Peer-reviewed literature and reference texts establish that pain is a subjective experience distinct from physiological nociception and neural reflex pathways.
AbstractNociception reliably elicits an autonomic nervous system (ANS) response. Because pain and ANS circuitry interact on multiple spinal, subcortical, and cortical levels, it remains unclear whether autonomic responses are simply a reflexive product of noxious stimulation regardless of how stimulation is consciously perceived or whether the experience of pain mediates ANS responses to noxious stimulation. To test these alternative predictions, we examined the relative contribution of noxious stimulation and individual pain experience to ANS responses in healthy volunteers who underwent 1 or 2 pain assessment tasks. Participants received 8 seconds of thermal stimulation of varied temperatures and judged pain intensity on every trial. Skin conductance responses and pupil dilation responses to stimulation served as measures of the heat-evoked autonomic response. We used multilevel modelling to examine trial-by-trial relationships between heat, pain, and ANS response. Although both pain and noxious heat stimulation predicted skin conductance response and pupil dilation response in separate analyses, the individual pain experience statistically mediated effects of noxious heat on both outcomes. Furthermore, moderated mediation revealed that evidence for this process was stronger when stimulation was perceived as painful compared with when stimulation was perceived as nonpainful. These findings suggest that pain appraisal regulates the heat-evoked autonomic response to noxious stimulation, documenting the flexibility of the autonomic pain response to adjust to perceived or actual changes in environmental affordances above and beyond nociceptive input.
<h4>Abstract</h4>Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence-based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.
A compound paradox has been identified in the revised (2020) International Association for the Study of Pain (IASP) definition of pain, such that it simultaneously prescribes a connection between pain and tissue damage and allows that prescription to be violated. In a narrative form, the objective of this paper is to reveal these paradoxes and to offer a pathway to their resolution, thus clarifying the definition of pain for the purposes of scientific study and clinical application. The first paradox is that contradictory true positions can be held, when the experiencer claims to be "in pain" and the observer cannot find the required association with tissue damage or, preferably as is argued, nociception. The second paradox is revealed by the construct of "nociplastic" pain, which contradicts the IASP definition to the extent that nociceptors have not been activated, yet at the same time is consistent with that definition to the extent that it "resembles" an experience associated with actual or potential tissue damage. In the interests of all concerned parties, the IASP definition of pain can be strengthened by removing the current ambiguity of interpretation, grounding the experience in a reconceptualisation of nociception as activation of a nociceptive apparatus, and clearly distinguishing it from suffering.
Pain serves the protection of the body. Consequently, noxious stimuli or, more precisely, the thereby induced neurophysiological processes commonly lead to pain perception. Identical noxious stimuli, however, do not always translate into the same pain experience depending on multiple factors. To acknowledge this variability, the distinction between nociception as the neural process elicited by noxious stimuli and pain as subjective multifactorial experience is essential. During longer-lasting experimental pain and chronic pain, nociception and pain can substantially dissociate. Moreover, longer-lasting experimental pain resembles chronic pain regarding certain perceptual features such as prolonged pain duration and intensity fluctuations. Thus, longer-lasting experimental pain offers the opportunity to gain new insights into both the differential neural representation of noxious stimuli and pain and the neuronal mechanisms associated with the state of longer- lasting pain. We applied 10 minutes of painful heat stimulation to the left and right hand of 39 healthy participants while we recorded continuous pain ratings, electroencephalography (EEG), and autonomic responses. Data were analyzed in three distinct projects aiming at different aspects of neuronal mechanisms underlying longer-lasting pain. Project 1 assessed whether stimulus intensity as proxy of nociception and pain intensity relate to distinct patterns of oscillatory brain activity. EEG recordings revealed that incr
[Physiopathology of leg pain].
The real definition of pain, the mechanism of its genesis and the relation with its nociception are now very developed, even to the point of being extremely finely nuanced. The author explains the structure and physiopathology of the nociceptive system, the nociceptors, the role of the neurons in the posterior horn and the spinothalamic duct, and the function of the cerebral cortex. After analysing the international definition of the pain symptom, the author underlines the significance of the subjective component, suffering. There follows an analysis of the specific characteristics of superficial and deep pain (somatic and visceral), of psychical and central pain. The discriminative, affective, emotive, motor vegetative sensorial components and the psychomotor are explained. Finally the mechanism of the genesis of leg pain is examined, with emphasis on the important difference between nociceptive, neurological and projected pain.
Published in Phlebologie
of its body, away from the source of the stimulus. The concept of nociception does not imply any adverse, subjective "feeling" – it is a reflex action.
Fish fulfill several criteria proposed as indicating that non-human animals experience pain. These fulfilled criteria include a suitable nervous system and sensory receptors, opioid receptors and reduced responses to noxious stimuli when given analgesics and local anaesthetics, physiological changes to noxious stimuli, displaying protective motor reactions, exhibiting avoidance learning and making
The nerve impulses of the nociception response may be conducted to the brain thereby registering the location, intensity, quality and unpleasantness of the stimulus. This subjective component of pain involves conscious awareness of both the sensation and the unpleasantness (the aversive, negative affect). The brain processes underlying conscious awareness of the unpleasantness (suffering), are not well understood.
There have been several published lists of criteria for establishing whether non-human animals experience pain, e.g. Some criteria that may indicate the potential of another species, including fishes, to feel pain include:
Introduction: The complex and multidimensional nature of pain poses a major challenge in clinical pain assessments. In this study, we aimed to evaluate a novel approach combining quantitative sensory testing (QST) with event-related potential measurements for assessment of experimental pain in healthy individuals.Methods: QST was performed with a commercial device (PainVision, PS-2100), and numeric rating scale (NRS) scores after exposure to different sensory stimuli were reported by the participants. Resting-state electroencephalography (EEG) was simultaneously performed to capture the cortical responses to peripheral stimulation.Results: Pain scores increased with the intensity of stimuli, with mean NRS scores of 2.7 ± 1.0 after mild stimuli and 5.6 ± 1.0 after moderate stimuli. A reproducible, significant P2-N2 complex was evoked by both mild and moderately painful stimuli, but not by non-painful stimuli. The latency of pain-related potentials was not significantly different between stimuli. The amplitudes of both P2 and N2 components significantly increased when intense nociception was applied, and the increments mainly originated from theta oscillations.Conclusion: The combination of QST with EEG was feasible for subjective and objective pain assessment. Distinct patterns of brain potentials were associated with the phenotype of the peripheral stimuli (e.g., noxious versus. innoxious, high versus. low pain intensity).
Kako je bol fenomenološki dostupna tek nositelju iskustva, što predstavlja prepreku objektivne kategorizacije u jezičnome mediju, želeći je učiniti dostupnom za sugovornika, pacijenti opisuju bol vrlo detaljnim i elaboriranim metaforičkim scenarijima, najčešće onima koji se odnose na neki oblik oštećivanja tijela – osiguravajući takvim utjelovljenim metonimijskim i metaforičkim profiliranjima adekvatnu imaginativnu simulaciju subjektivna iskustva za primatelja, neophodnu za razvijanje empatije. Služeći se kognitivnolingvističkim teorijskim i metodološkim praksama, analizirali smo autentične de
physiological substrates of pain is not sufficient to understand what human pain is all about. People are defined … breakthrough concept simply, “pain is not neurology. The neurologists think that pain is their domain, and it’s … disease or injury severity. Report of pain is subjective, and numerous studies have shown that these
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