronic pain experience. The highly individual and often ineffable nature of chronic pain resists neat categorization, and the dominant biomedical framework, which assumes a direct correlation between tissue damage and reported pain, fails to accommodate cases where no such correlation exists.

We introduce inquisitive inertia as a distinct and under-recognized form of epistemic injustice in healthcare. This occurs when healthcare providers, despite medical indications, refrain from pursuing further inquiry into the patient’s condition. Instead of investigating, they prescribe and dismiss. Such inertia is reinforced by systemic pressures: fragmented care, short consultation windows, and bureaucratic constraints that discourage deeper engagement.

Addressing epistemic injustice in chronic pain requires more than correcting biases or expanding conceptual resources. It demands structural reform that enables and obliges healthcare professionals to take chronic pain reports seriously and to investigate them with the epistemic diligence they deserve.

Veronica Campos is an assistant professor at the Federal University of Minas Gerais (Brazil) and research fellow at the Jesuit School of Philosophy and Theology (Brazil). Her main areas of interest are epistemology, philosophy of pain, and philosophy of religion. 

Daniel De Luca-Noronha is an associate professor at the Jesuit School of Philosophy and Theology. His areas of interest include philosophy of pain, philosophy of emotions, and philosophy of religion.