To cause pain, it is not enough to deliver a dose of noxious stimulation. Pain requires the interaction of sensory processing, emotion, and cognition. In this paper, I focus on the role of cognition in the felt intensity of pain. I provide evidence for the cognitive modulation of pain. In particular, I show that attention and expectation can influence the experience of pain intensity. I also consider the mechanisms that underlie the cognitive effects (...) on pain. I show that all the proposed mechanisms of pain modulation affirm the view that cognition impacts the sensory and discriminative aspects of pain. I conclude that pain perception is a cognitively penetrated phenomenon. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the (...) characterization of placebo analgesia as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

Pain is commonly explained in terms of the perceptual activity of a distinct sensory modality, the function of which is to enable us to perceive actual or potential damage to the body. However, the characterization of pain experience in terms of a distinct sensory modality with such content is problematic. I argue that pain is better explained as occupying a different role in relation to perception: to indicate when the stimuli that are sensed in perceiving anything by (...) means of a sensory modality exceed a significant level of intensity. Viewing the system underlying pain experience as an integral and functionally integrated feature of all the senses provides a new perspective on the diverse forms of pain, what it is like to experience pain and the contrasting natures of pain and pleasure. (shrink)

A recent widely reported study found that some participants would prefer to self-administer a small electric shock than be bored. This flawed study serves as a departure point to diagram pain and sensation beyond the boundaries of the individual body, consisting of four sections. First, in terms of laboratory-based experimentation and auto-experimentation with pain, there is a long history of viewing pain and touch through introspective means. Second, later theories of pain successively widened the scope of (...) the physiological mechanisms and external influences on the organism, such as Melzack and Wall’s cybernetics-influenced gate control theory. Third, we briefly consider the nervous system as a homeostatic system, which finds an historical parallel in explanations of the milieu intérieur of the organism, via Claude Bernard and Kurt Goldstein. Fourth, pain helps tip the organism as a whole from perception to action, but also operates beyond the organism as a biopsychosocial phenomenon. (shrink)

two-dimensional modal framework introduced by Evans [2] and developed by Davies and Humberstone. [3] This framework provides Chalmers with a powerful tool for handling the most serious objection to conceivability arguments for dualism: the problem of..

The paper proposes a novel interpretation of Berkeley's so-called Assimilation Argument in the First Dialogue between Hylas and Philonous.

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)

While extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant co‐ordinators. Semi‐structured face‐to‐face interviews conducted with ten transplant co‐ordinators who have worked for more than 20 years in this job. The transplant co‐ordinators spoke of negative feelings and moral distress with regard to futile care of deceased donor family members as well as of living donors. Transplant co‐ordinators experience intense negative feelings, emotional pain, and moral distress on (...) a daily basis. Transplant co‐ordinators play a pivotal role in the process of obtaining consent for live or dead donation of organ; however, their well‐being and job satisfaction are impaired by contradictions between their moral values and the tasks they are instructed to perform. The study exposes the silent emotional suffering of transplant co‐ordinators; main findings show that the transplant co‐ordinators are torn between contradictory expectations and a gap between values and praxis. It is recommended to offer them training and support for the sake of their retention. (shrink)

When you suffer a pain are you suffering a sensation? An emotion? An aversion? Pain typically has all three components, and others too. There is indeed a distinct sensory system devoted to pain, with its own nociceptors and pathways. As a species of somesthesis, pain has a distinctive sensory organization and its own special sensory qualities. I think it is fair to call it a distinct sensory modality, devoted to nociceptive somesthetic discrimination. But the typical (...) class='Hi'>pain kicks off other processes too. For one it can grab your attention in a distinctive way, alerting you to its presence and sometimes obliging you to focus attention on the damaged member. Intense pain can eliminate your ability to think about anything else. Pain typically has direct and immediate motivational consequences: one wants it to stop, has an incentive to do whatever one can to reduce it, and is gratified by its termination. As these desires and motives collide with neural reality, emotional components of mental anguish, anxiety, and dread arise. The suffering involved in suffering from pain has multiple strands: it is not just the painfulness of the sensation, or the frustration of the desire that it end, but also the anguish over the possibility that it will never end, and the impossibility, if the pain is sufficiently intense, of focusing one’s attention on anything else. (shrink)

There seem to be two kinds of pain: fundamental pain, the intensity of which is a direct function of the intensity of various pain stimuli, and pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and the sociocultural setting in which the stimulus occurs.

One barrier to optimal pain management in the neonatal intensive care unit is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are vulnerable to pain and harm, and completely (...) dependent on others for pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate’s family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers. (shrink)

Receiving a diagnosis of cancer can be devastating. Cancer continues to be one of the most feared diagnoses, and experiencing pain is a major fear for people diagnosed with cancer. Cancer pain is complex in aetiology and can be acute or chronic and can be caused by various compression, ischaemic, neuropathic or inflammatory processes. Many people with cancer will experience excruciating pain, which is often underreported and undertreated. The reasons for this are complex and include various factors (...) including fears and beliefs held by patients. Cognitive factors are important modulators of pain and the appraisals, meanings and beliefs that people have in relation to illness, cancer, and pain, have implications in regard to help-seeking behaviours and the coping strategies people adopt. Cancer pain can impact a range of psycho-social factors across its course. Cancer pain relates to higher rates of psychological distress, anxiety and low mood, and the perception of pain intensity is, in turn, influenced by psychological factors. Cancer pain can negatively affect psychological health, and psycho-social factors can affect the pain experience. It has been suggested that people with a life-limiting illness experience ‘total pain’, and this can encompass psychological, social, practical, spiritual domains. Research demonstrates that cancer is predominantly an illness affecting older people, yet there is a higher risk of under-treated pain in this age group and there is a paucity of research into the subjective experiences of older people managing their cancer pain. Many older people are required to self-manage cancer pain at home as outpatients, due to drivers to keep people out of inpatient care, such as the high healthcare costs of inpatient treatment, and patients wanting to manage their illness, and die, at home. Our own research into this area found that the self-management of cancer pain involves a sequential and temporal process, which centres on perceptions of control. We describe how the older people in our study experienced a perceived loss of control, followed by a sense of gaining control over pain through various experience of certain internal and external factors. The assessment and treatment of physical pain should be done in combination with assessment and treatment of psycho-social and spiritual pain, and interventions for cancer pain need to focus on increasing positive affect and reducing helplessness. No person should suffer with poorly controlled pain and we argue for the need for further research in this area to ensure adequate treatment for all.Clinical Implications: Assessment and treatment of physical pain in people with cancer needs to be conducted in combination with assessment and treatment of psycho-social issues and spiritual pain. Psychological and behavioural approaches have strong evidence supporting their efficacy for reducing cancer pain. Interventions should target helplessness and focus on increasing positive affect through positive psychological states including fighting spirit and resilience. Person-centred interventions that focus on helping people with the search for meaning may help those with cancer pain derive positive benefits. (shrink)

Though the vegetarian movement sparked by Peter Singer’s book Animal Liberation has achieved some success, there is more animal suffering caused today due to factory farming than there was when the book was originally written. In this paper, I argue that there may be a technological solution to the problem of animal suffering in intensive factory farming operations. In particular, I suggest that recent research indicates that we may be very close to, if not already at, the point where we (...) can genetically engineer factory-farmed livestock with a reduced or completely eliminated capacity to suffer. In as much as animal suffering is the principal concern that motivates the animal welfare movement, this development should be of central interest to its adherents. Moreover, I will argue that all people concerned with animal welfare should agree that we ought to replace the animals currently used in factory farming with animals whose ability to suffer is diminished if we are able to do so. (shrink)

Table of Contents: Olivier Massin, 'Pleasure and Its Contraries'; Colin Klein, 'The Penumbral Theory of Masochistic Pleasure'; Siri Leknes and Brock Bastian, 'The Benefits of Pain'; Valerie Gray Hardcastle, 'Pleasure Gone Awry? A New Conceptualization of Chronic Pain and Addiction'; Richard Gray, 'Pain, Perception and the Sensory Modalities: Revisiting the Intensive Theory'; Jonathan Cohen and Matthew Fulkerson, Affect, Rationalization, and Motivation; Murat Aydede, 'How to Unify Theories of Sensory Pleasure: An Adverbialist Proposal'; Adam Shriver, 'The Asymmetrical Contributions (...) of Pleasure and Pain to Subjective Well-Being'. (shrink)

What is the function of pain? A popular view in contemporary philosophy is that the pain system is a bodily disturbance detector: pain states track/detect and represent bodily disturbances and the phenomenal character of the (sensory dimension of) pain supervenes on this representational content. The view can accommodate paradigmatic pain cases, e.g., when pain follows from stepping on a nail. Once we consider more complex pain phenomena, however, it has seemingly little to offer. (...) In this paper, I discuss dissociation between pains and bodily disturbances, variation in pain thresholds, the effects of repeated stimulation on experienced pain intensity, and the modulation of pain experience by cognitive and emotional states. I argue that these phenomena suggest that the pain system is not a bodily disturbance detector, but a sophisticated security system. (shrink)

A collection, edited by David Bain, Michael Brady, and Jennifer Corns, originating in our Pain Project. Table of Contents: Colin Klein and Manolo Martínez – ‘Imperativism and Pain Intensity’; Murat Aydede and Matthew Fulkerson – ‘Pain and Theories of Sensory Affect’; Dan-Mikael Ellingson, Morten Kringlebach, and Siri Leknes – ‘A Neuroscience Perspective on Pleasure and Pain’; Michael Brady – ‘The Rationality of Emotional and Physical Suffering’; Jennifer Corns – ‘The Placebo Effect’; Jesse Prinz – ‘What (...) is the Affective Component of Pain?’; Adam Shriver – ‘The Unpleasantness of Pain for Humans and Other Animals’; Valerie Gary Hardcastle – ‘When is a Pain Not a Pain? The Challenge of Disorders of Consciousness’; Frédérique de Vignemont – ‘The First-Person in Pain’. (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)

Public’s concern about poor animal welfare provided by intensive farming systems has increased over the last decades. This study reviewed the interest of the scientific research on the pain issue in pig production to assess if the societal instances may be a driving force for the research activity. A literature search protocol was set up to identify the peer-reviewed papers published between 1970 and 2017 that covered the topic of ‘pain in pigs’ using Scopus®, database of Elsevier©. One (...) hundred and thirty papers were selected and they were mainly focused on the practice of castration followed by tail docking. The scientific community first focused on these painful practices as a way to improve production efficiency and quality issues while more recently, due to the increased pressure by the public opinion, turned its interest towards the search of alternative solutions. A text mining analysis on the abstract of the selected papers clearly indicated the effort of the research to explore solutions to alleviate pain. Evocative words of this target were the selected terms ‘pharmacological analgesic’ and ‘anaesthetic treatments’. The text mining highlighted vocalizations as the main pain indicators in pigs as this term was frequently associated to ‘acute stress’. Ethical issues were a minor research topic in the scientific literature on pig breeding but in the short run, they are supposed to become a major subject to justify the acceptance of the modern production systems at the eyes of the consumers. (shrink)

Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is, making perceived meaning important in the study of pain. The book contributors explain why meaning is important in the way that pain is felt and promote the integration of quantitative and qualitative methods to study meanings of pain. For the first time in a book, the study of (...) the meanings of pain is given the attention it deserves. All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person’s life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning. Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers. (shrink)

In Why pains are not mental objects Guy Douglasrightly argues that pains are modes rather than objects ofperceptions or sensations. In this paper I try to go a stepfurther and argue that there are circumstances when pains canbecome objects even while they remain modes of experience.By analysing cases of extreme pain as presented by Scarry,Sartre, Wiesel, Grahek and Wall, I attempt to show thatintense physical pain may evolve into a force that, likeimagination, can make our most intense state (...) of experiencebecome a mental object. I shall finally argue that, thoughextreme pains cannot serve as paradigm cases, they do showthe general importance of taking pain states to be objects. (shrink)

Resilience factors have been suggested as key mechanisms in the relation between symptoms and disability among individuals with chronic pain. However, there is a need to better operationalize resilience and to empirically evaluate its role and function. The present study examined psychological flexibility as a resilience factor in relation to symptoms and functioning among 252 adults with chronic pain applying for participation in a digital ACT-based self-help treatment. Participants completed measures of symptoms (pain intensity, anxiety), functioning (...) (pain interference, depression), as well as the hypothesized resilience factor psychological flexibility (measured as avoidance, value obstruction, and value progress). As expected, symptoms, functioning and resilience factors were significantly associated. Hierarchical linear regression analyses showed that psychological flexibility significantly contributed to the prediction of pain interference and depression when adjusting for age, pain and anxiety. Also, participants with low levels of psychological flexibility were more likely to be on sick leave. Furthermore, a series of multiple mediation analyses showed that psychological flexibility (avoidance, value obstruction, value progress) had a significant indirect effect on the relationship between symptoms and functioning. Avoidance was consistently shown to contribute to the indirect effect. Results support previous findings and suggest the importance of psychological flexibility as a resilience factor among individuals with chronic pain and anxiety. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, (...) sensory, affective, and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing amultidimensional phenomenal spacefor pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whosestructurereflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes aprimitivephenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses theutilityof continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

Tracking representationalism explains the negative affective character of pain, and its capacity to motivate action, by reference to the representation of the badness for us of bodily damage. I argue that there is a more fitting instantiation of the tracking relation – the badness for us of extremely intense stimuli – and use this to motivate a non-reductive approach to the negative affective character of pain. The view of pain proposed here is supported by consideration of three (...) related topics: the pain caused when the body is damaged, reparative pain, and the messenger-shooting objection to tracking representationalism. (shrink)

Our pains can be more or less intense, our mental imagery can be more or less vivid, our perceptual experiences can be more or less striking. These degrees of intensity of conscious experiences are all manifestations of a phenomenal property I call mental strength. In this article, I argue that mental strength is a domain-general phenomenal magnitude; in other words, it is a phenomenal quantity shared by all conscious experiences that explains their degree of felt intensity. Mental strength (...) has been largely overlooked in favor of mental states’ type, representational contents, domain-specific phenomenology, or processes such as attention. Considering mental strength in our reflections about the mind illuminates debates about the relation of representational contents and phenomenal character, and it also helps address questions about the structure and functions of consciousness. Mental strength provides a unifying construct to model what is shared in the phenomenology of different types of conscious experiences. (shrink)

Traditional hedonists like Epicurus, Bentham and Sidgwick were quantitative hedonists who assumed that pleasures and pains differ, not just from each other, but also from other pleasures and pains only in such quantitatively measurable ways as intensity, duration, and nearness or remoteness in time. They also differ with respect to their sources or causes. John Stuart Mill introduced an interesting and important complication into the modern theory of hedonism by insisting that pleasures also differ qualitatively as well as quantitatively. (...) This article thoroughly and critically examines Mill’s attempt to explain what qualitative differences might mean, and it proposes, defends, and extends a plausible theory of qualitative differences. (shrink)

Estimating the financial value of pain informs issues as diverse as the market price of analgesics, the cost-effectiveness of clinical treatments, compensation for injury, and the response to public hazards. Such costs are assumed to reflect a stable trade-off between relief of discomfort and money. Here, using an auction-based health market experiment, we show the price people pay for relief of pain is strongly determined by the local context of the market, determined either by recent intensities of (...) class='Hi'>pain, or their immediately disposable income, but not overall wealth. The absence of a stable valuation metric suggests that the dynamic behaviour of health markets is not predictable from the static behaviour of individuals. We conclude that the results follow the dynamics of habit formation models of economic theory, and as such, the study provides the first scientific basis for this type of preference modelling. (shrink)

It is often held that it is conceptually impossible to distinguish between a pain and a pain experience. In this article I present an argument which concludes that people make this distinction. I have done a web-based statistical analysis which is at the core of this argument. It shows that the intensity of pain has a decisive effect on whether people say that they 'feel a pain'(lower intensities) or 'have a pain' (greater intensities). This (...) 'intensity effect'can be best explained by people's varying confidence about their pain, and indicates that 'feeling pain' can be identified as introspective report and 'having pain' as an objective statement — analogous to the traditional sense modalities. However, if people have the ability to make both introspective and objective statements about pain, then it seems indeed the case that they distinguish the appearance from the reality of pain. (shrink)

We investigated the effect of monetary rewards on the rate of pain discounting. Our aim, also, was to understand the effect of previous painful dental experiences on the rate of discounting pain. Two groups completed a discounting task. In the first group, delayed pain was weaker than immediate pain, and in the second group delayed pain was stronger than immediate pain. Two conditions were studied: pain was either accompanied by a monetary reward or (...) not. We found that people preferred immediate pain when it was weaker than delayed pain; however, when delayed pain was stronger than immediate pain, there was no clear preference. In both groups the preference for immediate pain was higher when pain was accompanied by a monetary reward. Previous painful experiences were not related to the rate of discounting. It was concluded that the preference for delayed pain depends on the intensity of pain, and it can be modified by rewards that accompany pain. (shrink)

“Living involves being exposed to pain every second—not necessarily as an insistent reality, but always as a possibility,” writes Arne Vetlesen in A Philosophy of Pain, a thought-provoking look at an inevitable and essential aspect of the human condition. Here, Vetlesen addresses pain in many forms, including the pain inflicted during torture; the pain suffered in disease; the pain accompanying anxiety, grief, and depression; and the pain brought by violence. He examines the dual (...) nature of pain: how we attempt to avoid it as much as possible in our daily lives, and yet conversely, we obtain a thrill from seeking it. Vetlesen’s analysis of pain is revealing, plumbing the very center of many of our most intense and complicated emotions. He looks at pain within different arenas of modern life such as family and work, and he specifically probes at a very common modern phenomenon, the idea of pushing oneself to the limit. Engaging throughout with the ideas of thinkers such as Søren Kierkegaard, Sigmund Freud, Martin Heidegger, Jean-Paul Sartre, Maurice Merleau-Ponty, Max Horkheimer, Theodor Adorno, Alice Miller, Susan Sontag, and Melanie Klein, A Philosophy of Pain asks which came first, thinking or feeling, and explores the concept and possibility of empathy. Vetlesen offers an original and insightful perspective on something that all of us suffer and endure—from a sprained ankle to a broken heart. Although pain is in itself unpleasant, our ability to feel it reminds us that we are alive. (shrink)

: Research done in recent years shows that Virtual Reality can be an effective tool for distracting attention from pain. The purpose of this study was to test how the complexity of Virtual Environment influences the experienced intensity of thermal pain stimuli. A within-subjects design experiment was conducted, using cold pressor test for pain stimulation. Research was done on 31 students of Wroclaw Universities. Participants played games created for the purpose of the study, using head mounted (...) displays and movement sensors. Two Virtual Environments differing in the level of complexity and non-VR control condition were used. The order of all conditions was counterbalanced. Participants reported significantly lower pain intensity after playing the high complexity game, compared to the low complexity game. There were also significant differences between non-VR control condition and high complexity game, but not between non-VR and low complexity game. The pain tolerance was significantly higher in both VR conditions comparing to non-VR conditions. However, no significant differences between VE’s were found in pain tolerance ratings. Results of this study provide preliminary evidence that game complexity can be related to pain experience during VR interventions. (shrink)

Maura Tumulty has raised two objections to my imperative account of pain.1 First, she argues that there is a disanalogy between pains and other imperative sensations like itch, hunger, and thirst. Suppose (with Hall) one thinks that an itch says “Scratch here!”2 Scratch the itch, and it dutifully disappears. Not so with pain. The pain of a broken ankle has the content ‘Do not put weight on that ankle!’ Yet the coddled ankle still throbs: obeying the imperative (...) does not extinguish it. Second, Tumulty argues that the imperative account cannot handle certain pains, particularly pains of the deep viscera. On my account, pains proscribe against taking action with the painful body part. Yet some pains are associated with body parts over which we have no control. Kidney stones cause intense pain, but I cannot (voluntarily) control my kidney. What action, then, could that pain possibly proscribe? Lacking such a story, it is hard to say (as I do) that pains are exhausted by their imperative content. (shrink)

Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents (...) aged 8–18 years were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities, socioemotional functioning, psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key. (shrink)

Pain is often used as the paradigmatic example of a phenomenal kind with a phenomenal quality common and unique to its instantiations. Philosophers have intensely discussed the relation between the subjective feeling, which unites pains and distinguishes them from other experiences, and the phenomenal properties of sensory, affective, and evaluative character along which pains typically vary. At the center of this discussion is the question whether the phenomenal properties prove necessary and/or sufficient for pain. In the empirical literature, (...) sensory, affective, and evaluative properties have played a decisive role in the investigation of psychophysical correspondence and clinical diagnostics. This paper addresses the outlined philosophical and empirical issues from a new perspective by constructing a multidimensional phenomenal space for pain. First, the paper will construe the phenomenal properties of pains in terms of a property space whose structure reflects phenomenal similarities and dissimilarities by means of spatial distance. Second, philosophical debates on necessary and sufficient properties are reconsidered in terms of whether there is a phenomenal space formed of dimensions along which all and only pains vary. It is concluded that there is no space of this kind and, thus, that pain constitutes a primitive phenomenal kind that cannot be analyzed entirely in terms of its varying phenomenal properties. Third, the paper addresses the utility of continued reference to pain and its phenomenal properties in philosophical and scientific discourses. It is argued that numerous insights into the phenomenal structure of pain can be gained that have thus far received insufficient attention. (shrink)

The widely touted discovery of mirror neurons has generated intense scientific interest in the neurobiology of intersubjectivity. Social neuroscientists have claimed that mirror neurons, located in brain regions associated with motor action, facial recognition, and somatosensory processing, allow us to automatically grasp other people's intentions and emotions. Despite controversies, mirror neuron research is animating materialist, affective, and embodied accounts of intersubjectivity. My view is that mirror neurons raise issues that are directly relevant to feminism and cultural studies, but interventions are (...) needed for the work to be compatible with nonreductionist critical thought. In this article I critique the dominant neuroscientific account of mirror neurons, called embodied simulation theory. I draw from feminist epistemologies as well as alternative interpretations of mirror neurons in cognitive science and philosophy of mind to consider mirroring as situated, embodied perception. (shrink)

“Living involves being exposed to pain every second—not necessarily as an insistent reality, but always as a possibility,” writes Arne Vetlesen in _A Philosophy of Pain_, a thought-provoking look at an inevitable and essential aspect of the human condition. Here, Vetlesen addresses pain in many forms, including the pain inflicted during torture; the pain suffered in disease; the pain accompanying anxiety, grief, and depression; and the pain brought by violence. He examines the dual nature (...) of pain: how we attempt to avoid it as much as possible in our daily lives, and yet conversely, we obtain a thrill from seeking it. Vetlesen’s analysis of pain is revealing, plumbing the very center of many of our most intense and complicated emotions. He looks at pain within different arenas of modern life such as family and work, and he specifically probes at a very common modern phenomenon, the idea of pushing oneself to the limit. Engaging throughout with the ideas of thinkers such as Søren Kierkegaard, Sigmund Freud, Martin Heidegger, Jean-Paul Sartre, Maurice Merleau-Ponty, Max Horkheimer, Theodor Adorno, Alice Miller, Susan Sontag, and Melanie Klein, _A Philosophy of Pain_ asks which came first, thinking or feeling, and explores the concept and possibility of empathy. Vetlesen offers an original and insightful perspective on something that all of us suffer and endure—from a sprained ankle to a broken heart. Although pain is in itself unpleasant, our ability to feel it reminds us that we are alive. (shrink)

This article focuses on the ethical aspects of medically-induced sedation and pain relief in intensive care medicine. The study results reported are part of a larger investigation of patients’ experiences of being sedated and receiving pain relief, and also families’ experiences of having a close relative under controlled sedation in an intensive care unit. The study is based on qualitative in-depth interviews with nine nurses and six doctors working in intensive care and surgical units in a major Norwegian (...) hospital. The textual data are interpreted according to Kvale’s method for analyzing qualitative data. There are ethical problems regarding how to achieve an acceptable balance between a patient’s subjective well-being and the medical need for reduced sedation. The authors discuss whether some medical reasons for reduced sedation are ethically justifiable, given the actual medical knowledge available. The study also addresses the ethical consequences of reducing medically-induced sedation and the demands it puts on interdisciplinary co-operation and communication, as well as the importance of improving the quality of medical and nursing care. (shrink)

Background: Pain has been associated with structural changes of the brain. However, evidence regarding white matter changes in response to acute pain protocols is still scarce. In the present study, we assess the existence of differences in brain white matter related to pain intensity reported by patients undergoing surgical removal of a mandibular impacted third molar using diffusion tensor imaging analysis.Methods: 30 participants reported their subjective pain using a visual analog scale at three postsurgical stages: (...) under anesthesia, in pain, and after the administration of an analgesic. The diffusion data were acquired prior to surgery.Results: DTI analysis yielded significant positive associations of fractional anisotropy in white matter areas related to pain processing with the differences in pain between the three postsurgery stages. Extent and location of these associations depended on the magnitude of the subjective pain differences. Tractography analysis indicated that some pain–tract associations are significant only when pain stage is involved in the contrast, while others are only when anesthesia is involved in the contrast.Conclusions: The association of white matter fractional anisotropy and connectivity, measured before the pain stages, with subjective pain depends on the magnitude of the differences in pain scores. (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)

Respect and dignity are central to moral life, and have a particular importance in health care settings such as the intensive care unit (ICU). We conducted 15 semistructured interviews with 21 participants during an ICU admission to explore the definition of, and specific behaviors that demonstrate, respect and dignity during treatment in the ICU. We transcribed interviews and conducted thematic qualitative analysis. Seven themes emerged that focused on what it means to be treated with respect and/or dignity: treated as a (...) person; Golden Rule; acknowledgement; treated as family/friend; treated as an individual; treated as important/valuable; and treated as equal. Participants described particular behaviors or actions that were considered related to demonstrating treatment with respect and dignity: listening; honesty/giving information; attention to body/modesty/appearance; caring/bedside manner; patient and family as an information source; attention to pain; and responsiveness. These behaviors provide a framework for improving experiences with care in the ICU. (shrink)

Introduction: Traditionally, empathy has been studied from two main perspectives: the theory-theory approach and the simulation theory approach. These theories claim that social emotions are fundamentally constituted by mind states in the brain. In contrast, classical phenomenology and recent research based on enactive theories consider empathy as the basic process of contacting others’ emotional experiences through direct bodily perception and sensation. Objective: This study aims to enrich knowledge of the empathic experience of pain by using an experimental phenomenological method. (...) Method: Implementing an experimental paradigm used in affective neuroscience, we exposed 28 healthy adults to a video of sportspersons suffering physical accidents while practicing extreme sports. Immediately after watching the video, each participant underwent a phenomenological interview to gather data on embodied, multi-layered dimensions (bodily sensations, emotions, and motivations) and temporal aspects of empathic experience. We also performed quantitative analyses of the phenomenological categories. Results: Experiential access to the other person’s painful experience involves four main-themes. Bodily resonance: participants felt a multiplicity of bodily, affective, and kinesthetic sensations. Attentional focus: some participants centered their attention more on their own personal discomfort and sensations of rejection, while others on the pain and suffering experienced by the sportspersons. Kinesthetic motivation: some participants experienced the feeling in their bodies to avoid or escape from watching the video, while others experienced the need to help the sportspersons avoid suffering any injury while practicing extreme sports. Temporality of experience: participants witnessed temporal fluctuations in their experiences, bringing intensity changes in their bodily resonance, attentional focus, and kinesthetic motivation. Finally, two experiential structures were found: one structure is self-centered empathic experience, characterized by bodily resonance, attentional focus centered on the participant’s own experience of seeing the sportsperson suffering, and self-protective kinesthetic motivation; the other structure is other-centered empathic experience, characterized by bodily resonance, attentional focus centered on the sportsperson, and prosocial kinesthetic motivation to help them. Discussion: We show how phenomenological data may contribute to comprehending empathy for pain in social neuroscience. In addition, we address the phenomenological aspect of the enactive approach to the three dimensions of embodiment of human consciousness, especially the intersubjective dimension. Also, based on our results, we suggest an extension of the enactive theory for non-interactive social experience. (shrink)

Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying (...) ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1) Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9); 2) Deputy chief provincial coroners (N = 5); 3) Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12). Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia. (shrink)