Recent studies indicate a role of the sympathetic nervous system in acute and chronic pain. However, the terminology of the clinical sympathetically maintained pain (SMP) syndromes continues to be confusing and the criteria for diagnosis of SMP are being refined. (blumberg et al.) Despite significant progress in recent years, the mechanisms of the interaction between the sympathetic and sensory systems in SMP remain puzzling.

How do technologies that are too complex for any one individual to produce arise and persist in human populations? Contra prevailing views focusing on social learning, Osiurak and Reynaud argue that the primary driver for cumulative technological culture is our ability for technical reasoning. Whilst sympathetic to their overall position, we argue that two specific aspects of their account are implausible: first, that technical reasoning is unique to humans; and second, that technical reasoning is a necessary condition for the production (...) of cumulative technological culture. We then present our own view, which keeps technical reasoning at the forefront but jettisons these conditions. This produces an account of cumulative technological culture that maintains an important role for technical reasoning, whilst being more evolutionarily plausible. (shrink)

The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain (...) is likely to respond to sympatholytic interventions. In a second group, called (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic–sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied. (shrink)

Complex regional pain syndromes (reflex sympathetic dystrophy, causalgia) are often characterized by pain and autonomic and motor abnormalities. Pathophysiological mechanisms are in the central and peripheral nervous system. Differences in skin temperature and may be used as diagnostic criteria. Sympathetic blocks relieve pain and other symptoms in a subgroup of patients (sympathetically maintained pain, SMP).[blumberg et al.].

Sterols and the reductant nicotinamide adenine dinucleotide phosphate (NADPH), essential for eukaryotic life, arose because of, and as an adaptation to, rising levels of molecular oxygen (O2). Hence, the NADPH and O2‐intensive process of sterol biosynthesis is inextricably linked to redox status. In mammals, cholesterol biosynthesis is exquisitely regulated post‐translationally by multiple E3 ubiquitin ligases, with membrane associated Really Interesting New Gene (RING) C3HC4 finger 6 (MARCHF6) degrading at least six enzymes in the pathway. Intriguingly, all these MARCHF6‐dependent enzymes require (...) NADPH. Moreover, MARCHF6 is activated by NADPH, although what this means for control of cholesterol synthesis is unclear. Indeed, this presents a paradox for how NADPH regulates this vital pathway, since NADPH is a cofactor in cholesterol biosynthesis and yet, low levels of NADPH should spare cholesterol biosynthesis enzymes targeted by MARCHF6 by reducing its activity. We speculate MARCHF6 helps mammalian cells adapt to oxidative stress (signified by low NADPH levels) by reducing degradation of cholesterogenic enzymes, thereby maintaining synthesis of protective cholesterol. (shrink)

This commentary on blumberg et al. addresses complications associated with diagnostic testing for sympathetic dependence of pain that can lead to inappropriate positive and negative conclusions. In addition, it is suggested that their test be conceived as a test of the effect of local vascular pressure and that the two types of sensory disorders presented may differ primarily in the degree of sensitization of central pain pathways. Detailed reports with functionally-oriented testing like that done by BLUMBERG are essential (...) for an understanding the pathophysiological mechanisms. (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)

In the Doctrine of Virtue Kant divides duties of love into three categories: beneficent activity , gratitude and Teilnehmung – commonly referred to as the duty of sympathy . In this paper I will argue that the content and scope of the third duty of love has been underestimated by both critics and defenders of Kant's ethical theory. The account which pervades the secondary literature maintains that the third duty of love includes only two components: an obligation to make use (...) of our natural receptivity to sympathetic feelings as a means to fulfilling other duties of love, and an indirect duty to cultivate these feelings. As a result, Kant's duty of sympathy has been widely regarded as a duty whose value is derived from the way in which it serves other duties, in particular, the duty of beneficent activity, which obliges agents ‘to promote according to one's means the happiness of others in need’ . Teilnehmung has thus assumed something of a second-class status among the duties to others. My aim in this paper is to demonstrate that the prevailing account of Kant's third duty of love is incomplete. (shrink)

In a series of articles in this journal, Michael Tye (2002) and Paul Noordhof (2001, 2002) have sparred over the correct explanation of the putative invalidity of the following argument: the pain is in my fingertip; the fingertip is in my mouth; therefore, the pain is in my mouth. Whereas Tye explains the failure of the argument by stating that “pain “creates an intensional context, Noordhof maintains that the “in” in ‘the pain is in my fingertip’ (...) is not spatial, but has state-attributing character. In this paper, we offer a third account, explaining the failure of the argument through state-attributing pragmatic implicatures. Empirical evidence is provided in support of this account. (shrink)

Which nonhuman animals experience conscious pain?1 This question is central to the debate about animal welfare, as well as being of basic interest to scientists and philosophers of mind. Nociception—the capacity to sense noxious stimuli—is one of the most primitive sensory capacities. Neurons functionally specialized for nociception have been described in invertebrates such as the leech Hirudo medicinalis and the marine snail Aplysia californica (Walters 1996). Is all nociception accompanied by conscious pain, even in relatively primitive animals such (...) as Aplysia, or is it the case, as some philosophers continue to maintain, that conscious experiences are the exclu- sive province of human beings? What philosophical and scientific resources are presently available for assessing claims lying between these extremes? (shrink)

The traditional desire view of painfulness maintains that pain sensations are painful because the subject desires that they not be occurring. A significant criticism of this view is that it apparently succumbs to a version of the Euthyphro Dilemma: the desire view, it is argued, is committed to an implausible answer to the question of why pain sensations are painful. In this paper, I explain and defend a new desire view, and one which can avoid the Euthyphro Dilemma. (...) This new view maintains that painfulness is a property, not of pain sensations, but of a pain experience, understood as a relational state constituted by a pain sensation and a desire that the sensation not be occurring. (shrink)

Using conversation analysis and a collection of naturally occurring US primary care consultations, this article explores the search for pain during primary care physical exams. Inhabiting this activity is a ‘collision’ of expertise between physicians’ clinical knowledge about bodies and patients’ knowledge about their bodies. I show how patients responding to questions like does that hurt? tacitly guide physicians to their pain using pain displays, glottal cutoffs and response delays to observably react to the physician’s touch, delineating (...) painful from non- or less-painful areas. Physicians respond to these practices by altering the trajectory of their touch in coordination with the patient’s embodied behavior. In this local context, physicians’ touch not only constrains patients to affirm pain in a particular location, but it is also a unique affordance for patients to guide physicians while nonetheless preserving the physician’s authority over where to test for pain, thereby maintaining the physical examination activity framework. (shrink)

In patients with pain characterized by a painful focus and allodynia, the painful symptoms arise from altered central processing that is initiated and subsequently maintained by persistent input from nociceptive afferents. Treatments directed at this normal consequence of persistent input are inherently limited. The most efficacious treatments will target the pathology, the various sources of ongoing nociceptor input. [blumberg et al.; coderre & katz; dickenson].

Why is pain bad? The most straightforward theory of pain's badness,dolorism, appeals to the phenomenal quality of displeasure. In spite of its explanatory appeal, the view is too straightforward to capture two central puzzles, namely pain that is enjoyed and pain that is not painful. These cases can be captured byconditionalism, which makes the badness of displeasure conditional on an agent's attitude. But conditionalism fails where dolorism succeeds with explanatory appeal. A new approach is proposed,reverse conditionalism, (...) which maintains the explanatory appeal of dolorism, but gives attitudes a value-defeating role. It is argued that this view does best in fulfilling the desiderata and capturing the cases. (shrink)

Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, (...) some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production. (shrink)

There is an apparent contradiction within Levinas’s work: on the one hand, Levinas upholds an account of existence that seemingly requires a creation narrative, while maintaining, on the other hand, that an account of the ethical import of that existence needs no recourse to the divine. This seeming contradiction results from a fundamental misunderstanding concerning Levinas’s account of creation and its logical consequences concerning the divine. This paper aims to clarify this misunderstanding by exploring the similarities between and influence of (...) F. W. J. Schelling’s work on Levinas’s thereby providing a more complete picture of both author’s respective accounts of genesis and the existence of God. (shrink)

Though pain scientists now understand pain to be a complex experience typically composed of sensation, emotion, cognition, and motivational responses, many philosophers maintain that pain is adequately characterized by one privileged aspect of this complexity. Philosophically dominant unitary accounts of pain as a sensation or perception are here evaluated by their ability to explain actual cases—and found wanting. Further, it is argued that no forthcoming unitary characterization of pain is likely to succeed. Instead, I contend (...) that both the motivating intuitions behind unitary accounts and the wide range of pain phenomena are best accommodated by a componential view of pain that does not privilege any single component as necessary or sufficient. (shrink)

While political blackness seems to be making quite a comeback, this resurgence has also met with frustration and ambivalence. This paper aims to make sense of why this mobilising concept is accepted in some contemporary black feminist circles and outright rejected in others. It unpicks the diasporic dimensions of political blackness, reflecting on the issues that converged to foreground ‘black’ as the basis for mobilising women of African and Asian decent to engage in collective activism. Attention is given to the (...) Organisation of Women of Asian and African Descent, a national network that linked black women's organisations and expressed and projected what the author defines as gendered political blackness. Interrogating its implications and the tendency towards ideological policing, the author argues that political blackness must be viewed as a politics of solidarity. If it is to maintain its viability, political blackness needs reframing, contextualising and further analysis. A retelling of its ideological underpinnings, and crucially the tensions and contradictions inherent in political blackness, offers a critical lens through which to rethink how we use it as a mobilising tactic in the present. (shrink)

Few people will easily admit to taking pleasure in the misfortunes of others. But who doesn't enjoy it when an arrogant but untalented contestant is humiliated on American Idol, or when the embarrassing vice of a self-righteous politician is exposed, or even when an envied friend suffers a small setback? The truth is that joy in someone else's pain--known by the German word schadenfreude--permeates our society. In The Joy of Pain, psychologist Richard Smith, one of the world's foremost (...) authorities on envy and shame, sheds much light on a feeling we dare not admit. Smith argues that schadenfreude is a natural human emotion, one worth taking a closer look at, as it reveals much about who we are as human beings. We have a passion for justice. Sometimes, schadenfreude can feel like getting one's revenge, when the suffering person has previously harmed us. But most of us are also motivated to feel good about ourselves, Smith notes, and look for ways to maintain a positive sense of self. One common way to do this is to compare ourselves to others and find areas where we are better. Similarly, the downfall of others--especially when they have seemed superior to us--can lead to a boost in our self-esteem, a lessening of feelings of inferiority. This is often at the root of schadenfreude. As the author points out, most instances of schadenfreude are harmless, on par with the pleasures of light gossip. Yet we must also be mindful that envy can motivate, without full awareness, the engineering of the misfortune we delight in. And envy-induced aggression can take us into dark territory indeed, as Smith shows as he examines the role of envy and schadenfreude in the Nazi persecution of the Jews. Filled with engaging examples of schadenfreude, from popular reality shows to the Duke-Kentucky basketball rivalry, The Joy of Pain provides an intriguing glimpse into a hidden corner of the human psyche. (shrink)

Fibromyalgia is a chronic pain syndrome characterized by dysfunctional processing of nociceptive stimulation. Neuroimaging studies have pointed out that pain-related network functioning seems to be altered in these patients. It is thought that this clinical symptomatology may be maintained or even strengthened because of an enhanced expectancy for painful stimuli or its forthcoming appearance. However, neural electrophysiological correlates associated with such attentional mechanisms have been scarcely explored. In the current study, expectancy processes of upcoming laser stimulation (painful (...) and non-painful) and its further processing were explored by event-related potentials (ERPs). Nineteen fibromyalgia patients and twenty healthy control volunteers took part in the experiment. Behavioral measures (reaction times and subjective pain perception) were also collected. We manipulated the pain/no pain expectancy through an S1–S2 paradigm (cue-target). S1 (image: triangle or square) predicted the S2 appearance (laser stimulation: warmth or pinprick sensation). Laser stimuli were delivered using a CO2 laser device. Temporal and spatial principal component analyses were employed to define and quantify the ERP component reliability. Statistical analyses revealed the existence of an abnormal pattern of pain expectancy in patients with fibromyalgia. Specifically, our results showed attenuated amplitudes at posterior lCNV component in anticipation of painful stimulation that was not found in healthy participants. In contrast, although larger P2 amplitudes to painful compared to innocuous events were shown, patients did not show any amplitude change in this laser-evoked response as a function of pain predictive cues (as occurred in the healthy control group). Additionally, analyses of the subjective perception of pain and reaction time indicated that laser stimuli preceded by pain cues were rated as more painful than those signaling non-pain expectancy and were associated with faster responses. Differences between groups were not found. The present findings suggest the presence of dysfunction in pain expectation mechanisms in fibromyalgia that eventually may make it difficult for patients to correctly interpret signs that prevent pain symptoms. Furthermore, the abnormal pattern in pain expectancy displayed by fibromyalgia patients could result in ineffective pain coping strategies. Understanding the neural correlates of pain processing and its modulatory factors is crucial to identify treatments for chronic pain syndromes. (shrink)

The paper explores Burke’s twofold solution to the paradox of negative emotions. His Philosophical Enquiry (1757/59) employs two models that stand on different anthropological principles: the Exercise Argument borrowed from authors like the Abbé Du Bos, guided by the principle of self-preservation, and the Sympathy Argument, propageted by notable men of lettres such as Lord Kames, ruled by the principle of sociability. Burke interlocks these two arguments through a teleologically-ordered physiology, in which the natural laws of the human body and (...) mind, secretly working in the depth of the nerve fibres, ensure both self-preservation and sociability. Utilizing both efficient and final causes throughout his Enquiry, Burke argues that the experiences of pain and terror – under certain conditions – are made agreeable (delight) by providence,so that the physiological mechanisms underlying these experiences could ensure the health and strenuousness of the nerve fibres amidst the corrupting pleasures of commercial society (Exercise Argument). Furthermore, due to the ambiguous character of this delight annexed to such experiences, they also function as exercises for our social passions (Sympathy Argument). Te 'egoistic' anthropological drive to remove the visceral uneasiness that dominates these experiences facilitates moral action when it is needed the most: when others in pain need our help. In accordance with the anthropocentric providentialism of the moderate Enlightenment, it is the design of the human frame that ensures the activities essential to our health (self-preservation) and moral conduct (sociability), a design that not only guarantees that pleasure, if exclusive and excessive, is 'inconvenient', and pain, if mitigated and harmless, is aesthetically agreeable, but also that our 'egoistic' drive to self-preservation ultimately improves sociability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dominion over Wildlife? An Environmental Theology of Human–Wildlife Relations by Stephen M. VantasselColeman FanninDominion over Wildlife? An Environmental Theology of Human–Wildlife Relations Stephen M. Vantassel Eugene, OR: Resource, 2009. 232pp. $26.00In Dominion over Wildlife?, Stephen Vantassel, a scholar with professional experience in animal damage control, provides a substantive examination of the neglected subject of human–wildlife relations. For this, he is to be commended. Although ultimately disappointing, his argument (...) indicates that much work remains to be done in this area.Vantassel’s subtitle is somewhat misleading since he devotes the bulk of the book to a polemic against a small group he terms “Christian Animal Rights (CAR) activists”—especially Anglican theologian Andrew Linzey and his followers—who question the idea that God grants humans dominion over creation (“Dominionism”), including the moral right to manage, kill, and eat animals. “The critical question... is whether CAR activists are correct in their belief that Scripture exhorts us to adopt a vegetarian and non-violent stance toward animals” (14). Vantassel’s response is more exegetical than theological, and in the mode of conservative evangelical apologetics, he devotes chapters to refuting CAR activists’ appeals to the Old Testament (specifically the covenant of Creation, the narratives of the Fall and Noah, the sacrificial system, and passages that support humane treatment of animals); the New Testament (Christ’s concern for animals, a Christus Victor view of the atonement, and an Edenic eschatology); ethics (compassion, restraint, and stewardship); and science (a case study of whether trapping is unnecessarily cruel and environmentally irresponsible). Only in the final chapter does he propose his model of “Shepherdism,” which “avoids the negative stereotypes held against Dominionism, while upholding God’s decree that humans maintain their superintendence over animals” (160). Shepherdism centers on the principles that creation is “God’s property,” that humans are charged with being its caretakers, and that Christ is a model for behavior toward it. Vantassel insists that humans should treat wildlife humanely and not exterminate species.For Vantassel, theology is a matter of individuals—largely apart from church or tradition—reading an inerrant Bible to discern God’s commands. Likewise, ethics is a matter of individuals using reason to construct arguments that “stand on their own merits” and “may still be sufficient to persuade, if not compel, Christian behavior even if Scripture does not mandate the behavior” (99). This [End Page 193] is not the forum for criticizing these approaches, but they not only distance Vantassel’s argument from scholarship in the field—which he does not engage—but also make it unlikely that it will persuade those who do not read the Bible or view God in the same way. To note two examples, on the basis of Amos 4, he contends that “some environmental problems are caused not through our direct abuse of the land but through our disobedience, which God then punishes through sending environmental catastrophes” (165n13), and on the basis of Christ’s acceptance of fishing with nets (Luke 5:4), he contends that “Christians are permitted to not only eat animals, they may employ means to capture them that will cause pain and injury” (171). Indeed, as a lifelong hunter who shares Vantassel’s basic position, I found myself more sympathetic to the CAR activists’ arguments toward which he is frequently uncharitable; he associates them with Darwinism and feminist and liberation theologies, labels their hermeneutics “modernistic” for stressing narrative, and variously calls their ideas “absurd,” “incredulous,” and “strange.”Vantassel discusses a number of helpful statistics and studies, and he rightly points out the problems posed by factory farming, the disproportionate effects of environmental degradation on the poor, and the practical difficulties of vegetarianism. However, his preoccupation with exegesis means that he underemphasizes these issues and overlooks others, including hunting becoming a trophy-obsessed, technology-dominated “sport.” Hopefully he and other scholars will produce more on this subject in the near future.Coleman FanninBaylor UniversityCopyright © 2013 Society of Christian Ethics... (shrink)

The viscerally Freudian elements of Adorno's use of the concept of mimesis interweave with readings of Kafka in which certain thoughts about childhood play an important role. The first section of this article links biological mimicry with critical theory and art: both mimic what they criticize, while also conserving a repressed and childlike mimetic relationship with otherness and sexual difference. Adorno criticizes both the civilized repression of the mimetic impulse and its subsequently distorted return, a dialectic neglected by direct appeals (...) to mimesis. Good art tries to extricate itself from these distortions. Conversely, the second section of this article explores Adorno's suggestion that fascistic psychology is a refuge for a twisted mimesis of mimesis, which gratifies the worst side of repressed nature while ideologically appealing to the best. Anti-Semitic humour shows how the fascist mimics his own aggressive fantasy of natural law, while secretly envying the closeness to nature he thinks he detects in other races. The final section uses Freud's theories on sympathetic and sadistic comedy to unpack Adorno's readings of Kafka and Mörike. Adorno's critical recuperation of mimetically childlike moments of ridiculousness in art clarifies his differentiation of the varieties of mimesis, as well as countering the gloomy stereotype of the humourless intellectual. But the black side of Adorno's use of laughter dialectically maintains his commitment to painfully remembering the victims of history. (shrink)

Modern technology offers the ability to prolong life by supporting physiologic processes in dying patients who would have succumbed more peacefully to their illnesses in the past. We prolong life, but witness the pain and suffering that our interventions cause. Regardless of one's religious beliefs, the process of making end-of-life decisions is inherently difficult and emotionally trying. The caregiver, family member or friend is faced with making heart-wrenching decisions for loved ones where the line between support and cruelty may (...) feel blurred.This is the nature of ethical dilemmas that arise when core ethical principles collide, necessitating the establishment of the primacy of one over the other. It is... (shrink)

When I say ‘pain’, it is clearly a singular phenomenon. Yet if I ask for an example, you can provide many varying instances that confound the idea of its singularity. How can a pinprick be of the same thing as depression or grief? This study maintains the singularity of pain by exploring the process and structure of its experience to account for its variance and its subjectivity. Heidegger’s Being and Time provides the pathway to achieving this, where we (...) comprehend how pain’s myriad manifestations, and their inherent subjectivity, relate to our way of Being – the meaningful horizon through which we encounter pain. The study comes to tie the process of encountering pain with a structure that suffering provides, which explains both the variance and the subjectivity of the pain experience. This can then be mapped onto individual experiences of a singular phenomenon to understand how they arose and what has conditioned them. (shrink)

This paper aims to provide a theoretical framework for explaining the subjective character of pain experience in terms of what we will call ‘embodied predictive processing’. The predictive processing (PP) theory is a family of views that take perception, action, emotion and cognition to all work together in the service of prediction error minimisation. In this paper we propose an embodied perspective on the PP theory we call the ‘embodied predictive processing (EPP) theory. The EPP theory proposes to explain (...) pain in terms of processes distributed across the whole body. The prediction error minimising system that generates pain experience comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system, maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI ensemble as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. We set out to show how the EPP theory can make sense of how pain experience could be neurobiologically constituted. We take it to be a constraint on the adequacy of a scientific explanation of subjectivity of pain experience that it makes it intelligible how pain can simultaneously be a local sensing of the body, and, at the same time, a more global, all-encompassing attitude towards the environment. Our aim in what follows is to show how the EPP theory can meet this constraint. (shrink)

The experience of pain appears to be associated, from early infancy and across pain stimuli, with a consistent facial expression in humans. A social function is proposed for this: the communication of pain and the need for help to observers, to whom information about danger is of value, and who may provide help within a kin or cooperative relationship. Some commentators have asserted that the evidence is insufficient to account for the consistency of the face, as judged (...) by technical means or in the perceptions of observers, or that facial expression is epiphenomenal to a gross behavioural defensive response to pain. The major criticism is that it is unnecessary to invoke evolutionary mechanisms beyond the emergence of an unconditioned facial response to pain in neonates, subsequently shaped and maintained by instrumental and social reinforcement throughout life. These criticisms are addressed, acknowledging the need for further data to address some, and elaborating the areas in which evolutionary and operant mechanisms would predict different behavioural interactions, rather than acting synergistically. Several supportive commentaries propose extending evolutionarily-based hypotheses to sex differences, the complexities of others' responses within the social relationship, and the role of empathy. A number of commentators provided valuable suggestions for experimental paradigms or methodological issues. Overall, addressing these issues indicates the need for further conceptual development and for collection of data specifically in relation to these hypotheses. (shrink)

The experience of pain appears to be associated, from early infancy and across pain stimuli, with a consistent facial expression in humans. A social function is proposed for this: the communication of pain and the need for help to observers, to whom information about danger is of value, and who may provide help within a kin or cooperative relationship. Some commentators have asserted that the evidence is insufficient to account for the consistency of the face, as judged (...) by technical means or in the perceptions of observers, or that facial expression is epiphenomenal to a gross behavioural defensive response to pain. The major criticism is that it is unnecessary to invoke evolutionary mechanisms beyond the emergence of an unconditioned facial response to pain in neonates, subsequently shaped and maintained by instrumental and social reinforcement throughout life. These criticisms are addressed, acknowledging the need for further data to address some, and elaborating the areas in which evolutionary and operant mechanisms would predict different behavioural interactions, rather than acting synergistically. Several supportive commentaries propose extending evolutionarily-based hypotheses to sex differences, the complexities of others' responses within the social relationship, and the role of empathy. A number of commentators provided valuable suggestions for experimental paradigms or methodological issues. Overall, addressing these issues indicates the need for further conceptual development and for collection of data specifically in relation to these hypotheses. (shrink)

This research used the embodied approach to analyse the pain experiences of 25 heterosexually married Israeli-Jewish women undergoing in vitro fertilization (IVF) treatments for a first pregnancy. Semi-structured interviews were conducted to allow the women to openly discuss issues concerning their perceptions of pain. Research findings show that the women’s pain perceptions dictated two distinct categories of discourse. The first category of discourse surfaced in the accounts of 14 of the interviewees. Women belonging to this category expressed (...) their willingness to “do everything for a child”. These women insisted on silencing pain and considered it to be irrelevant. They refused to locate bodily pains at the centre of their experience, fearing that this would delay their goal of reproducing. The second discourse of pain emerged from the accounts of 11 interviewees. This discourse was associated with women’s motivation to maintain an active dialogue with painful experiences. They obstinately sought to direct internal attentiveness to what was happening inside their bodies. This approach enabled them to define body boundaries and form an active negotiation with the authority treating their bodies. The research findings suggest that women who share the same socio- cultural environment (Israeli pronatalism) and physical circumstances (the inability to conceive) have varied and wideranging interpretations of pain. It seems that medical authorities can benefit the understanding of pain by providing new support resources to women undergoing IVF treatments. (shrink)

Although young children might be uncertain about the nature of certain representations, most modern adults would explicitly maintain that photographs have no ongoing physical connection the objects that they depict. We demonstrate here in three studies that destruction of a photograph of a sentimental object produces significantly more electrodermal activity than destruction of photographs of other control objects. This response is not attributable to anxiety about being observed whilst destroying the picture, nor is it entirely due to simple visual association (...) ‐ the same response occurs when the photograph does not resemble the object. We suggest that this effect may reflect a tacit acceptance of “sympathetic magic”. (shrink)

In his incarnation as ‘Morus’ in Utopia, Thomas More asserts his profound disagreement with his fictional character, Raphael Hythlodaeus. Whereas Hythlodaeus extols the merits of commonality and the moral value of pleasure, Morus dismisses the whole project as absurdity, or hopeless wishful thinking. This divergence has been variously interpreted, but mostly played down. This paper argues that the civilized, amicable, and yet genuine discord between Raphael Hythlodaeus and Morus is the key to Utopia. We can appreciate its importance only if (...) we understand who Hythlodaeus is, and what the purpose of the dialogue is. We also have to do justice to Thomas More’s politics, which were grounded on the authority of the Christian tradition, in the Old and the New Testament. Over the years, Thomas More maintained a very clear and consistent line of thought on the legitimacy of worldly wealth, the responsibilities inherent in its management, the imperative to curb their enjoyment, the temptation of ‘business’ and greed, the duty of charity, and the value of penance, remorse, prayer, and other kinds of self-inflicted suffering. In A Dialogue of Comfort against Tribulation, Anthony, the wiser character, conveys Thomas More’s relentless praise of pain. Anthony has the last word. So, too, does Morus. (shrink)

This is one of a group of papers read at the London Medical Group conference of "Pain: a necessity?",' which was held in Charing Cross Hospital Medical School, London in February 1978. Dr Twycross argues that complete assessment implies the ability not only to make a diagnosis but also to initiate appropriate treatment. Describing the site, severity and quality of the pain is only the first step. A doctor needs to: 1) Be aware of the range of diagnostic (...) possibilities 2) Appreciate the influences of non-physical factors such as mood and morale 3) Be aware of the range of treatemnt options 4) Establish realistic objectives with the patient 5) Reassess at appropriate intervals to review treatment, monitor side-effects, and develop and maintain a good working relationship with the patient. (shrink)

The coronavirus disease 2019 pandemic had a negative psychological impact on the population at scale, yet it is possible that vulnerable patient populations may experience a heavier burden with increased feelings of anxiety and distress. Cancer patients have to trade-off between the fear of exposing themselves to the virus and the need to continue life-saving medical procedures. The present study investigated the prevalence of generalized anxiety and post-traumatic stress symptoms in a population of Italian cancer patients and healthy participants in (...) the months following the COVID-19 outbreak. Using standardized measures of PTSS and generalized anxiety, we found that patients experienced higher levels of adverse mental health outcomes. Several variables were found to negatively affect PTSS and anxiety in this population, including the younger age of respondents, having children, and the impossibility to attend regular medical check-ups. These findings stress the importance of maintaining a clear and regular communication with patients throughout future waves of the pandemic and ensure continuity of care in this vulnerable population. Furthermore, this study indicates the need to establish psychological interventions aimed at patients with cancer, targeting especially younger generations who are more likely to experience adverse psychological outcomes. (shrink)

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of (...) response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer. (shrink)

This paper aims to provide a theoretical framework for explaining the subjective character of pain experience in terms of what we will call ‘embodied predictive processing’. The predictive processing (PP) theory is a family of views that take perception, action, emotion and cognition to all work together in the service of prediction error minimisation. In this paper we propose an embodied perspective on the PP theory we call the ‘embodied predictive processing (EPP) theory. The EPP theory proposes to explain (...) pain in terms of processes distributed across the whole body. The prediction error minimising system that generates pain experience comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system, maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI ensemble as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. We set out to show how the EPP theory can make sense of how pain experience could be neurobiologically constituted. We take it to be a constraint on the adequacy of a scientific explanation of subjectivity of pain experience that it makes it intelligible how pain can simultaneously be a local sensing of the body, and, at the same time, a more global, all-encompassing attitude towards the environment. Our aim in what follows is to show how the EPP theory can meet this constraint. (shrink)

The prevalence of obesity skyrocketed over the past decades to become a significant public health problem. Obesity is recognized as a low-grade inflammatory disease and is linked with several comorbidities such as diabetes, circulatory disease, common neurodegenerative diseases, as well as chronic pain. Adipocytes are a major neuroendocrine organ that continually, and systemically, releases pro-inflammatory factors. While the exact mechanisms driving obesity-induced pain remain poorly defined, nociceptors hypersensitivity may result from the systemic state of inflammation characteristic of obesity (...) as well as weight surplus-induced mechanical stress. Obesity and pain also share various genetic mutations, lifestyle risk factors, and metabolic pathways. For instance, fat pads are often found hyper-innervated and rich in immune cell types of multiple origins. These immunocytes release cytokines, amplifying nociceptor function, which, in turn, via locally-released neuropeptides sustain immunocytes’ function. Here, we posit that along with mechanical stressed stemming from extra weight, the local neuro-immune interplay occurring within the fat pads maintains the state of chronic low-grade inflammation and heightens sensory hypersensitivity. Overall, stopping the harmful neuro-immune crosstalk may constitute a novel pathway to prevent obesity-associated comorbidities, including neuronal hypersensitivity. (shrink)

After situating Andreas Reckwitz’s The Society of Singularities within the broader context of the tradition of social theory, we discuss in detail the obvious strengths of this book, notably its impressive range and originality. Subsequently, we elaborate on two limitations of Reckwitz’s argument. Firstly, we argue that Reckwitz’s use of categories such as ‘singularity’ and ‘universality’ is too all-embracing, lacking the clarity and focus needed to sustain a productive line of inquiry. Secondly, and related to the previous point, we contend (...) that Reckwitz’s claims about the recent trend towards increasing singularity are so broad that they are difficult to refute empirically. Further, we discuss briefly contemporary political developments to demonstrate why the core societal issues at stake cannot be explained through all-inclusive categories such as singularity. Finally, we maintain that existence theory can provide an alternative fruitful perspective on some of the phenomena discussed in this book. (shrink)

Chronic pain is of significant global concern. There is growing evidence that body–mind therapies and psychological approaches can contribute toward changing chronic pain perceptions. This is the first model described in the literature that combines a mindfulness-based approach with dance movement therapy and explores the potential psychological and pain-related changes for this client population. In this paper, the results from the pilot study are presented involving patients with chronic headache recruited in an outpatient rehabilitation setting.Methods: In this (...) pilot study, 29 patients with chronic headache were randomized to either the Mindful-Based Dance Movement Therapy group or the waiting list control group. The MBDMT group was offered 10 sessions in a clinical outpatient rehabilitation setting for 5 weeks. Data were collected pre- and post-intervention and 16 weeks after the intervention was finished. The Hospital Anxiety and Depression Scale, Patient Health Questionnaire−9, Five Facet Mindfulness Questionnaire, and Numeric Rating Scale were used as outcome measures.Results: The working model of MBDMT identifies nine therapeutic mechanisms. Per-protocol analysis reveals statistically significant reduction of pain intensity and depression scores in favor of the MBDMT group, and these improvements were maintained in the follow-up assessment.Conclusions: The results suggest that MBDMT is a feasible and promising therapy approach for chronic pain patients. The pilot study offered sufficient information and preliminary results in the desirable direction to enable the researchers to move to a randomized controlled trial stage in order to establish the efficacy of the intervention.Clinical Trial Registration: The study was registered in the www.researchregistry.com, registry. (shrink)

In this paper I argue that bodily pain, as a phenomenal property, is an essentially and substantial dispositional property. To this end, I maintain that this property is individuated by its phenomenal roles, which can be internal -individuating the property per se- and external -determining further phenomenal or physical properties or states. I then argue that this individuation allows phenomenal roles to be organized in a necessarily asymmetrical net, thereby overcoming the circularity objection to dispositionalism. Finally, I provide reasons (...) to argue that these roles satisfy modal fixity, as posited by Bird, and are not fundamental properties, contra Chalmers’ panpsychism. Thus, bodily pain can be considered a substantial dispositional property entrenched in non-fundamental laws of nature. (shrink)

Both the sensory and the motivational-affective component of pain must be taken into account in studies on sex differences as well as on neuropathic, postoperative, sympathetic, and visceral pain. In all these cases, therapeutic strategies should be aimed at controlling the peripheral, central, and psychological mechanisms underlying the global pain experience. Similarly, it should be recalled that some neuropeptides act on both sensory and affective pain mechanisms. [berkley; mcmahon; dickenson; coderre & katz; wiesenfeld-hallin et al.; blumberg (...) et al.]. (shrink)

Evidence that central sensitization needs to be maintained in an ongoing manner by nociceptive input from the periphery makes the peripheral drive, rather than the central amplification process, the highest priority target for understanding and control. To stop the peripheral drives to kill two birds with one stone. Moreover, the amplification that central sensitization does provide is selective and not necessarily striking in intensity. A that neutralized central sensitization would probably be less effective in controlling persistent pain than (...) many investigators would like to believe. [berkley; blumberg et al.; coderre & katz; dickenson; mcmahon; weisenfeld-hallin et al.]. (shrink)

This Perspective adapts the ViolEx Model, a framework validated in several clinical conditions, to better understand the role of expectations in the recovery and/or maintenance of musculoskeletal pain. Here, particular attention is given to the condition in which dysfunctional expectations are maintained despite no longer being supported by confirmatory evidence. While the ViolEx Model suggests that cognitive immunization strategies are responsible for the maintenance of dysfunctional expectations, we suggest that such phenomenon can also be understood from a Bayesian (...) Brain perspective, according to which the level of precision of the priors is the determinant factor accounting for the extent of priors’ updating. Importantly, this Perspective translates the theory behind these two frameworks into clinical suggestions. Precisely, it is argued that different strategies should be implemented when treating MSK pain patients, depending on the nature of their expectations. (shrink)

This article is concerned with what Nietzsche claims about particular kinds of suffering that can emerge in encounters with others. I maintain that, even taking into account statements of Nietzsche’s that contradict or modify his language of solitude, hardness and domination, his acknowledgement of the capacity of witnessing others’ suffering to cause pain does not indicate an intersubjective notion of self-affirmation, but is an instance of a tension he identifies between our inescapable implication in social ways of being, and (...) our need to create ourselves independently to overcome self-alienation. I argue that Nietzsche’s claims about pity are a particular instance of this tension – that is, that while he recognizes that we feel pity, he treats this as an unfortunate affect to be overcome, to be appropriated on an individual basis, rather than as an invitation to be authentically with others – as indicating the possibility of a mutual project of self-affirmation. (shrink)

Dennett has maintained that a careful examination of our intuitive notion of qualia reveals that it is a confused notion, that it is advisable to accept that experience does not have the properties designated by it and that it is best to eliminate it. Because most scientists share this notion of qualia, the major line of attack of his project becomes that of raising objections against the ability of science to answer some basic questions about qualia. I try to (...) show that science appeals to qualia and that it in fact adheres to a notion of qualia different from the one that Dennett has attributed to it. It is argued that qualia are amenable to scientific investigation and that this is the reason why science contributes toward the clarification of the notion of qualia. I also try to show that Dennett's skepticism about the abilities of science in answering questions posited by one of his thought experiments is unwarranted. I conclude that we need not accept Dennett's eliminativism about qualia. (shrink)

Although activated spinal cord glia contribute importantly to neuropathic pain, how nerve injury activates glia remains controversial. It has recently been proposed, on the basis of genetic approaches, that toll-like receptor 4 may be a key receptor for initiating microglial activation following L5 spinal nerve injury. The present studies extend this idea pharmacologically by showing that TLR4 is key for maintaining neuropathic pain following sciatic nerve chronic constriction injury. Established neuropathic pain was reversed by intrathecally delivered TLR4 (...) receptor antagonists derived from lipopolysaccharide. Additionally, -naltrexone, -naloxone, and -naloxone, which we show here to be TLR4 antagonists in vitro on both stably transfected HEK293-TLR4 and microglial cell lines, suppressed neuropathic pain with complete reversal upon chronic infusion. Immunohistochemical analyses of spinal cords following chronic infusion revealed suppression of CCI-induced microglial activation by -naloxone and -naloxone, paralleling reversal of neuropathic pain. Together, these CCI data support the conclusion that neuron-to-glia signaling through TLR4 is important not only for initiating neuropathic pain, as suggested previously, but also for maintaining established neuropathic pain. Furthermore, these studies suggest that the novel TLR4 antagonists -naloxone and -naloxone can each fully reverse established neuropathic pain upon multi-day administration. This finding with -naloxone is of potential clinical relevance. This is because -naloxone is an antagonist that is inactive at the -opioid selective receptors on neurons that produce analgesia. Thus, these data suggest that -opioid antagonists such as -naloxone may be useful clinically to suppress glial activation, yet -opioid agonists suppress pain. (shrink)

In this paper I shall speak sympathetically of a hedonistic theory of intrinsic value which, ignoring any other such theories, I shall simply call the hedonistic theory of value. How far I am finally committed to it will partly appear at the end.

Thomas Paine was a hugely influential revolutionary pamphleteer, whose writings were instrumental in bringing about some of the greatest political changes the world has seen. Paine's enduring importance lies not so much in the depth of his political philosophy as in his great abilities as a communicator of political ideas. Conway's Writings was the first complete critical collection of Paine's works, and his Life was the first account to show Paine in a positive light.

Dr. Benjamin Rush, who was much impressed by the essay, says, " He [Paine] told me the essay to which I alluded was the first thing he had ever published in ...