The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant (...) to force us to substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982. The new definition follows (most of) my recommendations.]. (shrink)

The official definition of ‘pain’ by the International Association for the Study of Pain (IASP) hasn’t seen much revision since its publication in 1979. There have been various criticisms of the definition in the literature from different quarters: that the definition implies a dubious metaphysical dualism, that it requires a strong form of consciousness as well as linguistic abilities, that it excludes many vulnerable groups that are otherwise perfectly capable of experiencing pain, that it (...) has therefore unacceptable practical as well as ethical consequences, that it is unhelpful to the health-care professional as an operational definition, that it is too narrow, and many others. In my view, most of these criticisms depend on misunderstandings or on uncharitable interpretations. My aim is to go over the definition, clarify some potential ambiguities, and argue that these criticisms don’t cut much ice. At the end, I will present a few slightly reworded versions of the definition that I claim are more felicitous and capture the original intended meaning by the members of the taxonomic committee in a much better and transparent way that avoids all the major extant criticisms in the literature. (Written for interdisciplinary audiences.). (shrink)

[DOI: 10.1097/j.pain.0000000000000765] Amanda Williams and Kenneth Craig, in a recent article in the IASP official journal _Pain_ (DOI: 10.1097/j.pain.0000000000000613), have argued that it is time to revise the IASP's well-entrenched definition of 'pain'. They propose an alternative definition. We critically discuss their proposed revision and argue that it admits clear counterexamples as both sufficient and necessary conditions. We further discuss the wisdom of replacing 'unpleasant' in the IASP definition with 'distress' as Williams and Craig (...) propose. [Craig and Williams respond to our criticism in DOI: 10.1097/j.pain.0000000000000766]. (shrink)

Like other fundamental experiences, the phenomenal qualities of pain seem to defy description. But, unlike these experiences, it is difficult to define pain in terms of a consistent relationship with the extra-mental world. The IASP's solution is to qualify an imprecise characterization of pain's phenomenal qualities through an association with tissue damage and an ability to recognize pain sensation. In this paper I will argue that the IASP's definition lacks the clarity and coherence necessary to (...) provide an adequate definition of pain. I begin by setting out the difficulties of defining pain. I then describe the IASP's solution and provide a detailed criticism of their approach. I also discuss inconsistencies evident in their wider taxonomy. In the final section I argue that pain can be objectively grounded by reference to pain's evolutionary role and suggest an alternative definition. (shrink)

My main interest here is to look at pain as a sign of the body that something is wrong. I will argue that there is a meaning of pain before and after an illness is diagnosed. An illness contains its own semantic paradigm, but the pain before the diagnosis affects the pace of life, not only by limiting our interactions, but also as a struggle with its meaning and a reminder of mortality.My main approach is what I (...) call bio-hermeneutics, an extension of medical hermeneutics branching out from the Continental hermeneutical tradition. As such, I will explore the connection between pain and language, temporality, dialectics, and ontology. Given the centrality of language in constructing the meaning of pain, my analysis is informed by the semantics (looking at pain metaphors), syntax (pain as incoherence), and pragmatics (pain as companion) of expressing pain.The last section explores the meaning of pain in connection with death, as memento mori. Revisiting an old definition of philosophy asmelete thanatou, or ‘rehearsal of death’, I will reflect on the difficulty of finding meaning not only for pain, but also for death as cessation of all existential possibilities. (shrink)

This is a Letter to Editor of _Pain_ recommending revision of a pain term ('nociplastic pain') recently added to the IASP Pain Terms. (With a response from the Taxonomy Committee, Eva Kosek et al. PAIN: June 2018 - Volume 159 - Issue 6 - p 1177–1178.

We present an ontology of pain and of other pain-related phenomena, building on the definition of pain provided by the International Association for the Study of Pain (IASP). Our strategy is to identify an evolutionarily basic canonical pain phenomenon, involving unpleasant sensory and emotional experience based causally in localized tissue damage that is concordant with that experience. We then show how different variant cases of this canonical pain phenomenon can be distinguished, including (...) class='Hi'>pain that is elevated relative to peripheral trauma, pain that is caused neuropathically (thus with no necessary peripheral stimulus), and pain reports arising through deception either of self or of others. We describe how our approach can answer some of the objections raised against the IASP definition, and sketch how it can be used to support more sophisticated discrimination of different types of pain resulting in improved data analysis that can help in advancing pain research. (shrink)

McCaffery's definition of pain has proven to be one of the most consequential in nursing and healthcare more generally. She put forward this definition in response to the persistent undertreatment of pain. However, despite raising her definition to the status of a dogma, the undertreatment remains a real problem. This essay explores the contention that McCaffery's definition of pain elides critical aspects of it, aspects that demand consideration when treating pain. In section (...) I, I set the stage. I discuss how McCaffery's definition and her understanding of pain science interrelate. In section II, I raise three problems for this understanding. In section III, I argue that these problems stem from an incoherency in her definition. Finally, in section IV, I draw from hospice nursing as well as philosophy and the social sciences to redefine ‘pain’ so that an intersubjective feature of it is foregrounded. I also briefly discuss one implication this redefinition has for pain management. (shrink)

A scientific understanding of pain requires an experiential‐phenomenological approach and method, one that precedes mechanistic explanations provided by neuroscience, molecular neurobiology, and even the rest of psychology. A key challenge in this approach is to find ways to observe and characterize the experience of pain. An experiential method applied to both clinical and experimental pain has found three common factors in all instances of pain: a somatic or visceral experience that is comprised of 1) unique sensory (...) qualities that are like those which occur during tissue damaging stimulation, 2) a closely related meaning of intrusion and/or threat, and 3) a feeling of unpleasantness and/or other possible negative emotion(s) in response to 1 and 2. These three factors comprise an experiential definition of pain and they are each correlated with brain activities and functional connections that serve them. Much more is to be learned about the factors and their neural basis. (shrink)

Is a phenomenal pain a conscious primitive or composed of more primitive phenomenal states? Are pain experiences necessarily or only contingently unpleasant? Here, I sketch how to answer such questions concerning intra-phenomenal metaphysics using the example of pain and unpleasantness. Arguments for a symmetrical metaphysical independence of phenomenal pain and unpleasant affect are presented, rejecting a composite view like the IASP definition and dimensional views. The motivating intuition of these views is explained by common binding (...) mechanisms in consciousness and characterized as fallacious if generalized. There are, however, underlying commonalities between pain perception and unpleasant affect, e.g. formal content or evolutionary ancestry. (shrink)

I argue that the understanding of "pain" as presented in the official medical definition by the IASP is ambiguous and likely a cluster concept.

This paper is an attempt to spell out what makes the scientific study of pain so distinctive from a philosophical perspective. Using the IASP definition of ‘pain’ as our guide, we raise a number of questions about the philosophical assumptions underlying the scientific study of pain. We argue that unlike the study of ordinary perception, the study of pain focuses from the very start on the experience itself and its qualities, without making deep assumptions about (...) whether pain experiences are perceptual. This in turn puts scientific explanation in a curious position due to pain’s inherently subjective epistemic nature. The reason for this focus on the experience itself and its qualities, we argue, has to do with pain’s complex phenomenology involving an affective/motivational dimension. We argue for the scientific legitimacy of first‐person phenomenological studies and attempts to correlate phenomenology with neural events. We argue that this methodological procedure is inevitable and has no anti‐physicalist ontological implications when properly understood. We end the paper by commenting on a discussion between two prominent pain scientists in the field, Don Price and Howard Fields, about the need to distinguish more dimensions in the phenomenology of pain and how to classify them vis‐à‐vis the recent scientific findings. Our interest in this discussion is not only to introduce some clarifications but also to show how “neurophenomenology” has already been shaping the scientific research and to back our claim about why this methodology is inevitable with an example. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is (...) at odds with this conceptualisation. By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)

In this chapter we consider the tension between how pain researchers today typically define pains and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, (...) providing evidence that during large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

Contemporary pain literature increasingly acknowledges the need of a multidimensional approach to pain, which accounts for its complex biological, psychological and social components. This is reflected in the recently revised definition of the International Association for the Study of Pain (IASP) and some contemporary philosophical positions. This paper addresses the need to offer a theoretical approach that integrates the biopsychosocial and qualitative multidimensionality of pain by developing the “social grounding view of pain”. My focus (...) is on seeking a multidimensional philosophical approach that accounts not only for its complex biological and psychological aspects but also and specifically does justice to its social dimension. I draw from some of the most recent multidimensional theoretical and methodological approaches that attempt to account for the social component of pain, including enactivism and interpretative phenomenological analysis (IPA), to propose the advancement of the social grounding view, which has a particular focus on socially shared linguistic concepts in relation to the meaning and modulation of pain. More specifically, the social grounding view is based on the argument that the meaning of the experience of pain is determined in part by socially shareable linguistic concepts habitually associated with pain. I test this view against empirical cases drawn from pain neuroscience education (PNE) and try to demonstrate how the modification of the linguistic concepts of pain could be used effectively to modulate its experience. (shrink)

The English word ‘pain’ is commonly used by lay people in a ‘messy’ life-world of imprecise meanings. It has a complex etymology, including legal and political uses as ‘punishment’. Understandings of pain in the political theory of Hobbes and Bentham are summarized. This wider historical and philosophical account of the uses of ‘pain’ means the IASP definition can be seen in relation to medical history and to present-day clinical challenges. We can consider the misunderstandings that may (...) occur between clinicians and pain sufferers, and the ways in which ‘pain’, although ‘subjective’, is inescapably a political concern. Using Wittgenstein’s approach to meaning, however, we can envisage a context-sensitive and flexible approach to communication about pain. (shrink)

Since pain, as a phenomenon, is accessible only to the person who experiences it, when patients want to make it available to their interlocutors, they describe it with very detailed and elaborate metaphorical scenarios, most often those relating to a form of body damage. Using such embodied metonymic and metaphorical definitions, they provide an adequate imaginative simulation of their subjective experience for their recipients. The paper presents an overview of philosophical insights on the phenomenology of pain as well (...) as a review of contemporary neuroscience research on a social dimension of pain, but also the results of cognitive linguistic analysis of pain vocabulary based on descriptors from the McGill Questionnaire as well as on the corpus of authentic doctor-patient dialogues. (shrink)

There are few things in our lives we dislike or hate so strongly as pain. On the other hand, the symptoms of the patients suffered from so-called congenital analgesia teach us that if we are deprived of the ability to feel pain, our lives would be unbelievably miserable and disastrous. In this way, if we try to understand the meaning and the value of pain, it seems we immediately find a paradox. The paradoxical character of pain (...) is reflected in philosophical discussions between subjectivist’s and objectivist’s view of pain. In this paper, I try to show that the seemingly paradoxical character emerges because we are obsessed by groundless prejudice that the concept of pain must have one definite single meaning and that if phenomena of pain can be understood as multidimensional, the various characteristics of pain can be interpreted as various aspects of multi-dimensional pain experiences.Hay pocas cosas en nuestras vidas que nos desagraden u odiemos tan fuertemente como el dolor. Por otro lado, los síntomas de los pacientes que padecen la llamada analgesia congénita nos enseñan que, si nos privamos de la capacidad de sentir dolor, nuestras vidas serían increíblemente miserables y desastrosas. De esta manera, si tratamos de comprender el significado y el valor del dolor parece que encontramos inmediatamente una paradoja. El carácter paradójico del dolor se refleja en discusiones filosóficas entre la visión del dolor subjetivista y objetivista. En este trabajo, trato de mostrar que el carácter aparentemente paradójico surge porque estamos obsesionados por el prejuicio infundado de que el concepto de dolor debe tener un único significado definido; y que, si los fenómenos de dolor pueden entenderse como multidimensionales, las diversas características del dolor pueden ser interpretadas como varios aspectos de expe-riencias de dolor multidimensionales.Palabr. (shrink)

Pain is the most prominent member of a class of sensations known as bodily sensations, which includes itches, tickles, tingles, orgasms, and so on. Bodily sensations are typically attributed to bodily locations and appear to have features such as volume, intensity, duration, and so on, that are ordinarily attributed to physical objects or quantities. Yet these sensations are often thought to be logically private, subjective, self-intimating, and the source of incorrigible knowledge for those who have them. Hence there appear (...) to be reasons both for thinking that pains (along with other similar bodily sensations) are physical objects or conditions that we perceive in body parts, and for thinking that they are not. This apparent paradox is one of the main reasons why philosophers are especially interested in pain. One increasingly popular but still controversial way to deal with this apparent paradox is to defend a perceptual or representational view of pain, according to which feeling pain is in principle no different from undergoing other standard perceptual processes like seeing, hearing, touching, etc. But there are many who think that pains are not amenable to such a treatment. Although it was the treatment of pain as a sensory-discriminative experience that had dominated the philosophical discussions throughout most of the twentieth century, attention to pains’ affective-motivational dimension has gained prominence in recent years. (shrink)

The scientific and philosophical approach to pain must be supplemented by a hermeneutics studying how racism has complicated the communication of pain. Such an investigation reveals that not only are non-white people seen as credibly speaking their pain, but also pain “science” is one of the ways races have historically been constructed. I illustrate this through a study of Frantz Fanon’s clinical writings, along with eighteenth- and nineteenth-century slave-owners’ medical manuals and related documents. I suggest that, (...) with this history, what philosophers understand as the problem of pain is best framed as the problem of colonial violence. (shrink)

In hisRhetoricAristotle gives six definitions of emotions in approximately the following form, with the word(Rhetoric ii.2.137830–1). Does he mean ‘Let anger be a reaching-out, accompanied by pain, forconspicuousrevenge for someconspicuousslight to oneself or one's own, the slight not having been deserved’, or should ϕαινομένηςίην be taken to mean ‘manifest, plain’, or (a third possibility) should it be translated ‘perceived, apparent’? Since this is his fullest definition of anger, the question deserves discussion, even though a number of scholars, including (...) such an expert on Aristotle's philosophy of the emotions as W. W. Fortenbaugh, have previously answered the question in what I think is the right way. (shrink)

This paper develops a phenomenological approach to the concept of pain, which highlights the main presuppositions that underlie pain research undertaken both in the natural and in the sociohistorical sciences. My argument is composed of four steps: only if pain is a stratified experience can it become a legitimate theme in both natural and sociohistorical sciences; the phenomenological method is supremely well suited to disclose the different strata of pain experience; the phenomenological account offered here identifies (...) three fundamental levels that make up the texture of pain experience: pain can be conceived as a prereflective experience, as an object of affective reflection, or as an object of cognitive reflection; and such a stratified account clarifies how pain can be a subject matter in the natural and sociohistorical sciences. Arguably, the natural and sociohistorical sciences address pain at different levels of its manifestation. While the natural sciences address pain as an object of cognitive reflection, sociohistorical sciences first and foremost deal with pain as a prereflective experience and as an object of affective reflection. (shrink)

: Traditional definitions of pain assume that an individual learns about pain through verbal usages related to the experience of injury in early life. This emphasis on the verbal correlates of pain restricts our understanding of pain to the context of adult human consciousness. In this paper we instead support the idea that our understanding of pain originates in neonatal experience and is not merely a verbally determined phenomenon. We also challenge the definition of (...) pain as a merely sensory message related to peripheral tissue trauma. We aim to move beyond this definition by considering the relationship between the centre and periphery, taking into account certain phenomena such as phantom limbs and interoception. We show that pain helps an individual to develop a sense of awareness of himself immersed in a social context, and is thus a complex and adaptive phenomenon, that supports bodily integrity and social behavior. Keywords : Awareness; Consciousness; Experience; Pain; Self-representation Dolore e coscienza negli esseri umani. Ovvero, perché il dolore favorisce l’identità e la rappresentazione di sé Riassunto : La definizione classica di dolore presuppone che l’individuo ne apprenda l'uso verbale attraverso esperienze dolorifiche legate all’infanzia, favorendo una maggiore attenzione per i correlati verbali del dolore. Questo spesso relega il dolore nel contesto della coscienza dell’uomo adulto. Il presente lavoro si propone, in primo luogo, di sottolineare alcune evidenze, a partire dall'esperienza neonatale, a sostegno dell’idea di dolore come esperienza umana e non solo come fenomeno determinato verbalmente. Un secondo aspetto emerge dalla definizione di dolore, il concepirlo come un semplice messaggio sensoriale in seguito a lesioni dei tessuti periferici. Ci si propone, pertanto, di andare oltre tale ipotesi considerando il rapporto tra centro e periferia, a partire da alcuni fenomeni come l’arto fantasma e l’interocezione. Il dolore aiuta inoltre a sviluppare un senso di consapevolezza di sé immerso nel contesto sociale; si tratta dunque di un fenomeno complesso e adattivo, dall’integrità fisica alla dimensione sociale. Parole chiave : Consapevolezza; Coscienza; Esperienza; Dolore; Rappresentazione di sé. (shrink)

The IASP definition of 'pain' defines pain as a subjective experience. The Note accompanying the definition emphasizes that as such pains are not to be identified with objective conditions of body parts (such as actual or potential tissue damage). Nevertheless, it goes on to state that a pain "is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience." This generates a puzzle (...) that philosophers have been well familiar with: how to understand our utterances and judgments attributing pain to body parts. (The puzzle is of course general extending to all sensations routinely located in body parts.) The present work tackles this puzzle. I go over various options specifying the truth-conditions for pain attributing judgments, and at the end make my own recommendation which is an adverbialist, qualia-friendly proposal with completely naturalistic credentials that is also compatible with forms of weak intentionalism. The results are generalizable to other bodily sensations and can be used to illustrate, quite generally, the viability of a qualia-friendly adverbialist (but naturalist and weakly intentionalist) account of perception. (shrink)

In his Rhetoric Aristotle gives six definitions of emotions in approximately the following form, with the word . Does he mean ‘Let anger be a reaching-out, accompanied by pain, for conspicuous revenge for some conspicuous slight to oneself or one's own, the slight not having been deserved’, or should αινομένηςίην be taken to mean ‘manifest, plain’, or should it be translated ‘perceived, apparent’? Since this is his fullest definition of anger, the question deserves discussion, even though a number (...) of scholars, including such an expert on Aristotle's philosophy of the emotions as W. W. Fortenbaugh, have previously answered the question in what I think is the right way. (shrink)

Context: Despite the fact that pain and body awareness are by definition subjective experiences, most studies assessing these phenomena and the relationship between them have done so from a “third-person” perspective, meaning that they have used methods whose aim is to try to objectify the phenomena under study. Problem: This article assesses the question of what is the impact of a widespread chronic pain condition in the bodily experience of persons suffering from fibromyalgia. Method: I used an (...) interview methodology stemming from a phenomenological approach called the “elicitation interview.” Results: The results indicate that the intensification of fibromyalgia pain does in fact affect different aspects of body awareness: in particular, experienced body size, weight and localization, as well as the experience of owning one’s own body. In addition, these disruptions in patient’s body awareness have as a result, a modification of the experience of pain, leading to the apparently paradoxical experience of being in pain while not feeling it. Implications: The elicitation interview approach made it possible to gather and analyze descriptions of the bodily experience of persons suffering from fibromyalgia. This approach allowed the consideration of the hypothesis that the disruption of implicit knowledge of the topography of patients’ bodies prevents them from referring to the pain sensation in terms of its localization and intensity, transforming the sensation in a way that is experienced as paradoxical. Further studies should be conducted that focus on the interplay between attention, pain and body perception. Constructivist content: The study presented in this article is framed within the perspective that the study of conscious phenomena should consider a first-person perspective, which is in line with constructivist approaches. (shrink)

When it comes to communication of pain, Anna Wierzbicka (2012) takes issue with the scientific definition of pain and turns to natural semantic metalanguage (NSM). However, “pain” is not one of the 64 semantic primes in NSM, and therefore Wierzbicka suggests words such as “body,” “bad,” and “don’t want.” This blurs the boundaries between pain and other aversive sensations and it also challenges certain clinical features of the pain experience.

In this article, I focus on what is we know when we know pain or that someone is in pain. I argue that claims of knowledge about pains are problematic because of the complex nature of the phenomenon and because of "pain" is a cluster concept.

This is a Letter to Editor responding to another Letter by Dr. LR Bernstein (PAIN Reports 5, 2020, e814) reacting to my previous article on the IASP definition of pain that appeared in PAIN Reports 4(2019)e777.

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what (...) catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry, rumination, behavioral inhibition and behavioral activation systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing. (shrink)

This is a Letter to Editor responding to the reaction by Ken Craig, Amanda Williams, KJS Anand, to my previous article on the IASP definition of pain that appeared in PAIN Reports 4(2019)e777. The reaction is also in the form of a Letter to Editor in PAIN Reports 5(2020)e811.

Contrary to the commonly assumed opinion that Christianity sees pain as intrinsically evil – where evil is defined as the lack of something good – Aquinas defines pain not as a privation but rather a passion of the soul, i.e., an emotion that depends on sensual and/or intellective cognition of something evil, is good in itself, and may serve a purpose. This article offers a formalized version of the Thomistic definition of pain and related negative (unpleasant) (...) emotions experienced by humans. It also compares and contrasts this view with some contemporary scientific and philosophical models of pain. (shrink)

Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and (...) this state is type identical to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific 'emotion circuit', physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state. (shrink)

Assessments of animal experience and consciousness are embedded in all issues of animal welfare policy, and the field of animal welfare science has been developed to make these evaluations. In light of modern studies of the social construction of scientific knowledge, it is surprising how little attention has been paid to date on how crucial evaluations about animals are made. In this paper, I begin to fill that gap by presenting a historical case study of the attempt to define the (...) pain and distress of one common practice in animal research-the use of the tabletop guillotine to decapitate laboratory rodents. I describe the negotiations involved in reaching consensus on the meaning of the available data and caution animal care and use committees that they should always work with the realization that our scientific knowledge of what animals experience is partial and provisional knowledge at best. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Painful Lack of ConnectionChristopher Bailey (bio)Keywordsdepression, detachment (as a defense), empathy, evolution, masculinityI greatly appreciate the incredibly thoughtful responses to my clinical anecdote, “A Painful Lack of Wounds.” There is, in some more than others, a peculiar aura of detachment that, for me, evokes the very abyss (and its lack of an opposing force) that Colin and I found ourselves staring into that day. I realize, of course, (...) that some level of detachment is necessary to allow airspace for intellectual arrivals and departures.Detachment, moreover, is a form of emotional and psychological escape. In contrast with physical escape, detachment makes something that is present seem absent and, in that regard, is more like camouflage than flight. In some of the responses, therefore, I find myself tuning out the intellectual labyrinth and tuning in to how well it obscures its creator. What wounds or weaknesses, I wonder, is the author trying to hide? Insulin-dependent diabetes? An inferiority complex? Cannot climb chain-link fences? Is he or she hiding these problems from him- or herself? Or just the rest of us?This drive to connect, to regain the biological and the personal, was the ultimate point of my anecdote. I am not suggesting that human beings are biologically built for warfare or that all forms of pathology, at one time, must have conferred some evolutionary advantage. But as omnivorous, social primates, we are definitely adapted for engagement (of all varieties).Certainly, we need to avoid overidentification or sweepingly premature conclusions. Still, no doctor would deny his or her nostrils if cued by a foul, fetid odor to examine a patient for bed sores or gangrene. Likewise, we cannot in our clinical efforts recoil from the same instincts for sniffing out pathology that once made us successful predators. To paraphrase Jeffrey Masson and Susan McCarthy, the authors of When Elephants Weep, when one feels, from observing a bear, that the bear is sad, chances are the bear is sad. To call this anthropomorphizing is a much less parsimonious explanation than the possibility that evolutionary cousins can accurately read one another. And if inter-mammalian empathy is not too much of a stretch, we can probably trust what we feel from an animal of our own species.Granted, it is a long way from feeling to formulation. I chose to write about Colin because he expressed a kind of craving I am finding in a lot of men these days. I do not doubt that cultural pressure, heaped on personal issues and genetic prerogatives, can push a man to place heroism at the center of his psychic universe. Nonetheless, I find it odd that ostensibly comprehensive formulations, like the biopsychosocial model, fail to acknowledge the greater ecosystem in which we dwell. The wheelchair-accessible communities we have created to detach from natural selection are [End Page 249] the same frictionless planes on which masculinity, like a grotesque evolutionary artifact, tends to stumble nowadays.In short, were we not so dependent on the very things we call progress, had we not atrophied from a well-adapted ape to one that can die of hypothermia in 50° weather, I doubt if Colin's insecurity (or anyone's) would be so great. Not that I did not challenge Colin on aspects of his self-doubt. But I did not see it as “inappropriate” either. And although I agree a sense of helplessness can be both cause and effect of depression, his self-doubt, to me, was more than just a “cognitive error” unconsciously conceived as cover for a dark mood. Nondepressed people, after all, score higher than their depressed counterparts on measures of self-deception. The same false sense of security that we, as a culture, have coasted on for decades was shattered for Colin in Iraq. And I believe that is a good thing.Related ArticlesFeature Article: Clinical Anecdotes: A Painful Lack of WoundsCommentary: The Nature of Proof in PsychiatryCommentary: Truth and Healing a Veteran's DepressionCommentary: Inappropriate RegretCommentary: The Cultural Context of Post-traumatic Stress DisorderCommentary: Explication or Explanation?Commentary: The Importance of What Psychiatrists Care AboutCommentary: Mourning or MelancholiaResponse: A... (shrink)

Pains are unpleasant, universally unpleasant. What seems trivially true has been rejected by various pain scientists because of several phenomena which allegedly show that there can be pain which is not unpleasant. This rejection is partly based on the ambiguity of ‘pain unpleasantness’ which can be avoided by distinguishing between primary and secondary pain affect. As for the alleged counterexamples to the above, I will argue that experiences of episodic analgesia as well as the ‘pain’ (...) experiences of some lobotomized and morphine patients should not be construed as cases in which pain and unpleasantness come apart, but rather as cases in which nociceptive activity and pain dissociate. Regarding the notorious case of pain asymbolia, I will demonstrate that the behaviour of patients with this syndrome suggests that they do feel pain, and that their pain sensations are unpleasant, but much less unpleasant than the pains normal people would have if exposed to the same noxious stimuli. Adopting such an account of these phenomena allows us to retain the widely accepted IASP definition of pain, and thus avoids the issue of integrating non-unpleasant pains into a plausible definition of pain. (shrink)

Ben Rich, J.D., Ph.D., presents a scholarly, passionate view of the ethics of the His manuscript is detailed, analytical, and compassionate. No reasonable sensitive person, especially a physician committed to caring for patients, can disagree with the proposal that human beings should have their physical, emotional, and spiritual pain tended to aggressively, meticulously, and compassionately. Similarly, the same individuals advocating for such pain management would agree that no one should go to jail unless he or she is guilty (...) of a serious crime, that decent people should not be robbed or murdered, that children should not be hungry or homeless, and that all citizens of the United States deserve healthcare. Our society attempts to achieve these goals. Laws are written, discussed, and approved by state and federal congresses, voted on by citizens, and theoretically upheld by the courts, churches, and decent individuals. But, unless the world suddenly becomes inhabited by virtuous, ethical humans who can unfailingly differentiate from then, in spite of an abundance of laws and lawyers, doctors, and nurses, this world will continue to have pain and suffering. And, although we want to hold our doctors, politicians, educators, champion athletes, and others to than the average citizen, it is best to remind ourselves frequently that all humans can be weak and are bound to make imprecise judgments, that there is not a homogenous definition of that values and religious beliefs are variable. (shrink)

Fetal pain has long been a contentious issue, in large part because fetal pain is often cited as a reason to restrict access to termination of pregnancy or abortion. We have divergent views regarding the morality of abortion, but have come together to address the evidence for fetal pain. Most reports on the possibility of fetal pain have focused on developmental neuroscience. Reports often suggest that the cortex and intact thalamocortical tracts are necessary for pain (...) experience. Given that the cortex only becomes functional and the tracts only develop after 24 weeks, many reports rule out fetal pain until the final trimester. Here, more recent evidence calling into question the necessity of the cortex for pain and demonstrating functional thalamic connectivity into the subplate is used to argue that the neuroscience cannot definitively rule out fetal pain before 24 weeks. We consider the possibility that the mere experience of pain, without the capacity for self reflection, is morally significant. We believe that fetal pain does not have to be equivalent to a mature adult human experience to matter morally, and so fetal pain might be considered as part of a humane approach to abortion. (shrink)

"More than any other public figure of the eighteenth century, Tom Paine strikes our times like a trumpet blast from a distant world." So begins John Keane's magnificent and award-winning (the Fraunces Tavern Book Award) biography of one of democracy's greatest champions. Among friends and enemies alike, Paine earned a reputation as a notorious pamphleteer, one of the greatest political figures of his day, and the author of three best-selling books, Common Sense, The Rights of Man, and The Age of (...) Reason. Setting his compelling narrative against a vivid social backdrop of prerevolutionary America and the French Revolution, John Keane melds together the public and the shadowy private sides of Paine's life in a remarkable piece of scholarship. This is the definitive biography of a man whose life and work profoundly shaped the modern age. "Provide[s] an engaging perspective on England, America, and France in the tumultuous years of the late eighteenth century." -- Pauline Maier, The New York Times Book Review "It is hard to imagine this magnificent biography ever being superceded.... It is a stylish, splendidly erudite work." -- Terry Eagleton, The Guardian. (shrink)

The definition of cruelty used by the author is broad and ambiguous and does not distinguish between acts of sadism, abuse, and neglect that all lead to the suffering of other beings. Some of the research involving animal cruelty is reviewed with the aim of raising questions about the relevance of the pain–blood–death (PBD) complex described by Nell.

BackgroundThis article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them are critically discussed with such purpose.MethodsA philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of (...) what are found as better definitions of suffering and pain.ResultsPain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one’s own attachment to the world. An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person’s life, and the self is the ever-changing sum of these experiences.ConclusionsThe provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain. (shrink)

Transcranial magnetic stimulation, as a relatively new type of treatment, is a safe and non-invasive method for pain therapy. Here, we used CiteSpace software to visually analyze 440 studies concerning transcranial magnetic stimulation in pain research from 2010 to 2021, indexed by Web of Science, to clarify the research hotspots in different periods and characterize the process of discovery in this field. The United States ranked first in this field. Lefaucheur JP, Fregni F, and Andrade ACD made great (...) contributions to this field of study. The most prolific institution was University of São Paulo. The four main hot keywords were neuropathic pain, motor cortex, connectivity, and non-invasive brain stimulation. There were three main points that were generally accepted: definite analgesic effect of high-frequency rTMS of M1 contralateral to pain side in neuropathic pain; there are inconclusive recommendations regarding rTMS of the dorsolateral prefrontal cortex in fibromyalgia and neuropathic pain; there is low-quality evidence that single doses of high-frequency rTMS of the motor cortex may have short-term effects on chronic pain. This bibliometric analysis indicated that prospective, multi-center, large-sample, randomized controlled trials are still needed to further verify the effectiveness of various transcranial magnetic stimulation parameters in pain research. (shrink)

I propose a broad concept of happiness as an ultimate moral goal that is consistent with what reflective people desire and what people generally approve. Broad happiness includes many and various pleasures, a minimum of pain, a predominately active life and awareness of what can be attained. Besides these characteristics, which are found in Mill, I add that mental and physical faculties must be developed in accord with biological potential, people must be able to choose activities that exercise their (...) developed faculties and must be able to achieve many of the goals toward which their activities aim. This claim can be established by considering scientific data and analyzing what moralists usually approve. According to it, intellectual activities will be found to be the most important aspects of happiness.My concept will differ from Mill’s in that I reject the notion that happiness is synonymous with pleasure and the absence of pain, although both are part of happiness. Because Mill adopted this definition, his theory produced many anomalies. For example, in order to maintain that intellectual activities are morally superior, Mill was led to introduce qualities of pleasure. This maneuver is inconsistent with his empiricism. Moreover, the activities that are most approved from a moral point of view cannot be explained by the pleasure principle. The broad concept of happiness can account for the primacy of intellectual activities and those activities that are most often morally approved. (shrink)

I propose a broad concept of happiness as an ultimate moral goal that is consistent with what reflective people desire and what people generally approve. Broad happiness includes many and various pleasures, a minimum of pain, a predominately active life and awareness of what can be attained. Besides these characteristics, which are found in Mill, I add that mental and physical faculties must be developed in accord with biological potential, people must be able to choose activities that exercise their (...) developed faculties and must be able to achieve many of the goals toward which their activities aim. This claim can be established by considering scientific data and analyzing what moralists usually approve. According to it, intellectual activities will be found to be the most important aspects of happiness.My concept will differ from Mill’s in that I reject the notion that happiness is synonymous with pleasure and the absence of pain, although both are part of happiness. Because Mill adopted this definition, his theory produced many anomalies. For example, in order to maintain that intellectual activities are morally superior, Mill was led to introduce qualities of pleasure. This maneuver is inconsistent with his empiricism. Moreover, the activities that are most approved from a moral point of view cannot be explained by the pleasure principle. The broad concept of happiness can account for the primacy of intellectual activities and those activities that are most often morally approved. (shrink)

Certain patients with a possible contribution of the sympathetic system to pain may not fit the definition of complex regional pain syndromes (CRPS), which raises the question of terminology for those patients. To further clarify the relationship between the sympathetic system and pain, apart from the need for placebo studies, there remains an urgent need for a satisfactory definition of the criteria for a complete sympathetic block. It also remains uncertain whether a change in the (...) discharge pattern of sympathetic fibres underlies the changes in sympathetic organ function, often found in patients with CRPS. (shrink)

According to several prominent philosophers, pleasure and pain come in measurable quantities. This thesis is controversial, however, and many philosophers have presented or felt compelled to respond to arguments for the conclusion that it is false. One important class of these arguments concerns the problem of aggregation, which says that if pleasure and pain were measurable quantities, then, by definition, it would be possible to perform various mathematical and statistical operations on numbers representing amounts of them. It (...) is sometimes argued that such operations cannot be sensibly applied to pleasure and pain, and that sentences expressing such operations must be false or meaningless. The purpose of this paper is to present, explain, and rebut several versions of this argument. In the first section, I present a generic version of the argument. In the second section, I present a defense of its key premise based on a case involving comparisons of relief from pain, and explain why I think it fails. In the third section, I present and rebut another defense, based on a pair of analogies with temperature. In the final section, I present a third defense, based on an analogy with spatial distances. I then present my reasons for rejecting it. Along the way, I explain my reasons for thinking that pleasure and pain are amenable to interval measurement. (shrink)