Twinges- Susan Deborah King

Twinges

Once you've had cancer, even after
every odd sensation is worms
beginning to nibble you.
Jabbing pains, persistent aches
or coughs, cuts slow to heal can be
a witch's finger poking your flesh
to see if you're fath enough yet for the oven,
can be a choking piece of poisoned apple,
a spindle's prick casting an evil spell.

How to trick the witch, get the weight
of her own ego to throw herself
into the fire instead, how to
enlist hte assistance of dwarves
and princes for rescue. Before,
death was a fairy tale that would
never actually happen to us.
What liars our parents were!
The bogyman is too real!

That's not just the pounding of our hearts
when we discover another questionable
mole.  It's him on horseback,
his hoof beats aiming our way
to scare right into us, living hell.
We stick out our tongues, bare claws,
make like gargoyles, trying to protect
this sanctuary of our blood and breath
and drive off the monster another little while.

21 Love Poems - VIII- Adrienne Rich

I can see myself years back at Sunion,
hurting with an infected foot, Philoctetes
in woman's form, limping the long path,
lying on a headland over the dark sea,
looking down the red rocks to where a soundless curl
of white told me a wave had struck,
imagining the pull of that water from that height,
knowing deliberate suicide wasn't my metier*,
yet all the time nursing, measuring that wound.
Well, that's finished.  The woman who cherished
her suffering is dead.  I am her descendant.
I love the scar-tissue she handed on to me,
but I want to go on from here with you
fighting the temptation to make a career of pain.

*forte

Seeing the Dr.

I saw my (primary care) doctor again today to speak with him about the hallucinations.  Sunday night/Monday morning was the third time I've had hallucinations.  The first time, I had recurring visions of a main poised over me with a knife, and I would throw myself away from him, hurting myself.  The second time, which I did not mention to my doctor due to content, I imagined a man chasing me to rape me.  I hid in the bathroom.  This past time, I saw men in a loud machine trying to break into the house.  I suppose that means I've been reading too much steampunk and taking too much Vicodin.

In any case, I've been told I can have no more Vicodin, for now.  Apparently, this is the worst of side effects short of actual death or coma.  So let's see when the withdrawal kicks in.

I've been referred to a third back doctor- a woman this time.  And I am told to try another acupuncturist- one my doctor has recommended. 

Now, not only will I have a list of things I've tried, but a list of things I've tried more than once.  And I'll have to come downtown once a week, at least.

How will I pull that off when school starts again?

I can't use heatpads, because the last one burned me so badly.  We've taken pictures, and will send them with a letter to the manufacturer.  I'm not sure what my mom hopes will happen- but I'm hoping that they'll reconsider the warning label on their product- state that this can happen.

So tired and aching.  I don't know what will happen when the pain hits and I can't take anything much.  Let's find out, I guess.

Cancer Journals- Found Poem

On the morning of the third day,
the pain returned
home
bringing all of its kinfolk.  Not
that any
single
one of them was overwhelming, but just that all
in concert, or even in small repertory groups,

they were excruciating.

There were constant ones and intermittent ones.
There were short sharp and long dull and various combinations of the same ones.
The muscles in my back and right shoulder began to screech
as if they'd been pulled apart and
now
were coming back to life
slowly
and against their will.

My chest
wall
was beginning to ache and burn and stab
by turns.

My breast
which was no longer there
would hurt

as if were being squeezed in a vise.
That was perhaps the worst
pain
of all, because
it would come
with a full complement of horror
that I was to be forever reminded of
my loss
by suffering

in a part of me
which was no longer there. I suddenly seemed to get
weaker rather than stronger.  The euphoria
and numbing

effects
of the anesthesia
were beginning to subside

From page 37-38
Lorde, Audre. The Cancer Journals. Special Ed. San Francisco: aunt lute books, 1997.

McGill Pain Questionnaire- Found Poem

The McGill Pain Questionnaire

consists primarily of 3
major cl
asses of word descriptors —


sensory, affect
ive and evaluative — that
are used by patients to specify subjective
pain experience.

It also contains an intensity
scale and other items to determine
the properties of
pain experience.

The questionnaire was designed to provide
quantitative measures
of
clinical pain that can be
treated statistically.



From
Melzack, Ronald. "The McGill Pain Questionnaire: Major properties and scoring methods." Pain 1.3 (1975): 277-299.

I Will Make Violence Unto Myself

For I will burst open all my many blisters and pull away my scabs

For I will press down on my bruises
hard
so that the pain begins to seep

For I will allow the young and feisty she-cat to catch me sometimes
when we use my hands
as playthings

For I will let the heat pad warm me 'til
it burns
me
and pull away the fleshy remains
to bleed

For I will wear too high of heels and too strappy of shoes
that dig
into my toes
and rub my heels and
scar

For I will use my fingers as weapons, my will as a
weapon

For I will make violence unto myself
For I will casually assert my power over
my
body and
my
pain.

For I will carry biting spiders to freedom in naked hands
For I will tug away at hangnails, separate them from me
For I will clean my gums so that my brush and spit come out red

For I will no longer submit
to pills and pills and side effects of pills

For I will prove that I am visible: geographically and three-dimensionally
For I will not be oppressed by my own
blood and sinew and flesh and confused brain stem
For I will assert
my
self

For I will write until my wrist aches for I will be my own master

For I will make violence unto myself

On Considering Audrey Lorde's Cancer Journals

A deep feminist shame pulls
into port
and crashes into splintered, wooden shards
that tear at the skin
of the one-breasted woman metaphor

the scarves of concealment and auto-bio-liberation
imagining of the was-self
becoming lost in a crowd of well-accessorized women

there is an ugliness in these burns, I know
but why should it be an unfeminine ugly?
under this carefully crafted veil of falsely
straightened hair

of course,
the collar cannot show, of course
it is a fashion statement of self-pity and other pity
a woman is already a thing of pity
enough

this slight of hand/optical illusion
would have made me disappear
at least from the wary weary eyes of my sister-sufferers

these measures of concealment are the grabbing hands
they lead women to wear turtlenecks and
long-sleeved t-shirts and heavy
make up
and they cover the mouth to capture the pain
within
the lips

so
I will hold onto the dismembered figure of the one-breasted woman metaphor
and I will make myself disappear
through my silent invisbility and two-dimensionality
no more

McGill Pain Questionnaire

Words for describing pain- used to find out exactly how much pain we're really in. Expect commentary later.

Group 1 Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding

Group 2 Jumping, Flashing, Shooting

Group 3 Pricking, Boring, Drilling, Stabbing

Group 4 Sharp, Cutting, Lacerating

Group 5 Pinching, Pressing, Gnawing, Cramping, Crushing

Group 6 Tugging, Pulling, Wrenching

Group 7 Hot, Burning, Scalding, Searing

Group 8 Tingling, Itchy, Smarting, Stinging

Group 9 Dull, Sore, Hurting, Aching, Heavy

Group 10 Tender, Taut (tight), Rasping, Splitting

Group 11 Tiring, Exhausting

Group 12 Sickening, Suffocating

Group 13 Fearful, Frightful, Terrifying

Group 14 Punishing, Grueling, Cruel, Vicious, Killing

Group 15 Wretched, Binding

Group 16 Annoying, Troublesome, Miserable, Intense, Unbearable

Group 17 Spreading, Radiating, Penetrating, Piercing

Group 18 Tight, Numb, Squeezing, Drawing, Tearing

Group 19 Cool, Cold, Freezing

Group 20 Nagging, Nauseating, Agonizing, Dreadful, Torturing

I Will Bring Pain Unto Myself

That's the real trouble with this disease.  It pulls at you and stretches you and compresses you to the point of simultaneous implosion and explosion.  It vibrates and chimes in your head and reverberates through your body.  This pain should not be dismissed- seen as less than for being "non-life threatening"-- it is life threatening in so many ways.

For the first time all year, I noticed that the stairways in the University are suicide-proof-- crowded together so that there is no place to jump from.  All of the windows opening just a crack.  No roof access.  Low speed limits.  I can feel them trying to protect me from myself.

Yet, it is the controlled pain that is more beguiling than the possibility of complete release.  I find bruises on myself, press them to bring about the weak hurt, remove my hand, then press again.  Such a feeling of power.  I am the master of my own pain.

This is not enough- I want more bruises, more scabs, more blisters on my feet.  I wear shoes that are painful but forget so quickly the hurt.  I pick at my head until it bleeds then pick the healing wounds.  I have started hitting my arms when the pain, the real pain, gets too hard to understand.  I want my arms to become a visiblization of my hurt.

Today, I wore a new kind of heat pad all day.  It hurt for a few minutes, but then I forgot all about it, except the warmth.  When I removed it after returning home from work, I found deep burns all along my neck.  The heat pad literally burnt away layers of flesh on my neck and I didn't notice at all. 

Part of me is terrified.  I have become some sort of sideshow spectacle.  A human pincushion of sorts.  It can't be normal to simply not notice pain-- it must have hurt.  I notice is now and it hurts, but not really.  It just doesn't compare.

Part of me is proud.  I've been told that I've build up a tolerance to pain.  I can bear so much "regular pain" in comparison to the real pain that debilitates.  Why would this be something to feel proud about?  Perhaps it is simply me trying to be positive.

 I will need to consider this further.

Quote

“Our body is not in space like things; it inhabits or haunts space.”
Maurice Merleau-Ponty

research

wordifying the sensation
"let me tell you a story"

she trains for years
stretch herself up ten feet and backward into a crazy π
but contorting herself into 1.5 cubic feet
is the real goal

the humming of the machine is soothing
mmmm mmmm mmhmmm
such an approving appliance
and convenient, if she goes

not enough

drawn to the romantic notion of self-immolation
warmth not associated with hell
she learns not to run or fear
and crosses tiptoeingly across the burning coals

she learns that as the flames consumed they too
can be consumed
performing skilled irrumatio
bringing to both a sweet release

and still


the image of the man throwing his fist through a wall
stays with her as a distraction
she practices with the nails
lies herself on them, tries to sleep

allows the man with the many daggers
to pierce her with his inadequacy
does not flinch even
becomes adept at staring straight ahead

then

the searchlights tear through the crowded space
and children scream, men yell and boo, women clap politely
the animals chatter in excitement, the thrill of being the center of attention
voices announcing via an overhead PA system meant to extent for miles
and the band is brassy and full of egoists trying to be heard above it all
the glitter everywhere and mirrors everywhere reflecting lights
she's little dressed-- the show demands a display of flesh
it is a cold, cold night and cold air comes from a giant fan
and the energy of spectacle makes her turn warm-- too warm

she forms her lips into a well-practiced smile of orthodontically perfect teeth
and performs for them her pain

Knowing what hell is

tying up my bodied lusts
"sin," you say, "hate the sin."
screaming orgasms of religious manifestation
the look
that look on her face
That Sibyl of the Rhine
lock ourselves away in walls
then ( don't you see ? ) then
the presence will give us pleasure

"confess," you say, "confess it all
"confess away your sin"
without my sin, I'll be placed under a jar
labelled
stored away in a cupboard
my sexuality on display
a Hottentot Venus
"look at that clitoris,"
they will say,
"there's the perversion!"

hysterical woman
thinks she's a man
lusts like a man
lock her away
take her pen and pencil and Crayola crayons
file down her nails and her teeth
she will not bleed her ink
A bed cannot contain me
as all my she-lovers know
"I've got out at last"
"I've pulled off most of the paper, so you can't put me back!"

 And my body becomes an amputated thing
For a male body in pain
must be the soldierly result
of trench warfare
when the French corporal
shoots off his own hand

I would be that man

But a woman in pain
How boring
From between her legs comes the hurt
For all her life
Sex beginning with pain
so much blood for so many years
childbirth
and all those headaches
bed rest, let her have it
accepting bad sex
how often asked what lesbians do
how often I know a bad lover of women

that place between my legs
will be a place of pain
but I will caress it into pleasure
when the priest's back is turned

and you that condemn me to hell
you think I'm afraid
after five years
five years
of having my liver ripped from my body
by the great bird

no

if only it were so simple.

If all the world's a stage

All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts 
-Shakespeare, As You Like It

Considering the world as one grand dramatic piece of various genres of many themes, I feel as though trapped in an Artaudian Theatre of Cruelty production.  Disturbing and often unpleasant elements added through lighting, sound, performance- enveloping the viewer in the reality of suffering.

Little is needed for the effect of screeching.  The deafening noise can be produced my the merest thing; a door closing can be enough on the onset of a migraine.  The roaring almost hangover-esque cacophony of everyday life.  "But you don't really care for music, do you?" making sense in the context of the coming waves- a known drowning in the pained existence.  Becoming trapped in the now.

All light becomes enemy.  Even the dimmest candle burning itself out is enough to stab through the iris into the brain with the thought, "let me die."  A vampirical cave created of one's home, wherein lamps are broken in painful rages, blankets hung over shuttered or blinded windows.  The glowing reflection in the cat's eyes too much- go away.

How to make the outsider enter into this experience?  Perhaps a theatre of cruelty would support the effort.  Shine bright lights into the eyes of the audience, let the actors speak too loudly and roughly, their words come to the seated participants as a confused jumble that is sometimes lost beyond audible-- let them scream then whisper, speak directly to the outsiders then ignore their existence.  Let music play unkindly-- a popular song, perhaps, but distorted into a grating noise that is, again, too loud.  Turn down the temperature-- may audiences see their own breaths.  Pain is a cold sensation, but sometimes hot.  Let it be too hot as well.  Changing between intermission.

There can be a fourth wall.  Yet, it should be broken at the end.  Pain is a subjective happening, but I would like it to be beyond.  Perhaps the stage as a scene on the rooftop-- from it, the actor jumps.  Four feet or so in reality, one reality, but in the realness of the scene, she will go to her death.  Lights down.

Darkness can be used.  There are some lovely films paying tribute to the darkness.  The comfort in its presence- a place of hiding from the pursuer.  A monologue speaking to its wonder as a space of relative freedom from the glaring beams.

The pained existence is a theatre of cruelty in life.  You are forced to look at the nature of suffering as a real and constant thing.  To share this reality and bring empathy, the audience must suffer as well.  I would wish pain upon no one, but share the other effects.  Pain is not a lonely sensation.


Night Light - These bloopers are hilarious

House MD: An analysis of chronic pain managed with opiate therapy in entertainment television. -Jemma Theivendran

From the Pain Relief Foundation website:

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House MD – An analysis of chronic pain managed with opiate therapy in entertainment television.
Jemma Theivendran
House MD:
An analysis of chronic pain managed with opiate therapy in
entertainment television.
Jemma Theivendran
Imperial College Medical School London
November 2007
For a long while, television dramas have been a gateway for bringing ideas of
medicine and healthcare to the masses.1 Whilst House MD ranks at the top of the
list, reaching 20.8 million viewers in the US2 (and more worldwide) by focusing
much of the episode on the diagnostic process of patients with rare conditions, it
also portrays the life of a chronic pain sufferer. Researchers often consult
practising physicians when researching the medical facts before placing them
into the plot3, but in the depiction of the fictional Dr. Gregory House as a chronic
pain sufferer, how much of it is true to life and how much can be attributed to
increasing the dramatic effect?
As well as using current research to determine the accuracy of the medicine, this
essay also contains some original thoughts from viewers of the show, as it has
been shown that the audience can differentiate between fact and fiction to
produce their own interpretation of the show.4 The survey was carried out via a
message board, the thread requesting any viewer insight into the portrayal of
pain and pain management in House MD.
Introduction
Chronic pain is usually grouped into cancer-related pain and non-cancer-related
pain. The latter is dealt with in this essay. Chronic non-cancer pain (CNCP) is
defined as a pain which persists after the expected time of tissue regeneration,
usually lasting greater than six months.5 The causes of CNCP are varied,
encorporating all the systems of the body, and a staggering 35% of the American
population have some form of chronic pain.6
Dr. Gregory House, the head of the Department of Diagnostic Medicine at the
fictional Princeton-Plainsboro teaching hospital, is described as a medical
genius, who delights in solving medical mysteries with his hand-picked team of
specialists. However, Dr. House avoids patient contact as much as is feasibly
possible, is brutally honest and cynical, and is constantly in pain.7
His pain is derived from an infarct in his thigh muscle caused by a thrombus
preventing blood flow. As this was misdiagnosed initially, the prevention of blood
flow caused necrosis of the muscle and resulted in vast amounts of pain. Dr.
House has the necrotic part of his leg muscle removed leaving him with chronic
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Jemma Theivendran
pain in his right thigh and the necessity to walk with a cane. Whilst muscle
infarction is a relatively rare differential for leg pain, the medicine is accurate and
thus provides the basis for a main character in constant pain.
The writers make chronic pain a central theme in the show and have portrayed
some of the trials faced living with the condition.
“No, I do not have a pain management problem, I have a pain problem" a
Dr. House is prescribed Vicodin - a drug containing acetaminophen and
hydrocodone. Acetaminophen (also known as paracetamol) is believed to relieve
pain by interfering with cyclooxygenase activity8 and on its own does not have
any qualities for addiction. Hydrocodone acts similarly to codeine in relieving
pain, though the exact mechanism is unknown. It is usually prescribed to relieve
moderate to severe pain in the short term. It carries a danger that it can be habit
forming - as with all opioid analgesia “repeated administration may cause
dependence”.9 Dr. House has been on Vicodin for at least 5 years. This may
have been decided by the writers to help depict a chronic problem to the
audience. The research paper by Maier et al (2007) is supportive of this idea
showing that in a study of CNCP patients on opioid therapy, 85% still used the
same level of therapy 5 years later.10
The reluctance to prescribe opioids for CNCP lies in the potential for the patient
to develop side effects, as well as dependency. Side effects include nausea and
vomiting, constipation, dry mouth, headaches and, less commonly, ureteric
spasm and difficulty with micturition.9 Dr. House experiences urinary retention
caused by ureteric spasm. His self-catheterisation to relieve the discomfort
caused by the urinary retention proved a highly dramatic scene.11 The side
effects themselves are medically accurate but self-catheterisation is highly
irregular practise and was included for heightened drama. The episode raised
awareness about side effects of opioid treatment as highlighted by a viewer.
“Pain medication might have harmful effects such as constipation, renal
impairment etc…these issues would be more important for someone in chronic
pain (such as House) as opposed to someone who is terminally ill.”12
The quality of life for a CNCP sufferer can be very poor as the pain can be so
debilitating that it prevents the sufferer from functioning in day to day activities,
but the side effects too may have an impact on daily life. Most find a balance
between pain relief and management of the side effects “accepting more pain for
a reduction in sedation and nausea”.13 This may go some way to explaining why,
although Dr. House is continuously on pain medication, he still suffers from pain.
Quality of life can be significantly improved with long term use of opioids10
indicating that, whilst it is understandable for physicians’ hesitancy in prescribing
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Jemma Theivendran
opioids for CNCP, some CNCP sufferers can not control their pain any other way
and it is vital that the patients’ quality of life is not compromised.
One viewer was unhappy with the balance between story-telling and medical
fact, stating that although Dr. House may “questionably manage his pain, there
isn’t a reasonable pain management approach being promoted on the show”14
which is an important point as it does not portray any solution to the problem
faced by Dr. House. In some ways though, the show has done well by
highlighting the trials faced by chronic pain sufferers who are on opioid
analgesia. A chronic pain sufferer echoed this view by stating,
“House M.D. as far as I am concerned portrays life as it is with chronic pain and a
substance that allows you to have some sort of life instead of a mere existance
...” 15
"They [pills] let me do my job and they take away my pain" b
House MD endeavours to address the issue of physical dependency and
addiction – the first meaning the body has become tolerant to the drug but the
patient still maintains functionality in daily life at the higher doses, and the latter
meaning the patient has a psychological dependence on the drug and will
continue to take the medication regardless of loss of functionality.16
From the time Dr. House presented to the hospital with the pain, he has always
been shrouded in questions about addiction. When he first presented, the
residing doctor debated whether or not he was a drug seeker and hesitated to
give him necessary pain medication, during which time Dr. House injected
Demerol into his thigh himself.17This highlights the plight suffered by many
chronic pain sufferers who require pain relief but, due to their physical
dependence, are questioned by healthcare professionals wary of drug seekers.
Chronic use of opiates can cause the patient to develop tolerance to the drugs as
the P-glycoprotein molecules which pumps the opiate out of the circulation is up-
regulated. Therefore, more of the drug is required to reach the brain through the
blood-brain barrier to have the same effects.18 This is supported by other studies
which describe antinociceptive tolerance due to prolonged opioid use and the
consequent increase in dose required by the patient to produce the same amount
of pain relief.(10, 19)
Dr. House does not appear to adhere to the dosage policies of Vicodin – taking
the pills as and when he requires. Hocker (1994) showed that one of the
problems with prescribing opium derivatives to CNCP patients is “prescription on
request rather than time-scheduled therapy”.20 House MD shows, perhaps, a
more extreme form of “patient controlled analgesia”, but as Dr. House is
medically qualified, it appears that, for some time at least, his colleagues trust his
judgement. As the series continues, Dr. House’s colleagues express concern
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Jemma Theivendran
about the amount of Vicodin he is taking, worried that he may be addicted. They
challenge him to a week without Vicodin in the episode aptly entitled “Detox” and
during the episode Dr. House experiences withdrawal symptoms - chills, nausea
and a severe increase in pain. 21 His colleagues may have been right to be
concerned as Ives et al (2006) showed that opioid misuse can complicate chronic
pain management with 32% of patients recruited to the study committing opioid
misuse.22 Though his colleagues may have been expressing concern for his well
being, there are ethical questions behind their challenging him to stop his
medication.
"To leave a person in avoidable pain and suffering should be regarded as a
serious breach of fundamental human rights".23
A viewer seems to agree with the principal of not allowing a person to suffer in
pain.
“[his colleagues] do not appear to even consider his pain when discussing his
"addiction" i honestly would argue that putting a patient with chronic pain through
detox is a form of torture.” 14
Although Dr. House could have taken Vicodin at any time during that week, the
peer pressure his colleagues placed on him became the over-riding factor,
causing him to forgo his pain medication and remove elements of functionality
when performing his job in favour of winning the bet. The combination of the
severity of his withdrawal and his obvious requirement for Vicodin cause some
viewers to question the clarity with which the show portrays chemical
dependency.
“There is a difference between addiction and dependency. Something I think the
show has done a poor job about making clear.” 24
The withdrawal itself was highly dramatic and brings about the question of
whether Dr. House is addicted as Cowan et al (2001) showed that only 9.5% of
pain patients experienced withdrawal symptoms on discontinuing the therapy.25 It
could be argued that Dr. House is in the 9.5%, especially as his pain
management therapy is much less restricted than a standard patient, whose
dose is monitored by the prescribing physician. In addition, according to the BNF,
severe withdrawal symptoms can occur if the medication is withdrawn abruptly, 9
which was the case with Dr. House. Both patients and physicians are apprehensive
about addiction and misuse when using opioids in pain management therapy. As
fewer physicians are confident in prescribing opiates to CNCP patients, less is
known about the dosage-tolerance relationships and withdrawal symptoms.
However, prescribing opioid analgesia to CNCP patients derives more benefit
than harm.25
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Jemma Theivendran
At the end of his "detox", when asked if he had learnt anything, Dr. House
replies, "I said I was an addict. I didn't say I had a problem. I pay my bills, I make
my meals, I function." 21 Viewers have sympathised with this, stating that it is an
accurate depiction of how chronic pain sufferers cope with their medication.
“The amount of pain that he feels is torturous while he is not medicated. If he
were truly addicted to Vicodin and simply took the pills for the high he would not
be able to function….The people who try to tell him that he is addicted have no
idea for they do not feel his pain.” 26
“And everything's the leg? Nothing's the pills? They haven't done a thing to
you?” c
It is difficult to distinguish how much of Dr. House's personality is attributable to
his pain or his pain management. It is alluded to in previous episodes that he was
never really happy and avoids contact with patients as much as possible. It could
be argued that if Dr. House's pessimistic attitude is not caused by his pain, but is
used to enrich the character, and if this is not clearly defined, then it could,
perhaps, represent a negative image of chronic pain sufferers. Studies are
conflicting with regards to personality changes and opiate therapy. Pappagallo
and Heinberg (1997) state that there is a misconception that opioid therapy
causes depression and personality changes27, whereas the BNF states that
opioids can cause mood changes9. There may be disagreement with change in
mood associated with the medication but chronic physical pain itself can cause
depression and change in personality. Blake et al (2007) shows that CNCP is
associated with psychological impairment and depression28, and a study
revealed that 71% of CNCP patients were depressed.29 This correlates with the
experience of one viewer who stated:
“House is pretty dead on with the pain issue. My grandfather…is in chronic pain.
When he is in pain, he can be very nasty and he does say nasty things to
everyone, takes it out on us.” 30
This indicates that Dr. House's personality is not necessarily a misrepresentation
of chronic pain sufferers, and as well as enhancing the character, may in fact be
medically accurate.
Interestingly, patients who were single had a higher role emotional score29 which
could explain why Dr. House's pain increases with the return of a former girlfriend
(who is now happily married). Dr. House is concerned that the Vicodin is not
sufficient at managing his pain and requests spinal anaesthesia from his
supervisor. Though sceptical about the increase in pain, she injects him and his
pain promptly ceases. She reveals to him that she injected saline, a placebo, and
concluded that the increase in pain is psychological. Studies have shown that
depression may increase physical pain31 and this has been attributed to the
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Jemma Theivendran
connection between physical pain and depression, and neurotransmitters
serotonin and norepinephrine affecting them both.32 The writers created a
storyline that is both entertaining and backed by medical literature.
“Is there a TV anywhere? General Hospital starts in eight minutes.” d
The media has a responsibility to accurately represent medical information even
in the fictional setting. Studies have shown that entertainment can be a more
successful medium at providing information about medicine in comparison to the
news. In some cases, it is not evident as to what is fact and fiction and, as Turow
(1996) highlights, viewers can come away with false expectations.1
It is evident, therefore, that the portrayal of characters like Dr. House needs to be
accurate. This is highlighted in the case of a viewer, whose own doctor used Dr.
House as an example.
“I was discussing possible medications today with my physician and the
possibility of becoming addicted. To my surprise he used House as an example.
My doctor claims that the portrayal of House is the most accurate he has ever
seen.”26
Studies show that viewers can be influenced by entertainment television in their
expectations of modern healthcare, examples being the optimistic outcomes of
CPR and comas (33, 34). However, the very nature of House MD demands an
intelligent audience to keep up with the level of medicine and science involved in
the drama, and consequently the viewers have formed their own opinions about
chronic pain and its management.
Conclusion
House MD appears to accurately portray the life of a chronic non-cancer pain
sufferer who, perhaps controversially, finds functionality through management of
his pain with opioids. Dr. House is used as a reference point for chronic pain and
has increased the profile of an otherwise less commonly considered condition.
Conveying chronic pain is a complex process – language and physical
movements are limiting and, whilst other forms of disability are visible and
obvious, pain is an internal process. Viewers appreciate the limitations of
illustrating pain via television. A viewer writes:
“Do not forget that the most profound aspect of pain is its inexpressibility in the
transcendence of the confines of subjectivity.”35
Page 7
House MD – An analysis of chronic pain managed with opiate therapy in entertainment television.
Jemma Theivendran
Hugh Laurie as Dr. Gregory House.
Both the writing and the acting explore various aspects associated with chronic
pain, most obviously the relationship of the sufferer with his medication.
As with all medical television dramas, a responsibility is upon the writers to
accurately illustrate aspects of medicine whilst maintaining the dramatic effect. In
the case of the production team of House MD, not only do they produce a high
quality and, for the most part, accurate medical drama, but allow a deeper
appreciation into the complexities surrounding chronic non-cancer pain.
“The show is a reminder that people should be more careful about making
assumptions on chronic pain patients, and that pain is subjective and only the
patient can say what hurts or not.” 36
This is perhaps most poignantly highlighted in a conversation between Dr. House
and a patient.
Patient: How many of those [pills] are you taking?
House: I'm in pain.37
Word Count: 2729
Page 8
House MD – An analysis of chronic pain managed with opiate therapy in entertainment television.
Jemma Theivendran
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[DVD footage]
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footage]
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drugs for chronic non-cancer pain: a patient-initiated study. Br J Gen Pract. 2007
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psychosocial factors on low back pain: longitudinal results from the Belstress study. Spine. 2007
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coma in daytime television dramas. BMJ. 2005 Dec 24;331(7531):1537-9.
34. Van den Bulck JJ. The impact of television fiction on public expectations of survival following
inhospital cardiopulmonary resuscitation by medical professionals. Eur J Emerg Med. 2002
Dec;9(4):325-9.
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36. cosmic_quest IMDb: Message Boards: House MD. 2007 Jun Available from
http://www.imdb.com/title/tt0412142/board/thread/77806413?p=1 [cited 17 July 2007]
37. Jacobs K, Shore D, Attanasio P, Singer B, Sackheim D ‘ DNR’ Season 1, Episode 109 [DVD
footage]
a. Jacobs K, Shore D, Attanasio P, Singer B, Sackheim D ‘ Occam’s Razor’ Season 1, Episode 3
[DVD footage]
b. Jacobs K, Shore D, Attanasio P, Singer B, Sackheim D ‘ Detox’ Season 1, Episode 11 [DVD
footage]
c. Jacobs K, Shore D, Attanasio P, Singer B, Sackheim D ‘ Detox’ Season 1, Episode 11 [DVD
footage]
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footage]
Image available from http://www.buddytv.com/articles/house-hugh-laurie.jpg [cited 8 July 2007]
HOUSE MD belongs to Heel and Toe Films, Shore Z Productions and Bad Hat Harry Productions
in association with Universal Media Studios and the Fox TV Network. Katie Jacobs, David Shore,
Paul Attanasio, Bryan Singer and Dan Sackheim are executive producers.
Opinions of the viewers reproduced with their permission

Philosophical Bibliography on Pain by Murat Aydede

Bibliography—Philosophy of Pain

Compiled by Murat Aydede

(2/12/2006; ~320 entries)

This is a partially annotated bibliography containing largely philosophical literature on pain.  It also contains some scientific works that are of particular interest to philosophers or are useful to a general audience. It focuses on psychological, epistemological and metaphysical issues rather than ethical or religious ones.  It is a work in perpetual progress and by no means complete.  I’ll try to complete (or, replace) the annotations in time -- some of them are downloaded either from PsychInfo or Phil Index, and are not always very useful.  I would appreciate if the authors provide me with short abstracts of their own articles that appear below.  Corrections, modifications, suggestions and new entries are also welcome.  (I’ll organize the entries into cross-referenced sections in the future.)

Here are the categorization terms for the entries.  They are sorted roughly according to the first category in the category field in bold.

1.     pain access

2.     pain adverbialism

3.     pain affect

4.     pain animal

5.     pain asymbolia

6.     pain choice

7.     pain concept

8.     pain dennett

9.     pain disassociation

10.  pain general

11.  pain history

12.  pain imaging

13.  pain infant

14.  pain insensitivity

15.  pain language

16.  pain location

17.  pain nature

18.  pain perception

19.  pain phenomenology

20.  pain privacy

21.  pain science

(these items are selected with the interests of philosophers and the general audience in mind)

22.  pain sense-data

23.  pain surgery

24.  pain value

25.  adverbialism

26.  appearance theory

27.  pleasure

28.  sense-data

---

[adverbialism]

Sellars, W. (1975). "The Adverbial Theory of the Objects of Sensation." Metaphilosophy, 6: 144–160.

            One of the earliest defenses of adverbialism in general.

[adverbialism]

Kraut, R. (1982). "Sensory States and Sensory Objects." Nous, 16(2): 277–293.

            Kraut defends adverbialism by combining it with topic-neutral analyses of sensory states in terms of their standard causal nexus.

[adverbialism]

Tye, M. (1984). "The Adverbial Approach to Visual Experience." The Philosophical Review, 93(2): 195–225.

            Contains a brief and critical survey of adverbialist theories, and elaborates one Tye thinks is the best defensible theory.  Responds to Jackson’s (1975, 1977) criticisms.

[adverbialism]

Lycan, W. G. (1987). "Phenomenal Objects: A Backhanded Defense." Philosophical Perspectives (Metaphysics), 1: 513–526.

            Lycan defends the view that talk of phenomenal objects in perception is inevitable but argues that these individuals are intentional objects, thus don't pose any threat to physicalism.  He supports his view by a detour of what a proper understanding of adverbialism requires.

[adverbialism]

Caruso, G. (1999). "A Defense of the Adverbial Theory." Philosophical Writings, 10: 51–65.

           

[adverbialism ; pain perception ; appearance theory]

Chisholm, R. M. (1957). Perceiving: A Philosophical Study. Ithaca: Cornell University Press.

           

[adverbialism ; pain perception]

Jackson, F. (1977). Perception: A Representative Theory. Cambridge: Cambridge University Press.

            Defends a spatiotemporally locatable subjective and private sense-data as immediate objects of perceptual awareness

[adverbialism ; pain perception]

Ducasse, C. J. (1952). Moore's Refutation of Idealism. The Philosophy of G. E. Moore, P. A. Schilpp (Ed.), New York: Tudor.

            One of the earliest defenses of adverbialism in general.

[adverbialism ; pain perception]

Jackson, F. (1975). "On the Adverbial Analysis of Visual Experience." Metaphilosophy, 6: 127–135.

            The adverbial analysis holds that to have an image which is f is to sense f-ly; the attribute f goes to the mode f-ly. what account should it hold of having an image which is f and g. do both of the attributes go to separate modes, or do we have a new compound mode, f-g-ly? in this paper i argue that both of these answers, and the variants on them, face substantial difficulties.

[adverbialism ; sense-data]

Robinson, H. (1994). Perception. London ; New York, NY: Routledge.

           

[adverbialism ; pain perception]

Lycan, W. G. (1987). Consciousness. Cambridge, Massachusetts: MIT Press.

           

[pain adverbialism]

Aune, B. (1967). Knowledge, Mind, and Nature: An introduction to Theory of Knowledge and the Philosophy of Mind. New York: Random House.

            Pains are relations to damaged body parts, adverbialism, precursor to perceptual view of pain

[pain adverbialism]

Tye, M. (1984). "Pain and the Adverbial Theory." American Philosophical Quarterly, 21: 319–328.

            In this paper, I lay out an adverbial analysis for pain and I defend it against possible objections.  I also try to show that there are reasons for preferring the adverbial account I sketch to what is perhaps the most popular view, namely that pain statements involve existential quantifications over pain events, where pain events are taken to be identical with microphysical events located in the brain.

[pain adverbialism ; pain perception]

Douglas, G. (1998). "Why Pains Are Not Mental Objects." Philosophical Studies, 91(2): 127–148.

            Harold Langsam (1995) explicitly defends the thesis that pain is a mental object', and it is a major goal of this paper to dispute this view, and argue that pain is more accurately described adverbially as the way that we perceive or sense something, rather than something we perceive or sense. I also argue that the mental object' view of pain is the source of other problems and disputes in this area, and more generally regarding the issue of qualia.

[pain access]

Malcolm, N. (1958). "Knowledge of Other Minds." Journal of Philosophy, 55: 969–978.

            Wittgensteinean view of pain attributions

[pain access]

Nelson, J. O. (1966). "Can one tell that he is awake by pinching himself?" Philosophical Studies, 27: 81–84.

            Nelson claims to have discovered an "intrinsic mark" for distinguishing waking and dreaming states. he argues that it is logically impossible to "dream a pain". His central argument is that one cannot be deceived about being in pain, but if one could "dream a pain" then we would have to suppose that the dream pain did not "really exist", i.e. that one was deceived in thinking that one was in pain.

[pain access]

Margolis, J. (1966). "After-Images and Pains." Philosophy, 41: 41–347.

            The author notes that many current theories of meaning insist that the intelligibility of first-person reports necessarily depends on the verifiability of those reports. The author argues "that that doctrine cannot be maintained for the case of after-images (and images) and, therefore, need not be maintained for the case of pains (and similar sensations)."

[pain access]

Hodges, M., and W. R. Carter (1969). "Nelson on Dreaming a Pain." Philosophical Studies, 20: 43–46.

            The article criticizes John O. Nelson's ("Can one tell that he is awake by pinching himself?" in Philosophical Studies 27:81-84 (1966)) claim to have discovered an "intrinsic mark" for distinguishing waking and dreaming states. he argues that it is logically impossible to "dream a pain". His central argument is that one cannot be deceived about being in pain, but if one could "dream a pain" then we would have to suppose that the dream pain did not "really exist", i.e. that one was deceived in thinking that one was in pain. The argument is certainly fallacious, depending 1) on an ambiguity concerning "really exists" and 2) on the assumption that p entails believing that p. interestingly enough this final assumption is shared by Nelson and his most famous opponent Descartes.

[pain access]

Canfield, J. V. (1975). 'I Know That I Am in Pain' is Senseless. Analysis and Metaphysics, K. Lehrer (Ed.), Dordrecht: Reidel: 129–144.

           

[pain access]

Dalrymple, H. (1980). "Can a Person Know That He Is in Pain?" Southwest Philosophical Studies, 5: 55–63.

            Ordinary language philosophers often claim that a philosophical theory is wrong if it has consequences that no sane person can accept. Some of these same philosophers have also seemed to argue that first person sentences referring to the utterer's mental states should not be regarded as reports of something the utterer knows.  In this paper I argue for the rejection of this view on the grounds that it has the sort of skeptical consequences that its proponents have attributed to other theories and rightly deplored.

[pain access]

Blum, A., and R. Carasso (1988). "Pain Corrigibility." Manuscrito, 11: 127–128.

            We try to show how it is that being in pain is not equivalent to knowing that one is in pain.

[pain access]

Goldstein, I. (2000). "Intersubjective Properties by Which We Specify Pain, Pleasure, and Other Kinds of Mental States." Philosophy, 75: 89–104.

            By what properties do we name pain, pleasure, and other kinds of mental states? Wittgenstein identifies two possible ways. (1) Direct acquaintance: A person feels a sensation and sets about to use the word thereafter for the same sensation. (2) Outward signs: a person pins his use of the word to the sensation's outward signs. Wittgenstein thinks psychological words can be learned only through method two. People rest various strong claims on Wittgenstein's thesis.

[pain access]

Dartnall, T. (2001). "The Pain Problem." Philosophical Psychology: 14(1) 95–102.

            If pain exists only inasmuch as it is experienced, it seems that the pain did not exist when you were asleep, and so could not have woken you up. I shall argue that you were woken by a pain sensation that you did not know you had, so that the distinction between what is and what is known holds even for the contents of consciousness. This illuminates the relationship between consciousness and attention, and casts light on the classical empiricist tradition that identifies the foundations of knowledge with direct experience. (edited)

[pain access; pain nature]

Garfield, J. L. (2001). "Pain Deproblematized." Philosophical Psychology, 14(1): 103–107.

            In this paper I demonstrate that the "pain problem" Dartnall claims to have discovered is, in fact, no problem at all. Dartnall's construction of the apparent problem, I argue, relies on an erroneous assumption of the unity of consciousness, an erroneous assumption of the simplicity of pain as a phenomenon ignoring crucial neurophysiological and neuroanatomical information, a mistaken account of introspective knowledge according to which introspection gives us inner episodes veridically and in their totality and a model of consciousness that depicts the mind as an attic of inner objects towards which attention might or might not be directed. Once these errors are dispelled, no problem remains. (edited)

[pain access]

Dartnall, T. (2001). "The Pain Problem: Reply to Garfield." Philosophical Psychology, 14(1): 109–112.

            I am grateful for Garfield's comments, which clarify my position. He says, for example, that I am a phenomenalist. I am not a phenomenalist. I say that there can be contents of consciousness that we are not aware of, in the same sense that there really is a chair next door and a gorilla outside my window--a real, live gorilla, with big teeth and no conditional statements. His other comments are equally illuminating.

[pain access ; pain concept]

Hinton, R. T. (1975). "Is the Existence of Pain a Scientific Hypothesis?" Philosophy, 50: 97–100.

            There is an argument (Radford Philosophy 1972) which tries to show that pain is not a theoretical entity inferred from observed behavior. It is that the existence of theoretical entities may be refuted by experiment, but to deny the existence of pain would be to change the meaning of the word. The argument is based on the assumption that there is a clear criterion of meaning change and it does not consider the possibility that changes in theory also involve changes in meaning. It is argued that the languages of theory and of pain have important similarities in spite of the contingent differences highlighted by Radford's argument.

[pain access ; pain nature]

Leighton, S. R. (1986). "Unfelt Feelings in Pain and Emotion." Southern Journal of Philosophy, 24: 69–79.

            This paper defends views of emotion that make feelings necessary to (or sufficient for) occurrent emotion against a prominent objection, namely that while occurrent emotion states may be unfelt, there can be no sense to an unfelt feeling. by considering pains, it is argued that feelings while not noted may be felt. this sense of an unfelt feeling prevents the objection having the power it is assumed to have.

[pain access ; pain privacy]

Hudson, H. (1961). "Why Are Our Feelings of Pain Perceptually Unobservable?" Analysis, 21: 97–100.

           

[pain access ; pain privacy]

Carter, W. R. (1972). "Locke on Feeling Another's Pain." Philosophical Studies, 23: 280–285.

            Don Locke has claimed that it is possible for one person to feel another person's pain, but not possible for two or more people to own or share one pain. Locke discusses an alleged possible case in which one person is hooked up to another person's nervous system and subsequently feels what are, according to Locke, the first person's pain. Against Locke, it is argued that if two people were to feel one pain then it would be true that these people shared a pain, and so false that pains are 'l-private' in Locke’s sense. Finally, doubts are raised as to whether Locke's imagined physiological connections would enable two people to feel what was, numerically, the same pain.

[pain access ; pain privacy]

Wadia, P. S. (1973). "Multi-Person Pains." Mind, 82(327): 450–451.

            Discussion of Siamese twins' pain

[pain access ; pain privacy]

Palmer, D. (1975). "Unfelt Pains." American Philosophical Quarterly, 12: 289–298.

            This paper considers the traditional view that all pains, insofar as they exist, must be felt or noticed. the first section of the paper shows that some arguments at least implicitly presumed to support this traditional view are fallacious. The second part of the paper considers a broader thesis about all mental states from which the traditional thesis about pains follows. It is shown that this broader thesis is untenable. Finally it is argued by appeal to common cases that the traditional view of pains has such distasteful consequences that we are forced to seek an alternative. an alternative is suggested.

[pain access ; pain privacy]

Morris, K. J. (1996). "Pain, Injury and First/Third-Person Asymmetry." Philosophy and Phenomenological Research, 56(1): 125–136.

           

[pain access; pain concept; pain nature]

Radford, C. (1972). "Pain and Pain Behaviour." Philosophy, 47: 189–205.

           

[pain affect]

Pitcher, G. (1970). "The Awfulness of Pain." The Journal of Philosophy, 67(14): 481–492.

            Sets out the dialectics of the debate between those who say that the unpleasantness is not a necessary aspect of pain and those who claim that it is.  Argues that recent scientific findings (Melzack-Wall gate Control Theory) may resolve this old philosophical debate.

[pain affect]

Noren, S. J. (1974). "Pitcher on the Awfulness of Pain." Philosophical Studies, 25: 117–122.

            In a recent article, "The Awfulness of Pain," George Pitcher has presented an argument for the thesis that all pains are unpleasant. As his argument uses the well-known Melzack-Wall theory of pain, he views his argument as an instance of how philosophical problems can be dissolved empirically. This paper attempts to show that Pitcher's argument is fallacious and that the empirical theory of pain is irrelevant to settling the philosophic problem of whether all pains are unpleasant. It is further claimed that even if there are better reasons for holding that all pains are unpleasant there would still be difficult conceptual problems involving the possibility of masochism, fakirism, etc. Finally, it is suggested that '...is pleasant' etc., may be best construed as evaluative and not as descriptive predicates, thus undermining the need for Pitcher's thesis.

[pain affect]

Pitcher, G. (1976). Pain and Unpleasantness. Philosophical dimensions of the neuro-medical sciences: proceedings of the second Trans-disciplinary Symposium on Philosophy and Medicine, S. F. Spicker and H. T. Engelhardt (Eds.), Dordrecht, Holland: D. Reidel.

            Philosophical dimensions of the neuro-medical sciences: proceedings of the second Trans-disciplinary Symposium on Philosophy and Medicine, held at Farmington, Connecticut, May 15-17, 1975

[pain affect; pleasure]

Aydede, M. (2000). "An Analysis of Pleasure vis-à-vis Pain." Philosophy and Phenomenological Research, 61(3): 537–570.

            I take up the issue of whether pleasure is a kind of sensation (a feeling episode) or not. This issue was much discussed by philosophers of the 1950's and 1960's, and no resolution was reached. There were mainly two camps in the discussion: those who argued for a dispositional account of pleasure, and those who favored an episodic feeling (sensational) view of pleasure. Here, relying on some recent scientific findings I offer an account of pleasure which neither dispositionalizes nor sensationalizes pleasure. As is usual in the tradition, I compare pleasure with pain, and try to see its similarities and differences. I argue that pain and pleasure experiences have typically a complex phenomenology normally not so obvious in introspection. After distinguishing between affective and sensory components of these experiences, I argue that although pain experiences normally consist of both components proper to them, pleasure, in contradistinction to pain, is only the affective component of a total experience that may involve many sensations proper and cognitions. Moreover, I hold that although the so-called "physical" pleasure is itself not a sensation proper, it is nevertheless an episodic affective reaction (in a primitive sense) to sensations proper.

[pain affect]

Sufka, K. J., and M. P. Lynch (2000). "Sensations and Pain Processes." Philosophical Psychology, 13(3): 299–311.

            This paper discusses recent neuroscientific research that indicates a solution for what we label the "causal problem" of pain qualia, the problem of how the brain generates pain qualia. In particular, the data suggest that pain qualia naturally supervene on activity in a specific brain region: the anterior cingulate cortex (ACC). The first section of this paper discusses several philosophical concerns regarding the nature of pain qualia. The second section overviews the current state of knowledge regarding the neuroanatomy and physiology of pain processing. The third section highlights the recent research by Rainville et al.

[pain affect]

Grahek, N. (2001). Feeling Pain and Being in Pain. Oldenburg, Denmark: BIS-Verlag, University of Oldengurg.

            The most extensive and careful discussion of so-called “reactive disassociation” cases by a philosopher.  Grahek concludes that pain asymbolia is the only genuine form of having pain without the negative affect.

[pain affect]

Clark, Austen (ms.). "Painfulness is Not a Quale." Philosophy Department, University of Connecticut.

            Argues that painfulness is not a quale in the traditional strong sense of the word, and proposes a psychofunctionalist account of pain and painfulness.

[pain affect ; pain nature]

Noren, S. J. (1976). "The Efficacy of Pain." Journal of Critical Analysis, 6: 71–76.

           

[pain affect ; pleasure]

Penelhum, T. (1957). "The Logic of Pleasure." Philosophy and Phenomenological Research, 17(4): 488–503.

            Compares pain and pleasure states and their concepts in the context of criticizing Ryle’s quasi-behaviorist treatment of pleasure states.  One of the best discussions of this issue from the generation of “linguistic philosophy”.

[pain affect ; pleasure]

McCloskey, M. A. (1971). "Pleasure." Mind, 80(320): 542–551.

            Compares the concepts of pain and pleasure much like Penelhum 1957.  Very useful.

[pain affect ; pleasure]

Sprigge, T. L. S. (2000). "Is the Esse of Intrinsic Value Percipi?: Pleasure, Pain and Value." Philosophy, 47(Suppl): 119–140.

            If there is such a thing as a genuine property appropriately called "intrinsic value" this property must be such that recognition that something does, or would, possess it, has a necessary tendency to motivate towards sustaining that thing in existence or producing it (if possible). There is just one thing which possesses that property and that is the property of being pleasurable (properly conceived) which, therefore, is the same as intrinsic value. (The same, mutatis mutandis, applies to intrinsic disvalue and painfulness.) Why this seems not to be so is explained.

[pain affect ; pleasure; pain value]

Weiss, P. (1942). "Pain and Pleasure." Philosophy and Phenomenological Research, 3(2): 137–144.

           

[pain affect ; pleasure; pain value]

Edwards, R. B. (1975). "Do Pleasures and Pains Differ Qualitatively?" Journal of Value Inquiry, 9: 270–281.

            Mill did not explain adequately his claim that pleasures and pains differ qualitatively. I try to make sense of this claim, maintaining that the "lower" pleasures are localized bodily pleasures and the "higher" pleasures are non-localized. treatments of hedonism have been hampered by the linguistic assumption that where two or more things are called by the same name, they share a common property. This assumption is false when applied to pleasures and pains. Pleasure and pain are intentional concepts and pleasures and pains differ in quality with variations in their intentional objects.

[pain affect ; pleasure; pain value]

Edwards, R. B. (1979). Pleasures and Pains: A Theory of Qualitative Hedonism. Ithaca: Cornell University Press.

            The book tries to make sense out of mill's unexplained contention that pleasures and pains differ qualitatively as well as quantitatively, which most philosophers have dismissed as nonsense. It gives a new critique of quantitative hedonism, explores the relationship between hedonistic and pluralistic theories of intrinsic good and evil, and defends a qualitatively hedonistic position. It explores mill's conception of rational methodology in ethics, his "proof" of utilitarianism, and his "larger meaning of proof." It discusses electrode-induced happiness, qualitative senses of "more pleasant" and the intentionality of "pleasure" and "pain" concepts.

[pain affect ; pleasure; pain value]

Goldstein, I. (1989). "Pleasure and Pain: Unconditional, Intrinsic Values." Philosophy and Phenomenological Research, 50(2): 255–276.

           

[pain affect; pain value]

Puccetti, R. (1975). "Is Pain Necessary?" Philosophy, 50: 259–269.

            Examination of a well-documented case of insensitivity to pain indicates that pain sensations associated with tissue damage have biological usefulness. Contrary to the view of some writers, other kinds of physical pain are not mysterious but understandable on straightforward Darwinian principles. The suggestion that we could be made so as to withdraw from tissue-damaging stimuli without pain relates interestingly to physicalistic theories of the mind-body relation. It is argued that such views, specifically epiphenomenalism and the identity theory, fail to explain the occurrence of pain sensations, for on these theories there would be no evolutionary disadvantage to the species if they did not occur.

[pain affect; pain value]

Goldstein, I. (1983). "Pain and Masochism." Journal of Value Inquiry, 17: 219–224.

            That pleasure is wanted and pain unwanted is not a truism. There are people who do not want to enjoy life and who want to suffer pain. Not every desire for pain is 'masochistic', however. Like sadism, masochism entails irrationality and abnormality. The picture of the masochist as a rational, calculating hedonist seeking pain solely for the pleasure it brings him is oversimplified. Masochism is a perversion. A peculiar outlook on pain is entailed by masochism.

[pain affect; pain value]

Goldstein, I. (1988). The Rationality of Pleasure-Seeking Animals. Inquiries into Values, S. H. Lee (Ed.), Lewiston: Mellen Press: pp. 131–136.

            Pleasure-seeking animals, including the most primitive, are to some extent rational. intrinsically, pleasure is better than pain; there is reason to desire pleasure and prefer it to pain. in desiring pleasure and avoiding pain, an animal's dispositions towards these experiences are appropriate and guided by reason.

[pain affect; pain value]

Hall, R. J. (1989). "Are Pains Necessarily Unpleasant?" Philosophy and Phenomenological Research, 49(4): 643–659.

            Argues for a negative answer. For hall, unpleasantness consists of a spontaneous quasi-cognitive con-reaction to pain sensation proper.

[pain affect; pain value]

Rachels, S. (2000). "Is Unpleasantness Intrinsic to Unpleasant Experiences?" Philosophical Studies, 99: 187–210.

Unpleasant experiences include itches, backaches, phantoms pains and moments of embarrassment. What does their unpleasantness consist in? Philosophers have offered the following answers:

1. The unpleasantness of an experience consists in its representing bodily damage. (Damage)

2. The unpleasantness of an experience consists in its inclining the subject to fight its continuation. (Motivation)

3. The unpleasantness of an experience consists in the subject’s disliking it. (Dislike)

4. The unpleasantness of an experience consists in features intrinsic to it. (Intrinsic Nature)

Each of these theories stands or falls with its corresponding view of pleasure. So, I will assess Motivation, for instance, alongside the idea that the pleasantness of an experience consists in its inclining the subject to fight for its continuation. In the end, I will favor Intrinsic Nature.

[pain affect; pain value; pain value]

Goldstein, I. (1980). "Why People Prefer Pleasure to Pain." Philosophy, 55: 349–362.

            Why do we dislike pain? Why do we prefer pleasure? There are three answers to consider: (1) We have a "reason" for wanting pleasure and shunning pain. Our attitudes are guided by a rational insight about the experiences. (2) Pleasure and pain do not provide reason for preferring one to the other. It is a contingent fact about our constitution that we want pleasure and dislike pain. (3) That pleasure is wanted and pain unwanted is a tautology. Pleasure is "defined" as a wanted experience, pain as an unwanted one.  Hume, Hare, and Spencer, who held the second and third positions, are discussed. I defend the first position.

[pain animal]

Squire, A. N. N. (1985). "On Animals and Pain." Between the Species, 1: 19–20.

           

[pain animal]

Nollman, J. I. M. (1987). "To Judge the Pain of Whales." Between the Species, 3: 133–137.

           

[pain animal]

Carruthers, P. (1989). "Brute Experience." Journal of Philosophy, 86(5): 258–269.

           

[pain animal]

Carruthers, P. (1992). The Animals Issue: Moral Theory in Practice. Cambridge: Cambridge University Press.

           

[pain animal]

Robinson, W. S. (1997). "Some Nonhuman Animals Can Have Pains in a Morally Relevant Sense." Biology and Philosophy, 12(1): 51–71.

            In a series of works, Peter Carruthers has argued for the denial of the title proposition. Here, I defend that proposition by offering direct support drawn from relevant sciences and by undercutting Carruthers' argument. In doing the latter, I distinguish an intrinsic theory of consciousness from Carruthers' relational theory of consciousness. This relational theory has two readings, one of which makes essential appeal to evolutionary theory. I argue that neither reading offers a successful view.

[pain animal]

Rosenfeld, R. P. (1993). "Parsimony, Evolution, and Animal Pain." Between the Species, 9(3): 133–137.

            Peter Harrison appeals to the notion of parsimony to argue that mental pain states could not have evolved in animals. I argue that Harrison misuses the notion of parsimony and assumes an excessively adaptationist view of evolutionary theory. Appeals to parsimony can just as easily show that we "should" attribute mental pain states to animals. In addition, the process of evolution itself is not strictly parsimonious. Mental pain could still have arisen even if it were not the only or the best adaptive response to danger or harm. Harrison's evolutionary parsimony case against animal pain is thus unconvincing.

[pain animal]

Boonin Vail, D. (1993). "Response––Parsimony Made Simple: Rosenfeld on Harrison and Animal Pain." Between the Species, 9(3): 137–140.

           

[pain animal]

Gennaro, R. J. (1993). "Brute Experience and the Higher-Order Thought Theory of Consciousness." Philosophical Papers, 22(1): 51–69.

            Peter Carruthers attacks the natural view that animals have conscious pains and suffer. Thus, brutes do not warrant our moral concern. I defend the "higher-order thought theory of consciousness" as it pertains to brute experience. In sections I and II, I critique Carruthers' analysis of consciousness and show how he mischaracterizes the higher-order theory which is indeed compatible with many brutes having conscious pains. In section III, I show how brutes can have the conceptual sophistication required by the theory. In section IV I offer evidence concerning animal brain structure supporting the conclusion that most animals have conscious pains.

[pain animal]

Allen, Colin (ms.). "Animal pain." Department of Philosophy, Texas A&M University.

            A nice overview of the main issues and literature with a particular critical focus on Carruthers.

[pain animal]

Harrison, P. (1989). "Theodicy and Animal Pain." Philosophy, 64: 79–92.

            Do animals suffer pain? this paper argues that they do not. animal suffering, in the economy of natural selection, is unnecessary. animals need only respond appropriately to damaging stimuli. if their behaviour is determined, then the promptings of pain are superfluous. in free agents, however, pain is an essential, if harsh reminder that certain actions will result in tissue damage. it is further suggested that the experience of pain requires 'continuity of consciousness'--a temporally continuous background of experiences in which pain can be located. the lack of this feature of human consciousness in animals means that they cannot have inner states which are comparable to human suffering. if this account of animal pain is correct, then a major problem for modern theodicies is solved, for it is no longer necessary to attempt to reconcile the suffering of innocent creatures with the existence of an omnipotent and benevolent god.

[pain animal]

Harrison, P. (1991). "Do Animals Feel Pain?" Philosophy: 25–40.

            Most assessments of the moral status of animals are founded on the premise that animals feel pain. This premise is generally supported by three arguments. (1) We know that animals feel pain because they behave much the same as we do when we feel pain. (2) Many animals have nervous systems which resemble our own in structure and function. (3) Evolutionary theory provides for no radical discontinuity between human and other species, and it is therefore unlikely that only humans feel pain. These arguments are examined in turn and are shown to be defective or, at best, inconclusive. It is suggested that the experience of pain is essential only in agents capable of free choice--people. Accordingly, some views about how animals ought to be treated need to be revised.

[pain animal]

House, I. (1991). "Harrison on Animal Pain." Philosophy: 376–379.

            Peter Harrison (“Do Animals Feel Pain?” Philosophy, Volume 66, Number 255, January 1991, 25–40) is wrong to argue that animals do not feel pain. Because they behave as though they feel pain, have the equipment for feeling pain and are evolutionarily related to creatures which do feel pain (namely, human beings), we may conclude that animals feel pain. Harrison is, therefore, wrong to claim that we should treat animals well only for our own sakes and not at all for theirs.

[pain animal]

Lynch, J. J. (1994). "Harrison and Hick on God and Animal Pain." Sophia, 33(3): 62–73.

            Animal pain constitutes a distinct challenge to theism. It has been suggested that there are significant differences between animal and human pain and that these differences are important for theodicy. Peter Harrison has argued that animal pain is nonconscious, while John Hick has contended that only human beings are capable of genuine suffering. In either case, animal pain is alleged not to threaten seriously the goodness or the power of God. I argue that both Harrison's and Hick's theodicies deny the obvious reality of animal pain and that animal suffering should be acknowledged by Theists.

[pain animal]

Lynch, J. J. (1994). "Is Animal Pain Conscious?" Between the Species, 10(1-2): 1–7.

            Peter Carruthers and Peter Harrison have in separate articles resurrected a Cartesian attitude toward animal pain. If their positions are sound, we are mistaken in thinking that animals can feel their pains; and consequently we are also mistaken in thinking that animals could possibly be the appropriate objects of our moral sympathies. I contend that both arguments fail. We have compelling, if not conclusive, evidence for holding that animals feel their pains, and therefore have little reason to accept the skeptical and less plausible conclusions of either Carruthers or Harrison.

[pain animal]

Duran, J. (1994). "Commentary on 'Is Animal Pain Conscious?'" Between the Species, 10(1-2): 8–9.

            It is argued that Lynch's counter to the theorists who contend that animals do not feel pain is not quite strong enough. Their contentions rest on a series of conflations between Freudian and ordinary uses of the term "conscious" and their arguments can easily be refuted.

[pain animal]

Jennings Jr, D. (1991). "Why Animal Pain?: Considerations in Theodicies." Between the Species, 7(4): 217–221.

           

[pain animal]

Betty, L. S. (1992). "Making Sense of Animal Pain: An Environmental Theodicy." Faith and Philosophy, 9(1): 65–82.

            No present theodicy, including John Hick's, makes adequate sense of animal pain. Hick fails at the point that he enlists animal pain exclusively in the service of human soul growth. Frederick Ferre is correct to point out that this solution is too anthropocentric. The present theodicy avoids this mistake by showing that pain, from the amoeba's to our own, is crucial not only to the betterment of souls but to their very origination, a process beginning long before man evolved on the planet. Creation is the process by which God is multiplying his own experience, and this process necessarily requires eons, necessarily starts with the lowest forms of life, and necessarily entails pain and suffering. The resulting good justifies all the howls and lamentations of the planet from its inception.

[pain animal]

Perrett, R. W. (1997). "The Analogical Argument for Animal Pain." Journal of Applied Philosophy, 14(1): 49–58.

            Philosophical defenders of animal liberation believe that we have direct duties to animals. Typically a presumption of that belief is that animals have the capacity to experience pain and suffering. Notoriously, however, a strand of Western scientific and philosophical thought has held animals to be incapable of experiencing pain and even today one frequently encounters in discussions of animal liberation expressions of skepticism about whether animals really experience pain. This article responds to this skepticism by claiming that it is just as reasonable for me to believe that animals feel pain, given my only evidence for this is shared behavior and physiology, as it is for me to believe that other humans feel pain on the basis of similar evidence. In this paper I expound and defend this argument.(edited)

[pain concept]

Miller, D. S. (1929). "The Pleasure-Quality and the Pain-Quality Analysable, Not Ultimate." Mind, 38(150): 215–218.

           

[pain concept]

Margolis, J. (1965). "The Problem of Criteria of Pain." Dialogue, 4: 62–71.

           

[pain concept]

Long, T. A. (1965). "The Problem of Pain and Contextual Implication." Philosophy and Phenomenological Research, 26(1): 106–111.

           

[pain concept]

Long, T. A. (1965). "Strawson and the Pains of Others." Australasian Journal of Philosophy, 43: 73–77.

            The author examines Strawson's contention that if one does not accept Strawson's account of pain "one is refusing to accept the 'structure of the language' in which we talk about pain." The author disagrees with Strawson's "criteriological view," where behaviour is a criterion for the application of predicates not for states of consciousness.

[pain concept]

Gandhi, R. (1973). "Injury, Harm, Damage, Pain, Etc." Philosophy and Phenomenological Research, 34(2): 266–269.

           

[pain concept; pain nature]

Grahek, N. (1988). Philosophy and Pain Research. Contemporary Yugoslav Philosophy, A. Pavkovic (Ed.), Dordrecht: Kluwer (pp. 85-96).

            The aim of this article is to compare scientific and philosophical revisionary or eliminative demands concerning our pain concepts or discourse. This is an interesting topic to study, because philosophers of materialistic turn of mind claim that their revisionary or eliminative demands rely on the results of the scientific research on pain phenomena. But it is argued that upon closer examination, it may well turn out that their demands considerably diverge from, or even run counter to, those put forward by scientists.

[pain concept]

Edwards, J. (1993). "Following Rules, Grasping Concepts and Feeling Pains." European Journal of Philosophy, 1(3): 268–284.

           

[pain concept ; pain access]

Montague, R. (1975). "The Always-Painfree Pain-Behaver." Mind, 84(333): 47–62.

            Critically discusses behaviorism about pain.

[pain concept ; pain access]

Sharpe, R. A. (1983). "How Having the Concept of Pain Depends on Experiencing It." Philosophical Investigations, 6: 142–144.

            Contrary to what Norman Malcolm has claimed, a man who has never experienced pain will be limited in his linguistic capacity and will therefore have a less than full grasp of the concept. The reason lies in his inability either to invent new descriptions of the sensation or to adjudicate on the suggestions of others.

[pain concept ; pain nature]

Ochs, C. R. (1966). "The Sensitive Term "Pain"." Philosophy and Phenomenological Research, 27(2): 255–260.

           

[pain concept ; pain nature]

Kelly, M. L. (1991). "Wittgenstein and "Mad Pain"." Synthese: 285–294.

           

[pain concept; pain language]

Sullivan, M. D. (1995). "Key Concepts: 'Pain'." Philosophy, Psychiatry, and Psychology, 2(3): 277–280.

           

[pain dennett ; pain concept]

Dennett, D. C. (1978). Why You Can’t Make a Computer that Feels Pain. Brainstorms Cambridge, Massachusetts: MIT Press.

           

[pain dennett ; pain concept]

Conee, E. (1984). "A Defense of Pain." Philosophical Studies, 46: 239–248.

            In the paper, 'Why you can't make a computer that feels pain', Daniel Dennett argues against the coherence of the concept of pain. The present paper argues for the coherence of the concept. It also argues that there are no individual pains. it concludes with a discussion of how to find out whether computers can feel pain.

[pain dennett ; pain concept ; pain access]

Kaufman, R. (1985). "Is the Concept of Pain Incoherent?" Southern Journal of Philosophy, 23: 279–284.

            In Brainstorms, Dennett claims that 'pain' could not be a referring term because the very concept of pain is incoherent.  To show that the concept is incoherent, Dennett argues that two necessary features of pain, incorrigibility and awfulness, cannot be true together.  I argue that Dennett has not shown that these features are incompatible, and I go on to sketch a version of incorrigibility which avoids some of the problems raised by Dennett.

[pain dennett ; pain access]

Guirguis, M. M. (1998). "Robotoid Arthritis or How Humans Feel Pain." Philosophical Writings, 7: 3–12.

            In "Why You Can't Make a Computer That Feels Pain," Daniel Dennett calls for a revision of our intuitive conception of pain, including the doctrines of infallibility and privileged access. He cites the reports made by patients under the influence of analgesic drugs as evidence against the incorrigibility thesis. In this paper, I theorize on how to account for such odd reports while keeping the incorrigibility thesis in tact.

[pain dennet]

Nikolinakos, D. D. (2000). "Dennett on Qualia: The Case of Pain, Smell and Taste." Philosophical Psychology, 13(4): 505–522.

            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.

[pain general; pain science; pain perception]

Melzack, R. (1961). "The Perception of Pain." Scientific American, 204(2): 41–49.

           

[pain general]

Schrag, C. O. (1982). Being in Pain. The Humanity of the Ill, V. Kestenbaum (Ed.), Knoxville: University Tennessee Press: pp. 101–124.

           

[pain general ; pain perception]

Hardcastle, V. G. (1999). The Myth of Pain. Cambridge, Massachusetts: MIT Press.

           

[pain general; pain science]

Fields, H. L., and D. D. Price (1944). Pain. A Companion to the Philosophy of Mind, S. Guttenplan (Ed.), Oxford, UK: Basil Blackwell.

            An accessible review of basic pain mechanisms and its psychological aspects by two prominent pain scientists.

[pain history]

Brykman, G. (1985). "Pleasure and Pain Versus Ideas in Berkeley." Hermathena, 139: 127–137.

            To scrutinize pleasure and pain as opposed to ideas in Berkeley is a way to question the status of "passivity" in his works. It is generally admitted that ideas are passive in Berkeley; by contrast the mind is rather stressed as active, though human mind should be said to be passive as well as active. From an analysis of Berkeley's statements about pleasure and pain in the early works, 1) we shall bring forth what exactly is the mind-passivity as contrasted with the ideas-passivity; 2) we shall exhibit how the statement from Philonous about the mind as "altogether passive" in perception is only a trick; 3) we shall bring forth how the pleasure and pain polarity is the core of spirit for any living creature to whom "exteriority" is the objective side of a fictitious ideal balance between pleasure and pain. The world is not chiefly an exterior being but something distinct which may either gratify or hurt.

[pain history]

Chisholm, R. M. (1987). "Brentano's Theory of Pleasure and Pain." Topoi: 6 59–64.

            A nice and clear presentation of Brentano's conception of sensory and nonsensory pain and pleasure.  The results of this clean exposition are revealing: Brentano's views come close to some of the modern and prevalent views -- both scientific and philosophical.

[pain history]

Botterell, E. H., J. C. Callaghan, and A. T. Jousse (1942). Sensation and Perception in the History of Experimental Psychology. New York: Appleton-Century-Crofts.

           

[pain history]

Dallenbach, K. M. (1939). "Pain: History and Present Status." American Journal of Psychology, 52: 331–347.

[pain history; pain medicine]

Raj, P. P. (1996). History of Pain Medicine. Pain Medicine, P. P. Raj (Ed.), New York: Mosby.

           

[pain infant]

Cunningham Butler, N. (1989). "Infants, Pain and What Health Care Professionals Should Want to Know--An Issue of Epistemology and Ethics." Bioethics, 3: 181–199.

           

[pain infant]

Campbell, N. (1989). "A Response to Cunningham Butler's 'Infants, Pain and What Health Care Professionals Should Want to Know'." Bioethics, 3: 200–210.

            Despite contrary claims experienced observers believe babies experience pain differently from older age groups. Extremely premature babies probably do not consciously perceive pain at all. Pain relieving drugs have serious known side effects in babies. Past experience with new drugs in babies is that utterly unexpected serious side effects can occur. Morally our first duty remains to minimize harm. Will across-the-board introduction of potent new drugs, meant to control pain, the existence of which is putative, lead to more harm than good? The ethical onus remains with current advocates of new drug regimes, not those who recommend caution. There are many innovative ways of reducing distress in ill babies short of the "quick-fix" of potentially harmful drugs.

[pain infant; pain science]

Derbyshire, S. W. G. (1999). "Locating the Beginnings of Pain." Bioethics, 13(1): 1-31.

            This paper examines the question of whether a fetus can feel pain. The question is divided into four sub questions: What is pain? What is the neurology of pain processing? What is the fetus? Are there good reasons for holding that fetuses feel pain? Pain experience is placed at approximately 12 months of age, though this is within the context of a continuum of awareness rather than a straight on-off' switch. The major moral implication of this stance is to place the burden of proof for analgesic use onto clinical measures, rather than relying upon the, so far, poorly supported assumption of pain awareness.

[pain infant; pain science]

Derbyshire, S. W. G. (2001). "Fetal Pain: An Infantile Debate." Bioethics, 5(1): 77–84.

            The question of whether a fetus can experience pain is an immense challenge. The issue demands consideration of the physical and psychological basis of being and the relation between the two. At the center of this debate is the question of how it is that we are conscious, a question that has inspired the writing of some of our most brilliant contemporary philosophers and scientists, with one commentary suggesting surrender. In my earlier review I attempted to draw together the various strands of thinking that had attacked the question of fetal pain and relate them back to the bigger question of consciousness. In their vituperative response, Benatar and Benatar bite off my finger before looking to where I am pointing.  I will examine each of their criticism.

[pain infant; pain science]

Field, T. (1995). "Infancy is not without pain." Annals of Child Development: A Research Annual, 10.

            Discusses mounting evidence that newborns experience pain and the implications this conclusion may have for neonatal medical practices now that many have recognized the fact that newborns do in fact experience pain, the debate focuses on the relative efficacy and safety of medications.  Raise concerns regarding the risks of addiction, respiratory depression and systemic toxic reactions affecting the heart and brain.  Iin addition, because the liver is immature, the metabolism of drugs is very slow.  Highlights the need to further develop alternative forms of treatment that have no side effects such as the use of acupressure, massage and electrical stimulation.  Evidence that newborns experience pain behavioral responses, physiological responses, hormonal and metabolic changes.   The neurophysiology of pain perception nervous system involvement, the endocrine system, the endorphin or endogenous opioid system, fetal neuroanatomy and functional maturity.  Neonates' memory of pain / pain alleviation / alleviating stress in intensive-care unit neonates / drug interventions (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain infant]

Franck, L., and L. Lefrak (2001). "For Crying Out Loud: The Ethical Treatment of Infants' Pain." Journal of Clinical Ethics, 12(3): 275–281.

           

[pain infant]

Griffith, S. (1995). "Fetal Death, Fetal Pain, and the Moral Standing of a Fetus." Public Affairs Quarterly, 9(2): 115–126.

           

[pain infant]

Kaufman, R. (1985). "Fetal Pain." Southern Journal of Philosophy, 23: 305–311.

            The question of fetal pain has become a point of controversy in discussions about abortion.  I assess the force of this point with respect to the permissibility of abortion.  I go on to argue that the question of fetal pain is not something that medical experts are in a unique position to determine since they too must employ the ordinary criteria for the ascription of pain.

[pain language; pain science]

Melzack, R., and W. S. Torgerson (1971). "On the Language of Pain." Anesthesiology, 34: 50–59.

        

[pain language; pain science]

Ehlich, K. (1985). "The Language of Pain." Theoretical Medicine, 6: 177–188.

            The expression 'pain' refers to a phenomenon intrinsic to individuals. the object of the language of pain is restricted to an individual experience which excludes any form of direct access by others. Speaking about pain is thus one of the most difficult forms of linguistic activities, as has been repeatedly pointed out by Wittgenstein. The difficulties involved in this type of communication are not only dependent upon individual linguistic ability but are also clearly reflected in the state and structure of the linguistic means which are at the disposal of the speakers of a language. Linguistic means vary in status and complexity with respect to the ends for which they can be used for. In this paper, I discuss two aspects of communicating pain: types of expression which are involved in speaking about pain, and linguistic activities which are carried out when speaking about pain. The two aspects are interrelated. my analysis makes use of categories belonging to the theory of linguistic activity and to the extended field theory of language (an expansion of Buhler's concept of symbolic and deictic field analysis of language).

[pain location]

Baier, K. (1964). "The Place of a Pain." The Philosophical Quarterly, 14(55): 138–150.

           

[pain location]

Vesey, G. N. A. (1965). "Baier on Vesey on the Place of a Pain." The Philosophical Quarterly, 15(58): 63–64.

           

[pain location]

Vesey, G. N. A. (1967). "Margolis on the Location of Bodily Sensations." Analysis, 27: 174–176.

           

[pain location; pain perception]

Vesey, G. N. A. (1964). "Bodily Sensations." Australasian Journal of Philosophy, 42: 232–247.

            The author answers the criticisms of DM Armstrong, considers Berkeley on "visual depth," and finishes with a further discussion of Armstrong's objections. He concludes that Armstrong has not shown that "'there are two fundamentally distinct ways in which the experiencing individual apprehends his own body...'."

[pain location]

Taylor, D. M. (1965). "The Location of Pain." The Philosophical Quarterly, 15(58): 53–62.

           

[pain location]

Holborow, L. C. (1966). "Taylor on Pain Location." The Philosophical Quarterly, 16(63): 151–158.

            Criticizes Taylor, D. M. (1965).

[pain location]

Taylor, D. M. (1966). "The Location of Pain: A Reply to Mr. Holborow." The Philosophical Quarterly, 16(65): 359–360.

           

[pain location]

Coburn, R. C. (1966). "Pains and Space." Journal of Philosophy, 63(13): 381–396.

           

[pain location]

Holly, W. J. (1986). "The Spatial Coordinates of Pain." The Philosophical Quarterly, 36(144): 343–356.

            Contains a critical survey.

[pain location]

Combes, R. (1991). "Disembodying 'Bodily' Sensations." Journal of Speculative Philosophy: 107–131.

            Raw feels (e.g., pains) seem to present themselves to consciousness as being bodily fixtures and thereby appear recalcitrant to both the dualist view that these sensations are non-extended and the materialist view that, while extended, they are geographically confined to the contral nervous system. This paper supplies an account of localization that reconciles the habit of attributing bodily coordinates to somesthetic phenomena with either dualism or materialism. It is reasonable to suppose that these feelings, while originally given to consciousness as non-local, later become associated with their putative anatomical causes only as a result of experience.

[pain location]

Noordhof, P. (2001). "In Pain." Analysis, 61(2): 95–97.

            Michael Tye has claimed that a consideration in favor of representationalism is that it enables us to adopt a univocal sense of 'in' in terms of spatial location. I argue that this is not the case. There is a distinct sense of 'in' used to characterize states of objects to which the representationalist, as much as anybody else, will have to appeal in order to capture what we mean when we say that there is a pain in a finger.

[pain location]

Tye, M. (2002). "On the Location of a Pain." Analysis, 62(2): 150–153.

            Responds to Noordhof (2001).

[pain location]

Noordhof, P. (2002). "More in Pain." Analysis, 62(2): 153–154.

            In his reply to my article "In Pain," Michael Tye takes me to reject representationalism. In this response, I correct that impression. More crucially, Tye suggests that he may deal with the invalidity of the inferences I discussed in the original article by distinguishing two spatial senses of 'in'. I provide other cases which suggest that he will have to proliferate spatial senses of 'in' to explain the invalidity of a whole host of other inferences. I suggest that this speaks in favor of the claim that there is a sense of 'in' which is used in ascribing a certain state to an object.

[pain location] 

Bain, D. (2007). "The Location of Pains," Philosophical Papers, 36(2).

[pain location ; pain perception]

Vesey, G. N. A. (1964). "Armstrong on Bodily Sensations." Philosophy, 39: 177–181.

           

[pain perception ; pain location]

Armstrong, D. M. (1964). "Vesey on Bodily Sensations." Australasian Journal of Philosophy, 42: 247–248.

            The view of Godfrey Vesey, that bodily sensations are both located in our body and yet are "in the mind," is briefly discussed and criticized.

[pain location; pain nature]

Addis, L. (1986). "Pains and Other Secondary Mental Entities." Philosophy and Phenomenological Research, 47(1): 59–74.

            Pains are dependent existents, and pretty much they are literally where they feel to be.

[pain nature]

Bain, A. (1892). "Pleasure and Pain." Mind, 1(2): 161–187.

           

[pain nature]

Marshall, H. R. (1891). "The Physical Basis of Pleasure and Pain (I)." Mind, 16(63): 327–354.

           

[pain nature]

Marshall, H. R. (1891). "The Physical Basis of Pleasure and Pain. (II)." Mind, 16(64): 470–497.

           

[pain nature]

Marshall, H. R. (1892). "Pleasure-Pain and Sensation." The Philosophical Review, 1(6): 625–648.

           

[pain nature]

Marshall, H. R. (1893). "Prof. Bain on Pleasure and Pain." Mind, 2(5): 89–93.

           

[pain nature]

Marshall, H. R. (1894). "Pleasure-Pain." Mind, 3(12): 533–535.

           

[pain nature]

Marshall, H. R. (1894). Pain, pleasure, and Aesthetics: An Essay Concerning the Psychology of Pain and Pleasure. London and New York: Macmillan.

            Marshall was a party in a famous debate at the end of the 19^th century as to whether pain should be conceived as a specific sensory modality or as more like an emotion (a negative hedonic tone of sensations proper).  He defended the so-called “Affect Theory of Pain”.

[pain nature]

Marshall, H. R. (1895). "Emotions versus Pleasure-Pain." Mind, 4(14): 180–194.

           

[pain nature]

Singer, E. A., Jr. (1924). "On Pain and Dreams." Journal of Philosophy, 21(22): 589–601.

            Takes issue with Bergsonian unchecked subjectivism, and defends that modern psychophysical techniques for measuring pain sets a limit to this kind of explanation.

[pain nature]

O'Shaughnessy, B. (1955). "The Origin of Pain." Analysis, 15: 121–130.

            The author addresses the position that pain is in a "different realm from the kind of thing we normally regard as its occasion." he disagrees with this, asking what particular properties pain has by which it could "express itself."  Pain itself is a property of things.

[pain nature; pain religion]

Buytendijk, F. J. J. (1957). "The Meaning of Pain." Philosophy Today, 1: 180–185.

            A lot of discourse on the religious meaning of pain, but contains interesting stuff.

[pain nature]

Baier, K. (1962). "Pains." Australasian Journal of Philosophy, 40: 1–23.

            The author defends the "natural view, that pains are occurances in, or states of, the mind," against alternative accounts which he finds untenable. he modifies the natural view to meet the criticisms of these other views.

[pain nature]

Daniels, C. B. (1967). "Colors and Sensations, or How to Define a Pain Ostensively." American Philosophical Quarterly, 4: 231–237.

           

[pain nature]

Cowan, J. L. (1968). Pleasure and Pain: A Study in Philosophical Psychology. London: Macmillan.

            Chapters one through five attempt to provide an explanatory framework for feelings, sensations, appearances and the like, without either invoking a metaphysical dualism or failing to do justice to those factors which have inclined people to invoke such a dualism. chapters six and seven examine hedonism. six argues that ethical hedonism, properly construed, does not commit the naturalistic fallacy, but is rather founded precisely on the rejection of that fallacy. seven argues that psychological hedonism, properly construed, is a much more viable sort of explanation for human conduct than recent philosophy has allowed.  Pretty much an exercise in linguistic analysis.

[pain nature]

Szasz, Thomas Stephen (1975). Pain and Pleasure: A Study of Bodily Feelings. New York: Basic Books.

The aim of this study has been "to isolate and describe in terms of appropriate abstractions the essential formal characteristics of pain and pleasure at different levels of symbolic development." These formal attributes are found to be the "framework of object relationships and the notion of psychological development." During early stages of the latter pain and pleasure are associated with ego orientations toward the body. Later on, in addition to the nature of the ego's object orientation, "it was found that the ego's experience of whether it is gaining or losing something needed furnishes another unifying concept around which pain and pleasure can be ordered. Thus losses are felt as pain or anxiety and gains as pleasure." 18-page bibliography. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

 

[pain nature]

Robinson, W. S. (1979). "Do Pains Make a Difference to Our Behavior?" American Philosophical Quarterly, 16: 327–334.

            [Not particularly on pain, but uses pain as an example in his discussion of mental causation.]

A. Goldman tries to reconcile mental-physical dualism with both common sense (claims like "Jones did a because of the pain" are sometimes true) and science (physical events with sufficient causes have sufficient physical causes) by arguing that (non-physical) pains can be regarded as causes of behavior. I argue that this attempt fails. I consider L. Wright's reconciliatory view in "rival explanations."  I explain why this admirable view cannot be extended to cover sensations.  Finally, I explain how a reconciliation can be achieved.  This involves (1) taking the relevant claims of common sense to have the form (for example): "Jones did a in order to relieve the pain"; and (2) the view that if Jones has a pain and does what he thinks will relieve it then he acts in order to relieve his pain.

[pain nature]

Gustafson, D. (1979). Pain, Grammar, and Physicalism. Body, Mind and Method, D. F. Gustafson (Ed.), Dordrecht: Reidel: 149–166.

[pain nature]

Lewis, D. (1980). Mad Pain and Martian Pain. Readings in Philosophy of Psychology, N. Block (Ed.), Cambridge, MA: Harvard University Press. I.

            A common sense functionalism is defended for experiences like pain.

[pain nature]

Wilson, M. (1985). "What Is This Thing Called "Pain" -- The Philosophy of Science Behind the Contemporary Debate." Pacific Philosophical Quarterly, 66: 227–267.

            Not particularly on pain.  Defends a type-type identity theory against functionalism by examining a lot of scientific cases.

   

[pain nature]

Natsoulas, T. (1988). "On the Radical Behaviorist Conception of Pain Experience." Journal of Mind and Behavior, 9: 29–56.

            It is time for radical behaviorism no longer to pretend, but to begin to reflect with increasing accuracy the true state of affairs as regards people's inner lives. the present article pursues the part of the radical behaviorist conception of consciousness that bears, successfully or not, on our conscious experience of pain. I hope to see radical behaviorists assume some of the scientific leadership that psychology needs to bring it out of the inner darkness of the twentieth century.

             

[pain nature]

Gustafson, D. (1995). "Belief in Pain." Consciousness and Cognition, 4: 323–345.

            Author argues against the view that pain is a simple sensory raw feel that has a unified implementation base, and draws various consequences against the common philosophical conceptions of pain.

[pain nature]

Grahek, N. (1995). "The Sensory Dimension of Pain." Philosophical Studies, 79(2): 167–184.

            Criticism of Norton Nelkin's (1986, 1987) neo-Wittgensteinean "attitudinal" view of pain.  Grahek argues that Nelkin got his science completely wrong from the secondary resources.

[pain nature]

Bieri, P. (1995). Pain: A Case Study for the Mind-Body Problem. Pain and the Brain: From Nociception to Cognition, B. Bromm and J. E. Desmedt (Eds.), New York: Raven Press.

            A nice overview of the mind-body problem as it arises for the special case of pain.  Careful and clear discussion.

[pain nature]

Blum, A. (1996). "The Agony of Pain." Philosophical Inquiry, 18(3/4): 117–120.

            Pain, it is argued, is emotion at a place.

[pain nature]

Gustafson, D. (1998). "Pain, Qualia, and the Explanatory Gap." Philosophical Psychology, 11(3): 371–387.

            This paper investigates the status of the purported explanatory gap between pain phenomena and natural science, when the "gap" is thought to exist due to the special properties of experience designated by "qualia" or "the pain quale" in the case of pain experiences. The paper questions the existence of such a property in the case of pain by: (1) looking at the history of the conception of pain; (2) raising questions from empirical research and theory in the psychology of pain; (3) considering evidence from the neurophysiological systems of pain; (4) investigating the possible biological role or roles of pain; and (5) considering methodological questions of the comparable status of the results of the sciences of pain in contrast to certain intuitions underpinning "the explanatory gap" in the case of pain. Skepticism concerning the crucial underlying intuitions seems justified by these considerations.

[pain nature]

Slater, B. H. (2001). "Seeing Pains." Grazer Philosophische Studien, 62: 65–81.

            [Argues against Tye', Dretske's, and Lycan's intentionalist views of pain (and sensing, in general), seems to defend ability hypothesis and some sort of adverbialism.]

P.M.S. Hacker, recounting some of Wittgenstein's views, says (Hacker 1996, p 134): “(T)he pervasive conception of behavior that has informed philosophical psychology for the last three centuries has misrepresented human behavior as 'bare bodily movement', from which it is supposed we infer, by analogy or inference to best explanation, the inner state and so on from which the behavior might be thought to arise.... But we see the pain in a person's face hear the glee in his chortles, perceive the affection in the looks and gestures of lovers.” In this paper I explain how this can be, before meeting several objections.

[pain nature]

Skokowski, Paul (2007). "Is the pain in Jane felt mainly in her brain?", Harvard Review of Philosophy, Vol 15, Fall (2007).

 

[pain nature ; pain access]

Kripke, S. A. (1980). Naming and Necessity. Cambridge, Massachusetts: Harvard University Press.

            Pains are identified by their feel which is essential to them and partly for that reason cannot be identical to brain states.  Classic discussion of the modal argument against physicalism discussed with the example of pain.

[pain nature; pain access]

Barnette, R. L. (1977). "Kripke's Pains." Southern Journal of Philosophy, 15: 3–14.

            I argue against a central assumption made by Saul Kripke in his arguments against the identity thesis; viz. that (what he calls) the "epistemic situation" for picking out pains "fixes" "essentially" the reference of 'pain' or 'my pain', and that 'pain' or 'my pain' is a rigid designator, guaranteed to pick out a "sensation" which has the essential property of "being felt as a pain".  My case turns on successfully showing the possibility of a system which (a) is in the same (type of) epistemic situation as one is in when pain is (allegedly) present, but (b) does not undergo a painful "sensation", a phenomenon which is believed to account for the epistemic situation.  In other words, I show the possibility that the epistemic situation for pains is "ambiguous" vis-a-vis the presence of painful sensations (which Kripke argues cannot be material states, processes, etc.) and their absence.

[pain nature]

Pauen, M. (2000). "Painless Pain: Property Dualism and the Causal Role of Phenomenal Consciousness." American Philosophical Quarterly, 37(1): 51–63.

            Not on pain particularly, but uses pain as an example to argue against Chalmers.

[pain nature ; pain affect ; pain access ; pain general; pain value]

Trigg, R. (1970). Pain and Emotion. Oxford: Clarendon Press.

            Questions discussed include the analysis of the meaning of "pleasure," the conclusion being that the use of the word is not parallel to that of pain, the interpretation of masochism, the problem of the criteria for determining whether pain is felt in cases where response is not normal, the connection between pain and anxiety, and the application of the concept of identity to a pain or emotion.  One of the best philosophical discussions of pain and pleasure in the 20th century.

[pain nature ; pain history]

Duncan, G. (2000). "Mind-Body Dualism and the Biopsychosocial Model of Pain: What Did Descartes Really Say?" Journal of Medicine and Philosophy, 25(4): 485–513.

            Pain plays a key role in Cartesian as well as contemporary thinking about the problem of dualism. Theories of the psychological origins of pain symptoms persisted throughout the history of modern medicine and were not necessarily discouraged by Cartesian mental philosophy. Moreover, the recently developed bio-psycho-social model of pain may have more in common with Cartesian dualism than it purports to have. This article presents a rereading of Descartes' mental philosophy and his views on pain. The intention is not to defend his theories, but to re-evaluate them and to ask in what respect contemporary theories represent any significant advance in philosophical terms.

[pain nature ; pain perception]

Nelkin, N. (1986). "Pains and Pain Sensations." Journal of Philosophy, 83(3): 129–148.

           

[pain nature ; pain perception]

Nelkin, N. (1994). "Reconsidering Pain." Philosophical Psychology, 7(3): 325–343.

            Previously (Nelkin, 1986), I argued that phenomenal states only accompany pains, that pains are essentially a combination of cognitive, affective, and behavioral/ motivational states. I now wish to argue that phenomenal states "are" necessary for pains, though not sufficient. A cognitive state involving an "evaluation" of the phenomenon is also necessary. The evaluation is a "de re" belief, regarding the phenomenon as itself representing harm to the body. Besides admitting that phenomenal states are necessary for pains, I now claim that other belief, affective, and behavioral/ motivational states are "unnecessary" for pain, but normal "consequences" of pain.

[pain nature ; pain privacy ; pain access]

Zemach, E. M. (1971). "Pains and Pain-Feelings." Ratio, 13: 150–157.

            The following theses are argued for: (1) sensation-terms refer to sensations, felt by people and distinguishable both qualitatively and (pace Malcolm) numerically. Sensations are properties of material things (e.g., stomachs). logically, the same pain may be felt by many observers; hence pains are not private objects. (2) x's feeling of the pain p is not a private object either. It is not a factual question how many feelings of p are there. as Kant recognized, one cannot use the nonidentity of x's feeling of p with y's feeling of p in distinguishing x from y. The number of distinct feelings-of-p depends upon the number of feelers-of-p we wish to distinguish, and this is a matter of convention. (3) If the question 'do others have feelings as i do?' is about the sensations felt, it is empirically answerable. If it is about the feeling of sensations, it can be answered by stipulation only.

[pain nature; pain concept]

Gert, B. (1967). "Can a Brain Have a Pain?" Philosophy and Phenomenological Research, 27(3): 432–436.

           

[pain nature; pain concept]

Gillett, G. R. (1991). "The Neurophilosophy of Pain." Philosophy: 191–206.

            Pain is a complex neurological and psychological function which does not fit the traditional model of a self-evident (Cartesian) mental state. If we accept a more concept-based approach to the nature of mental ascriptions, we find that we get an analysis which is far more congenial to neurophysiology and psychology. This view suggests that a pain is a characteristic set of reactions by creatures like us to certain kinds of events.

[pain nature; pain value]

Plochmann, G. K. (1950). "Some Neglected Considerations on Pleasure and Pain." Ethics, 61(1): 51–55.

           

[pain perception]

Grice, H. P. (1962). Some Remarks About the Senses. Analytical Philosophy, R. J. Butler (Ed.), Oxford, UK: Blackwell: pp. 133–151.

            There is good reason to retain the distinction between bodily sensations and sensible properties.

[pain perception]

McKenzie, J. C. (1968). "The Externalization of Pains." Analysis, 28: 189–193.

            Argues as against G.P. Grice (in Analytical Philosophy series one, ed. R.J. Butler) that there is as much reason to speak of a pain-sense as of a sense of smell.

[pain perception]

Holborow, L. C. (1969). "Against Projecting Pains." Analysis: 29 105–108.

            I argue that pain cannot be accepted as a sense in the way in which smell is a sense. J.C. McKenzie (Analysis, vol. 28, no. 6) had argued as against G.P. Grice (in Analytical Philosophy eries one, ed. R.J. Butler) that there is as much reason to speak of a pain-sense as of a sense of smell. I defend Grice's conclusion on the ground that we have good reason to retain the distinction between bodily sensations and sensible properties.

[pain perception]

Pitcher, G. (1969). "Mckenzie on Pains." Analysis, 29: 103–105.

            A critique of J. C. McKenzie's "The Externalization of Pains" (Analysis, v. 28, pp. 189–193) in which the experiencing of pain is construed as a form of sense perception. It is argued that McKenzie's perceptual view of pain is inadequate.  A different perceptual view capable of meeting the objections raised against McKenzie's is briefly sketched.

[pain perception]

Armstrong, D. M. (1962). Bodily Sensations. London: Routledge and Kegan Paul.

            It is argued that bodily sensations are a sub-species of sense-impressions, standing to perception of our own bodily state (or in some cases to tactual perception) as visual impressions stand to the sense of sight. Alternative accounts of the nature of bodily sensations are examined and rejected. An account of tactual and bodily perception, and the range of properties which they involve, is also given.

[pain perception]

Armstrong, D. M. (1968). A Materialist Theory of the Mind. New York: Humanities Press.

            Argues for a perceptual theory of pain.

[pain perception]

Pitcher, G. (1970). "Pain Perception." The Philosophical Review, 79(3): 368–393.

            A very elegant and thorough defense of a direct realist version of perceptual view of pain.

[pain perception]

Pitcher, G. (1970). A Theory of Perception. Princeton, NJ: Princeton University Press.

[pain perception]

Mayberry, T. C. (1978). "The Perceptual Theory of Pain." Philosophical Investigations, 1: 31–40.

            I explore the logical gap between the concepts of feeling pain and that of perceiving a state of affairs and point out the absence of a conceptual framework to support any theory or supposition that feeling pain is perceiving a state of affairs.  I conclude that the perceptual theory of pain is based on misunderstandings and should be rejected.

[pain perception]

Pitcher, G. (1978). "The Perceptual Theory of Pain: A Response to Thomas Mayberry's, "the Perceptual Theory of Pain"." Philosophical Investigations: 1 44–46.

           

[pain perception]

Mayberry, T. C. (1979). "The Perceptual Theory of Pain: Another Look." Philosophical Investigations, 2: 53–55.

            I argue that pain receptors and nerves cannot play the role of sense organs when we feel pain, that feeling pain cannot be a type of perception, and that the connection between bodily disorders and pain is causal but not perceptual, so that bodily disorders are perceived only in the standard ways but not by means of pain receptors.

[pain perception]

Fleming, N. (1976). "The Objectivity of Pain." Mind, 85(340): 522–541.

            Argues for a perceptual theory of pain.

[pain perception]

Margolis, J. (1976). "Pain and Perception." International Studies in Philosophy, 8: 3–12.

            The viability of construing bodily sensations as forms of perception is analyzed. The views of philosophers and scientists concerned with the physiology of pain are reviewed--notably Melzack and Pitcher.  The disanalogies between sensation and perception are shown to bear decisively on the issue.  What is stressed is that the discrimination of pain does not entail negative affect or aversive drive and, if construed as a mode of perception, requires that the relevant discrimination must be of functional states, in fact, of potential states.

[pain perception]

Wilkes, K. V. (1977). Physicalism. London, UK: Routledge.

            Argues for a perceptual theory of pain.

[pain perception]

Perkins, M. (1983). Sensing the World. Indianapolis, Indiana: Hackett.

            In Chapter 1, Perkins argues for an indirect realist version of perceptual view of pain while rejecting sense-data theories and anti-physicalism they are usually associated with.

[pain perception]

Graham, G., and G. L. Stephens (1985). "Are Qualia a Pain in the Neck for Functionalists?" American Philosophical Quarterly, 22: 73–80.

            Pains and bodily sensations generally are allegedly resistant to functionalistic analysis, and this is supposed to undermine functionalism as a general theory of mind. but it doesn't. We argue that pains are composite states, and that the component of pain which may be resistant to functionalistic analysis is not even psychological. This part is pain's qualitative component and is a sensible quality of human and animal bodies.

[pain perception]

Stephens, G. L., and G. Graham (1987). "Minding your P's and Q's: Pain and Sensible Qualities." Nous, 21(3): 395–405.

            Complements Graham, G., and G. L. Stephens (1985).

[pain perception]

Everitt, N. (1988). "Pain and Perception." Proceedings of the Aristotelian Society, 89: 113–124.

            I offer an improved version of recent accounts of pain as a form of perception, and then argue that current attempts to combine an account of pain as perception with the thought that perception is itself a form of belief acquisition, must fail. in particular, the phenomenological aspects of pain mean that the identity conditions for pain and for belief acquisition must be different. so either pain is not perception, or perception is not belief acquisition.

[pain perception]

Newton, N. (1989). "On Viewing Pain As a Secondary Quality." Nous, 23(5): 569–598.

            Newton argues for a perceptual view of pain by arguing that the phenomenal quality of pain is a secondary property of body parts.  The best attempt to treat pain quality as a secondary quality.

[pain perception]

Grahek, N. (1991). "Objective and Subjective Aspects of Pain." Philosophical Psychology, 4: 249–266.

            The aim of this paper is to show that the empirical and conceptual constraints arising from the scientific research on pain phenomena should be taken into account in philosophical discussions concerning the nature and function of pain; otherwise, there is a good chance that philosophers will advocate too simplistic, confused or even outrightly mistaken theories or conceptions of pain. In order to prove this point, one of the most influential philosophical theories of pain--the so-called perceptual view of pain--is put to scrutiny in the light of the psychological, clinical and neurophysiological data coming from the field of pain research.  More specifically, these data are presented in such a way as to show that the sensory quality or sensory aspect of pain is, contrary to objectivistic claims of the perceptual view of pain, a necessary component of our total pain experience.

[pain perception]

Hardcastle, V. G. (1997). "When a Pain is Not." Journal of Philosophy, 94(8): 381–409.

            Pain is just like other sensory modalities except it has a separate inhibitory system.  This explains many puzzling features of pain.

[pain perception]

Block, N. (1996). Mental Paint and Mental Latex. Perception, E. Villanueva (Ed.), Atascadero: Ridgeview.

            This article argues for the view that the representational content of an experiential state does not exhaust its experiential character.

[pain perception]

Lycan, W. G. (1996). Consciousness and Experience. Cambridge, Massachusetts: MIT Press.

            Contains discussion of a representationalist view of pain.

[pain perception]

Harman, G. (1990). The Intrinsic Quality of Experience. Philosophical Perspectives: Action Theory and Philosophy of Mind, E. Villanueva (Ed.), Atascadero: Ridgeview. 4.  (Reprinted in Block, N., O. Flanagan, and G. Güzeldere, Eds. 1997. The Nature of Consciousness: Philosophical Debates. Cambridge: MIT Press.)

            [Contains defense of a direct realist representationalist view of pain.]

There are three familiar and related arguments against psychophysical functionalism and the computer model of the mind. The first is that we are directly aware of intrinsic features of our experience and argues that there is no way to account for this awareness in a functional view. The second claims that a person blind from birth can known all about the functional role of visual experience without knowing what it is like to see something red. The third claims that functionalism cannot account for the possibility of an inverted spectrum. All three arguments can be defused by distinguishing properties of the object of experience from properties of the experience of an object.

[pain perception]

Dretske, F. (1995). Naturalizing the Mind. Cambridge, Massachusetts: MIT Press.

            [Contains a section where he argues for a perceptual, direct realist representationalist view of pain.]

An analysis of qualitative experience--the what-it-is-like aspect of our mental life--in representational terms where representation is understood in a purely naturalistic way. Qualia are identified with the properties internal (physical) states represent, and the properties they represent are those internal states have the natural, the biological, function of indicating. These properties are generally properties of external physical objects (colors, shapes, movements, etc.) and sometimes (in the case of pain, thirst, etc.) of various internal conditions of the body. The final chapter is a defense of this externalistic theory of the mind against the more obvious objections.

[pain perception]

Dretske, F. (1999). "The Mind's Awareness of Itself." Philosophical Studies, 95(1-2): 103–124.

            [Contains a section where he argues for a perceptual, direct realist representationalist view of pain.]

Nothing in our head has (or needs to have) the properties (qualia) we are aware of when we have a perceptual experience. Yet, experiences are in the head. If knowing what something is like is a matter of knowing what properties it has, how, then, can we be aware (if not infallibly, then at least authoritatively) of what our own experiences are like?  To understand how this is possible one must distinguish three forms of awareness: object-, property-, and fact-awareness. Though we are not aware of mental properties, we become aware of mental facts (facts having to do with what properties our mental states have) by awareness of physical properties.

[pain perception]

Dretske, F. (2003). How Do You Know You Are Not A Zombie? Privileged Access: Philosophical Accounts of Self-Knowledge, B. Gertler (Ed.), Hampshire, UK: Ashgate Publishing.

            Contains a section where he argues for a perceptual, direct realist representationalist view of pain.

[pain perception]

Tye, M. (1996). Ten Problems of Consciousness: A Representational Theory of the Phenomenal Mind. Cambridge, Massachusetts: MIT Press.

            [Contains a section where he argues for a perceptual, direct realist representationalist view of pain.]

What is consciousness? Why do so many scientists and philosophers find it so puzzling? These are questions that Michael Tye addresses in this clear and lively book. Tye elaborates a new and enlightening theory about the phenomenal "what it feels like" aspect of consciousness. The test of any such theory, according to Tye, lies in how well it handles ten critical problems of consciousness. Tye argues that all experiences and all feelings represent things, and that their phenomenal aspects are to be understood in terms of what they represent.

[pain perception]

Tye, M. (1997). A Representational Theory of Pains and their Phenomenal Character. The Nature of Consciousness: Philosophical Debates, N. Block, O. Flanagan and G. Güzeldere (Eds.), Cambridge, Massachusetts: MIT Press.

           

[pain perception]

Byrne, A. (2001). "Intentionalism Defended." Philosophical Review, 110(2): 199–240.

            [Contains a section where he argues for a perceptual, direct realist representationalist view of pain.]

The basic claim of intentionalism (also called 'representationalism') is that the phenomenal character of an experience supervenes on its representational content. The paper explains the various versions of intentionalism, argues for the strongest of these versions, and defends the conclusion over a number of objections, including those due to Block and Peacocke.

[pain perception; affect; introspection; emotion]

Seager, W. (2002). "Emotional Introspection." Consciousness and Cognition, 11(4): 666–687.

            [This is an attempt to extend a Dretske style representationalist view of introspection to emotions and pain/pleasure.]

One of the most vivid aspects of consciousness is the experience of emotion, yet this topic is given relatively little attention within consciousness studies. Emotions are crucial, for they provide quick and motivating assessments of value, without which action would be misdirected or absent.  Emotions also involve linkages between phenomenal and intentional consciousness.  This paper examines emotional consciousness from the standpoint of the representational theory of consciousness (RTC).  Two interesting developments spring from this.  The first is the need for the representation of value, which is distinctive of emotional experience.  The second is an extension of RTC's theory of introspection to emotional states, revealing why emotional consciousness is so often introspective even though introspective abilities are not needed to experience emotions, and also explaining why introspection of emotional states is so much less reliable than that of other states of consciousness.

[pain perception]

Aydede, M. (2001). "Naturalism, Introspection and Direct Realism about Pain." Consciousness & Emotion, 2(1): 29–73.

            This paper examines pain states (and other intransitive bodily sensations) from the perspective of the problems they pose for pure informational/representational approaches to naturalizing qualia. The article starts with a comprehensive critical and quasi-historical discussion of so-called Perceptual Theories of Pain (e.g., D. M. Armstrong, G. Pitcher), as these were the natural predecessors of the more modern direct realist views. It then describes the theoretical backdrop (indirect realism, sense-data theories) against which the perceptual theories were developed. The conclusion drawn is that pure representationalism about pain in the tradition of direct realist perceptual theories (e.g., E. Dretske, M. Tye) leaves out something crucial about the phenomenology of pain experiences, namely, their affective character. The author touches upon the role that introspection plays in such representationalist views, and indicate how it contributes to the source of their trouble vis-a-vis bodily sensations. The paper ends by briefly commenting on the relation between the affective/evaluative component of pain and the hedonic valence of emotions.

[pain perception ; pain sense-data]

Broad, C. D. (1959). Scientific Thought. Paterson, NJ: Littlefield Adams.

            Contains one of the best and thorough defenses of a sense-datum theory.

[pain phenomenology]

Price, D.D., and Murat Aydede (forthcoming). “The Experimental Use of Introspection in the Scientific Study of Pain and its Integration with Third-Person Methodologies: The Experiential-Phenomenological Approach.” Journal of Consciousness Studies.

Understanding the nature of pain depends, at least partly, on recognizing its subjectivity. This in turn requires using a first-person experiential approach in addition to third-person experimental approaches to study it. This paper is an attempt to spell out what the former approach is and how it can be integrated with the latter. We start our discussion by examining some foundational issues raised by the use of introspection. We explain what makes such a first-person methodology indispensable in the scientific study of pain. We argue that there is no reason to think that the use of such a first-person approach is scientifically or methodologically suspect. We give examples approximating experiments that use the kinds of first-person methods that we propose and defend here, which we call the experiential or phenomenological approach that has its origins in the work of Price and Barrell (1980). We conclude that integrating such an approach to conventional third-person methodologies can only help us in having a fuller understanding of pain and of conscious experience in general.

[pain phenomenology]

Leder, D. (1984). "Toward a Phenomenology of Pain." Review of Existential Psychology and Psychiatry, 19: 255–266.

            In this paper I present a brief phenomenology of pain. I examine how pain transforms our sense of spatiality, temporality, embodiment, and sociality. I argue that pain creates a lived experience of mind-body and self-other dualism. When in pain our body seems something "other," a force opposed to our selfhood and will. In addition, we experience ourselves as cut off from others, who cannot fully share in or alleviate our pain. Pain can thus shatter the life-world into a series of contradictory terms.

[pain privacy; pain nature]

Anderson, J. (1985). "Pain, Private Language and the Mind-Body Problem." Auslegung, 12: 53–69.

           

[pain privacy]

Averill, E. (1978). "Explaining the Privacy of Afterimages and Pains." Philosophy and Phenomenological Research, 38(3): 299–314.

           

[pain privacy]

Fiser, K. B. (1986). "Privacy and Pain." Philosophical Investigations, 9: 1–17.

           

[pain privacy]

Sprigge, T. L. S. (1969). "The Privacy of Experience." Mind, 78(312): 512–521.

           

[pain privacy; pain access]

Bertman, M. A. (1973). "Pain." Philosophical Review (Taiwan): 73-75.

            The paper is a brief examination of pain from the viewpoint of Wittgenstein's discussion of private language and first and third person distinction.  It discusses the difficulties involved in his formulation of the problem.

[pain privacy; pain access]

Tibbetts, P. (1973). "On Making a Pain Public." Philosophical Studies (Ireland), 21: 96–99.

           

[pain privacy ; pain access]

Locke, D. (1964). "The Privacy of Pains." Analysis, 24: 147–152.

            Don Locke  claims that it is possible for one person to feel another person's pain, but not possible for two or more people to own or share one pain.  Locke discusses an alleged possible case in which one person is hooked up to another person's nervous system and subsequently feels what are, according to Locke, the first person's pain.

[pain privacy ; pain access]

Langsam, H. (1995). "Why Pains are Mental Objects." The Journal of Philosophy, 92(6): 303–313.

            The reason why we think pains are mental objects in the sense that they are private and subjective (mind-dependent) is (partly) because they follow us around as our bodies follow us around.

[pain privacy ; pain access ; pain concept]

Taylor, D. M. (1970). "The Logical Privacy of Pains." Mind, 79(313): 78–91.

           

[pain science; pain disassociation]

Head, H., and G. Holmes (1911). " Sensory Disturbances from Cerebral Lesions." Brain, 34: 102–154.

            From Price (2002): "Head and Holmes found patients with lesions of the lateral somatosensory thalamus (one of these was histologically verified to be within VPL) to have deficits in pain appreciation, including unpleasantness, throughout the low to moderate range of nociceptive stimulus intensities.  Like Ploner's (1999) patient, they developed vague feelings of unpleasantness or "pain-related feelings" when the stimulus intensity was raised to levels well above normal pain threshold."

[pain science; pain surgery]

Mark, V. H., F. R. Ervin, and T. P. Hackett (1960). "Clinical Aspects of Stereotactic Thalamotomy in the Human, I: The Treatment of Severe Pain." Arch. Neurol., 3: 351–367.

            Surgical lesion of medial thalamic nuclei for treatment of severe chronic pain.

[pain science]

Barber, T. (1964). "The effects of "hypnosis" on pain: A critical review of experimental and clinical findings." Journal of the American Society of Psychosomatic Dentistry & Medicine, 11(2).

            The data suggest that 'the hypnotic trance state' may be an extraneous variable in ameliorating pain experience in situations described as 'hypnosis'; the critical variables appear to include: (a) suggestions of pain relief, which are (b) given in a close inter-personal setting."

[pain science; pain history]

Melzack, R., and P. D. Wall (1965). "Pain Mechanisms: A New Theory." Science, 150(3699): 971–979.

            The most influential article in the scientific study of pain that started a revolution  in pain research in the last century.  The authors propose a gate-control mechanism in the dorsal horn of the spinal cord where the pain transmission to the brain is modulated by different patterns of peripheral stimulation as well as the descendant signals from the brain.  Contains a good deal of discussion of the history of pain theories.

[pain science]

Beecher, H. K. (1966). "Pain: One Mystery Solved." Science, 151(3712): 840–841.

           

[pain science]

Hilgard, E. R. (1967). "A Quantitative Study of Pain and its Reduction through Hypnotic Suggestion." Proceedings of the National Academy of Sciences of the United States of America, 57(6): 1581–1586.

           

[pain science]

Hosobuchi, Y., J. E. Adams, and R. Linchitz (1977). "Pain Relief by Electrical Stimulation of the Central Gray Matter in Humans and Its Reversal by Naloxone." Science, 197(4299): 183–186.

            Relief of intractable pain was produced in six human patients by stimulation of electrodes permanently implanted in the periventricular and periaqueductal gray matter. The level of stimulation sufficient to induce pain relief seems not to alter the acute pain threshold. Indiscriminate repetitive stimulation produced tolerance to both stimulation-produced pain relief and the analgesic action of narcotic medication; this process could be reversed by abstinence from stimulation. Stimulation-produced relief of pain was reversed by naloxone in five out of six patients. These results suggest that satisfactory alleviation of persistent pain in humans may be obtained by electronic stimulation.

[pain science]

Marx, J. L. (1977). "Analgesia: How the Body Inhibits Pain Perception." Science, 195(4277): 471–473.

           

[pain science]

Fields, H. L., and J.-M. R. Besson, Eds. (1988). Pain Modulation. Progress in brain research; v. 77. Amsterdam, New York: Elsevier.

           

[pain science]

Fields, H. L., Ed. (1990). Pain Syndromes in Neurology. Butterworths international medical reviews. Neurology ; 10. London, Boston: Butterworths.

           

[pain science]

Melzack, R. (1992). "Phantom Limbs." Scientific American, April: 120–126.

            Survey of phantom limb phenomena and phantom limb pain, and discussion of teh underlying brain mechanisms.

[pain science]

Craig, A. D., and M. C. Bushnell (1994). "The Thermal Grill Illusion: Unmasking the Burn of Cold Pain." Science, 265(5169): 252–255.

            In Thunberg's thermal grill illusion, first demonstrated in 1896, a sensation of strong, often painful heat is elicited by touching interlaced warm and cool bars to the skin. Neurophysiological recordings from two classes of ascending spinothalamic tract neurons that are sensitive to innocuous or noxious cold showed differential responses to the grill. On the basis of these results, a simple model of central disinhibition, or unmasking, predicted a quantitative correspondence between grill-evoked pain and cold-evoked pain, which was verified psychophysically. This integration of pain and temperature can explain the thermal grill illusion and the burning sensation of cold pain and may also provide a basis for the cold-evoked, burning pain of the classic thalamic pain syndrome.

[pain science]

Dubner, R., and M. Gold (1999). "The Neurobiology of Pain." Proceedings of the National Academy of Sciences of the United States of America, 96(14): 7627–7630.

           

[pain science]

Melzack, R., and P. D. Wall, Eds. (1999). Textbook of Pain. Edinburgh: Churchill Livingstone.

           

[pain science]

Sufka, K. J. (2000). "Chronic Pain Explained." Brain and Mind, 1: 155–179.

Pains that persist long after damaged tissue has recovered remain a perplexing phenomenon. These so-called chronic pains serve no useful function for an organism and, given its disabling ffects, might even be considered maladaptive. However, a remarkable similarity exists between the neural bases that underlie the hallmark symptoms of chronic pain and those that subserve learning and memory. Both phenomena, wind-up in the pain literature and long-term potentiation (LTP) in the learning and memory literature, are forms of neuroplasticity in which increased neural activity leads to a long lasting increase in the excitability of neurons through structural modifications at pre- and post-synaptic sites. Moreover, the synaptic modifications of wind-up and LTP share a common mechanism: a glutamate N-methyl-D-aspartate (NMDA) receptor interaction that initiates a calcium mediated biochemical cascade that ultimately enhances signal processing at the -amino-3-hydroxy-5-methyl-4-isoxazole proprionic acid (AMPA) receptor.  This paper argues that chronic pain, which has no adaptive value, can be accounted for in terms of the highly adaptive phenomenon of activity-dependent neural plasticity; hence, some cases of chronic pain can be conceptualized as a memory trace in spinal neurons.

[pain science]

Price, D. D., J. L. Riley, and J. B. Wade (2001). Psychophysical approaches to measurement of the dimensions and stages of pain. Handbook of pain assessment (2nd ed ).

            Current methods for measurement and assessment of pain have historical roots in psychophysics, the branch of psychology concerned with the relationships of physical stimulus properties to behavioral responses and sensory perceptions. The psychophysics of pain has been critical for improvements in pain measurement, particularly for providing methods for differential measurement of the different psychological dimensions of pain experience. Both of these applications of psychophysics have important relevance for the treatment and management of acute and chronic pain. The psychophysics of pain have a pivotal role in clarifying the mechanisms of pain and in providing a scientific basis for modern methods of pain measurement and assessment. With this psychophysical perspective in mind, we pursue two interrelated objectives in this chapter. The first is to briefly review modern approaches for the measurement of pain and to explain how psychophysical methods can be applied to measurement and assessment of both clinical and laboratory pain. The second objective is to review an approach for assessment and measurement of the different dimensions and stages of pain processing. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain concept; pain phenomenology]

Aydede, M., and G. Güzeldere (2002). "Some Foundational Issues in the Scientific Study of Pain." Philosophy of Science, 69(Suppl.): S265–S283.

            This paper is an attempt to spell out what makes the scientific study of pain so distinctive from a philosophical perspective. Using the IASP definition of 'pain' (1986) as our guide, we raise a number of questions about the philosophical assumptions underlying the scientific study of pain. We argue that unlike the study of ordinary perception, the study of pain focuses from the very start on the experience itself and its qualities, without making deep assumptions about whether pain experiences are perceptual. This in turn puts scientific explanation in a curious position due to pain's inherently subjective epistemic nature. The reason for this focus on the experience itself and its qualities, we argue, has to do with pain's complex phenomenology involving an affective/motivational dimension. We argue for the scientific legitimacy of first-person phenomenological studies and attempts to correlate phenomenology with neural events. We argue that this methodological procedure is inevitable and has no anti-physicalist ontological implications when properly understood. We end the paper by commenting on a discussion between two prominent pain scientists in the field, Don Price and Howard Fields, about the need to distinguish more dimensions in the phenomenology of pain and how to classify them vis-à-vis the recent scientific findings. Our interest in this discussion is not only to introduce some clarifications but also to show how "neurophenomenology" has already been shaping the scientific research and to back our claim about why this methodology is inevitable with an example.

[pain science]

Chapman, C. R., G. W. Donaldson, Y. Nakamura, R. C. Jacobson, D. H. Bradshaw, and J. Gavrin (2002). "A psychophysiological causal model of pain report validity." Journal of Pain, 3(2): 143–155.

            The validity of the pain report is vitally important but difficult to assess because pain is a personal experience. Human laboratory research affords an opportunity to investigate validity because one can measure the consistency and sensitivity of pain ratings produced in response to known stimuli. This article presents 2 levels of evidence characterizing the validity of the pain report measure. The within-subject agreement of pain report with known stimulus variation quantifies the criterion validity, or accuracy, of the measure. Causal modeling defines a second, between-subject, level of construct validity by suggesting a psychophysiological mechanism determining the observed individual variation in accuracy. We analyzed pain rating data obtained in a laboratory study where 100 subjects (56 men and 44 women) experienced varied levels of painful fingertip electrical stimulation, delivered in random order across 144 trials. Unknown to the subjects, there were only 3 stimulus intensities. Accuracy, defined operationally as the proportion of variance in pain report explained by stimulus level, ranged from 0.07 to 0.91 with a median of 0.64. Hypothesized determinants of accuracy comprised current intensity, event-related late near field evoked potentials, skin conductance response, heart rate, and pupil diameter change. We limited the evoked potential measures to the amplitude of the negative peak at 150 msec (N150amp) and combined the latter 3 measures to form a single index of overall sympathetic nervous system arousal (Arousal). Although men chose higher stimulus levels for the experiment and had higher Arousal than did women, their mean pain reports and their Accuracy did not differ from those of female subjects. We constructed a sequence of path analysis models designed to clarify the causal contributions of current intensity, N150amp, and Arousal, and to determine whether these relationships differ in men and women. The final model revealed a direct causal chain. Stimulus current determined the amplitude of N150amp (possibly an indicator of attention). N150amp in turn determined Arousal, and Arousal emerged as the sole determinant of the Accuracy of the pain report. In addition, this latter effect differed across the sexes. Men who experienced higher levels of Arousal gave more accurate pain reports than those who had lower levels, but women who had higher levels of Arousal gave less accurate pain reports than those with lower levels. Thus construct validation emerged, not from direct stimulus-response correlation, but from the elucidation of a causal chain that related stimulus to response. (C) 2002 by the American Pain Society.

[pain science]

Nakamura, Y., and C. R. Chapman (2002). "Measuring pain: An introspective look at introspection." Consciousness and Cognition, 11(4): 582–592.

            The measurement of pain depends upon subjective reports, but we know very little about how research subjects or pain patients produce self-reported judgments. Representationalist assumptions dominate the field of pain research and lead to the critical conjecture that the person in pain examines the contents of consciousness before making a report about the sensory or affective magnitude of pain experience as well as about its nature. Most studies to date have investigated what Fechner termed "outer psychophysics": the relationship between characteristics of an external stimulus and the magnitude and nature of pain experience. In contrast, Fechner originally envisioned that "inner psychophysics" should investigate the relationship between physiological states and subjective experience. Despite the lack of established research tradition, inner psychophysics has a potential utility in elucidating underlying mechanisms for the production of phenomenal self- report. We illustrate this, using causal modeling analyses of the accuracy of self-reported pain ratings from our laboratory. We submit that the results are inconsistent with representationalist assumptions. Converging trends from several domains of consciousness studies seem to suggest that we need to abandon the unquestioned doctrine of representationalism and search for a more viable framework for understanding the generation of subjective self-report. (C) 2002 Elsevier Science (USA). All rights reserved.

[pain science]

Wall, P. D., R. Melzack, and J. J. Bonica, Eds. (1994). Textbook of pain. Edinburgh ; New York: Churchill Livingstone.

           

[pain science]

Rachlin, H. (1985). "Pain and Behavior." Behavioral and Brain Sciences, 8(43–83).

            A neo-behaviorist view of pain and pain therapy.

[pain science]

Turk, D. C., and R. Melzack, Eds. (2001). Handbook of pain assessment. New York: Guilford Press.

           

[pain modulation; pain science]

Fields, H. L., and A. I. Basbaum (1999). Central Nervous System Mechanisms of Pain Modulation. Textbook of Pain, R. Melzack and P. D. Wall (Eds.), Edinburgh: Churchill Livingstone: 309–329.

            An up-to-date, detailed but accessible examination of the modulatory (local and descending) pain systems by two scientists who pioneered the research on endogenous pain modulation.

[pain science; pain animal]

De Grazia, D. (1991). "Pain, Suffering, and Anxiety in Animals and Humans." Theoretical Medicine: 193-211.

            We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result--or perhaps take the form--of a variety of states including pain, anxiety, fear, and boredom. Third, pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states.

[pain science; pain access]

Tinnin, L. (1994). "Conscious Forgetting and Subconscious Remembering of Pain." Journal of Clinical Ethics, 5(2): 151–152.

            The author of this commentary on "Informed Consent to Amnestics" (in the same journal) agrees that physicians use amnestic medication as anesthesia deceptively, allowing patients to believe they have been spared pain when they have only been spared the conscious memory of the pain. The author gives a theoretical explanation of how subconsciously remembered pain can cause later harm and warns physicians about this consequence of the use of benzodiazepine drugs to replace true anesthetics. It should be possible to alleviate the felt pain by some method that would influence the patient's subconscious appraisal of the sensations during the procedure.

[pain science; pain access]

Vogel, G. (1996). "Illusion Reveals Pain Locus in Brain." Science, 274(5291): 1301.

           

[pain science; pain affect]

Melzack, R., and K. L. Casey (1968). Sensory, Motivational, and Central Control Determinants of Pain: A New Conceptual Model. The Skin Senses, D. Kenshalo (Ed.), Springfield: Charles C. Thomas: 223–43.

            The second most influential article in the scientific study of pain in the last century where the authors propose different components to both pain experience and the underlying mechanisms: the sensory-discriminative, affective-motivational, and cognitive-behavioral components of pain.

[pain science; pain affect]

Wade, J. B., L. M. Dougherty, C. R. Archer, and D. D. Price (1996). "Assessing the stages of pain processing: A multivariate analytical approach." Pain, 68(1).

            Tested a 4-stage model of pain processing consisting of pain sensation intensity, pain unpleasantness (stage 1 affect), suffering (stage 2 affect), and pain behavior. 506 Ss with chronic pain (aged 16-85 yrs) were studied using a linear structural relations (LISREL) multivariate statistical technique in order to demonstrate the structural relationship among multiple indicators of pain processing and to characterize these stages in terms of their interactions. A strong relationship was revealed between the majority of the underlying indicators of each pain processing stage. A linear stage sequence best fitted the relationship between the 4 stages. Successive stages did not have recursive effects on earlier pain components. A confirmatory LISREL analysis was conducted with an additional sample of 502 Ss with chronic pain (aged 16-85 yrs). Results extend the validation of the pain dimensions, as well as the validity of the measure(s) of each separate stage. Items from the Pain Experience Visual Analogue Scales and the Psychosocial pain Inventory are appended. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect]

Fernandez, E., T. S. Clark, and D. Rudick-Davis (1999). A framework for conceptualization and assessment of affective disturbance in pain. Handbook of pain syndromes: Biopsychosocial perspectives.

            This chapter introduces a variety of affective phenomena, and explains the relevance of some of these to the experience of pain. The dynamic interaction between affect and pain is elaborated on. Data on emotions are drawn from a recent survey of pain sufferers, and case examples of affective disturbances in pain patients are provided. Finally, avenues for the assessment of affective disturbance in this population are outlined. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect]

Fernandez, E., T. S. Clark, and D. Rudick-Davis (1999). A framework for conceptualization and assessment of affective disturbance in pain. Handbook of pain syndromes: Biopsychosocial perspectives.

            This chapter introduces a variety of affective phenomena, and explains the relevance of some of these to the experience of pain. The dynamic interaction between affect and pain is elaborated on. Data on emotions are drawn from a recent survey of pain sufferers, and case examples of affective disturbances in pain patients are provided. Finally, avenues for the assessment of affective disturbance in this population are outlined. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect]

Fields, H. L. (1999). "Pain: An Unpleasant Topic." Pain, Suppl(6): 61–69.

            Fields proposes a distinction between the immediate unpleasant quality of pain and the more pervasive cognitively more sophisticated emotive component of pain, and distinguishes both of these from affect neutral pain quality which he calls algosity.  Compare Price 1988, 2000.

[pain science; pain affect; pain disassociation]

Price, D. D. (2000). "Psychological and Neural Mechanisms of the Affective Dimension of Pain." Science, 288(9): 1769–72.

           

[pain science; pain affect; pain disassociation]

Price, D. D. (2002). "Central Neural Mechanisms that Interrelate Sensory and Affective Dimensions of Pain." Molecular Interventions, 2: 392–403.

            [This is an extended version of Price (Science, 2002)]

Clinical and experimental studies show serial interactions between pain sensation intensity, pain unpleasantness, and secondary affect associated with reflection and future implications (i.e., suffering). These pain dimensions and their interactions relate to ascending spinal pathways and a central network of brain structures that process nociceptive information both in series and in parallel.  Spinal pathways to amygdala, hypothalamus, reticular formation, medial thalamic nuclei, and limbic cortical structures provide direct inputs to brain areas involved in arousal, bodily regulation, and hence affect.  Another major input to these same structures is from spinal pathways to somatosensory thalamic (VPL, VPM) and cortical areas (S-1, S-2, posterior parietal cortex) and from these areas to cortical limbic structures (insular cortex, anterior cingulate cortex).  This cortico-limbic pathway integrates nociceptive input with information about overall status of the body and self to provide cognitive mediation of pain affect.  Both direct and cortico-limbic pathways converge on the same anterior cingulate cortical and subcortical structures whose function may be to establish emotional valence and response priorities.  This entire brain network is under dynamic top-down modulation by brain mechanisms that are associated with anticipation, expectation, and other cognitive factors.

[pain science; pain affect; pain disassociation; pain surgery]

Barber, T. X. (1959). "Toward a theory of pain: Relief of chronic pain by prefrontal leucotomy, opiates, placebos, and hypnosis." Psychological Bulletin, 56.

            Research concerned with the neurological correlates of the pain response and how this response can be mitigated or eliminated by various clinical procedures permit several tentative conclusions: (a) pain producing stimuli activate a variety of nerve fibers rather than activating specific "pain" nerve pathways. (b) Pain producing stimuli set off patterns of neural impulses which are different from those produced by other stimuli. (c) Discomfit due to pain is not necessarily present when the noxious stimulus has been discriminated. Discomfit can be eliminated by various clinical procedures without necessarily altering the sensation of pain. (d) Mitigation of discomfort by clinical procedures appears to be secondary to their more generalized effect, i.e., anxiety reduction. 174-item bibliog. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect; pain disassociation]

Fernandez, E., and D. C. Turk (1992). "Sensory and affective components of pain: Separation and synthesis." Psychological Bulletin, 112(2).

            It has become increasingly accepted that pain is not simply a sensation generated by nociceptors, but a perceptual phenomenon with particular emotional qualities. The purpose of this article is to bring together vastly different streams of research on the divisibility of pain into sensory and affective components. Empirical evidence for this divisibility is drawn from recent studies using multivariate statistics, signal detection theory, and unidimensional scaling. An important conclusion is that separable though pain components may be, they are not necessarily independent. In critiquing previous research, new criteria are derived for partitioning pain into sensory and affective components. Finally, speculations are offered as to how these same components might be synthesized on the basis of theories of perceptual organization. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect; pain disassociation]

Greenspan, J. D., and J. A. Winfield (1992). "Reversible pain and tactile deficits associated with a cerebral tumor compressing the posterior insula and parietal operculum." Pain, 50(1).

            Conducted psychophysical tests on a 13-yr-old boy with a tumor located just inferior and posterior to the retroinsular cortex of the right hemisphere. The left hand exhibited a higher mechanical pain threshold, a higher heat pain threshold, a greater cold pain tolerance, and a poorer ability to discriminate roughness. The S was re-examined after operative removal of the tumor and had regained normal sensitivity in his left hand. Pre- and postoperative magnetic resonance imaging (MRI) showed resolution of the tumor's mass effect on the retroinsula and neighboring parietal operculum, which likely included the 2nd somatosensory cortex. This dramatic change in sensory capacity signifies an essential role for the posterior insula and parietal operculum in normal pain and tactile perception. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect; pain disassociation]

Fernandez, E., and T. W. Milburn (1994). "Sensory and affective predictors of overall pain and emotions associated with affective pain." Clinical Journal of Pain, 10(1).

            Psychological scaling techniques consistently produce separate ratings for sensory and affective components of pain. This correlational study examines the relative contributions of these components to pain as a whole and the contributions of different emotions to the affective component of pain. Ss were 40 chronic pain sufferers (mean age 44 yrs old) admitted to an inpatient pain management program. Visual analogue scales were used to quantify overall pain, sensory pain, affective pain, and individual emotions. These data lent themselves to regression techniques for expressing pain as a function of sensation and affect as a function of emotion types. Ratings of overall pain were not a simple summation of sensory and affective ratings, but a linearly additive function of both component ratings each with a unique weighting. The affective component of pain was a function of three differentially weighted sets of emotions, anger, fear, and sadness being most salient. Implications arise for the broader assessment of chronic pain and the treatment of specific emotions that may be particularly associated with the pain. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain affect; pain disassociation]

Chapman, C. R., Y. Nakamura, G. W. Donaldson, R. C. Jacobson, D. H. Bradshaw, L. Flores, and C. N. Chapman (2001). "Sensory and affective dimensions of phasic pain are indistinguishable in the self-report and psychophysiology of normal laboratory subjects." Journal of Pain, 2(5): 279–294.

            This study evaluated the discriminant validity of subjects differentially scaling the sensory and affective dimensions of pain. it sought to determine (1) whether subjects can differentially scale sensory and affective aspects of phasic laboratory pain in the absence of task demand bias that fosters apparent differential scaling; (2) whether psychophysiological responses to painful stimuli can predict pain report (PR); and (3) whether such responses contribute more to affective than to sensory judgments. Fifty-six men and 44 women repeatedly experienced varied painful electrical fingertip stimuli at low, medium, and high intensities. On half of the trial blocks, subjects made sensory judgments; on the remainder they made affective judgments. Response measures included PR, pupil dilation, heart rate, respiration rate, skin conductance response (SCR), and late near field evoked potentials. Subjects did not rate the stimuli differently when making sensory versus affective judgments. The psychophysiological variables, principally the SCR, accounted for 44% of the variance in the PR. Psychophysiological response patterns did not differentiate affective and sensory judgment conditions. Noteworthy sources of individual differences included baseline PR levels and the linear effects of SCR on PR. (C) 2001 by the American Pain Society.

[pain science; pain affect; pleasure]

Berridge, K. C. (1999). Pleasure, Pain, Desire, and Dread: Hidden Core Processes of Emotion. Well-Being: The Foundations of Hedonic Psychology, D. Kahneman, E. Diener and N. Schwarz (Eds.), New York: Russell Sage Foundation.

           

[pain science; pain asymbolia]

Weinstein, E. A., R. L. Kahn, and W. H. Slate (1995). "Withdrawal, Inattention, and Pain Asymbolia." Arch. Neurol. Psychiat., 74(235).

           

[pain science; pain asymbolia; pain disassociation]

Rubins, J. L., and E. D. Friedman (1948). "Asymbolia for Pain." Arch. Neurol. Psychiat., 60: 554–73.

           

[pain science; pain asymbolia; pain disassociation]

Berthier, M. L., S. E. Starkstein, and R. Leiguarda (1988). "Pain Asymbolia: A Sensory-Limbic Disconnection Syndrome." Annals of Neurology, 24: 41–49.

            Most thorough study of pain asymbolia.

[pain science; pain asymbolia; pain disassociation]

Berthier, M. L., S. E. Starkstein, M. A. Nogues, and R. G. Robinson (1990). "Bilateral sensory seizures in a patient with pain asymbolia." Annals of Neurology, 27(1).

            Documents the case of a 64-yr-old, right-handed man, suffering from bilateral sensory seizures and pain asymbolia (i.e., lack of motor and emotional reactivity to painful stimuli applied anywhere on the body surface) with lesions involving the posterior insula and the adjacent inner parietal operculum. These disorders are rare and their coexistence has not been reported in the literature before. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain disassociation]

Freeman, W., and J. W. Wattz (1946). "Pain of Organic Disease Relieved by Prefrontal Lobotomy." Proceedings of the Royal Academy of Medicine, 39: 44–447.

           

[pain science; pain disassociation]

Freeman, W., and J. W. Watts (1950). Psychosurgery, in the treatment of mental disorders and intractable pain. Springfield, IL: Charles.

           

[pain science; pain disassociation]

Hardy, J. D., H. J. Wolff, and H. Goodell (1952). Pain Sensations and Reactions. Baltimore, MD: Williams and Wilkins.

           

[pain science; pain disassociation]

Hardy, J. D., H. G. Wolff, H. Goodell, and H. K. Beecher (1953). "Pain--Controlled and Uncontrolled." Science, 117(3033): 164–167.

           

[pain sience; pain disassociation]

Foltz, E. L., and L. E. White (1962). "Pain 'Relief' by Frontal Cingulotomy." Journal of Neurosurgery, 19: 89–100.

           

[pain science; pain disassociation]

Foltz, E. L., and E. W. White (1962). "The Role of Rostral Cingulumonotomy in ‘Pain’ Relief." International Journal of Neurology, 6: 353–373.

           

[pain science; pain disassociation]

Gracely, R. H., R. Dubner, and P. A. McGrath (1979). "Narcotic Analgesia: Fentanyl Reduces the Intensity but not the Unpleasantness of Painful Tooth Pulp Sensations." Science, 203: 1261–63.

            One of the early studies of modifying pain affect without changing pain sensation.

[pain science; pain surgery;  pain disassociation]

Bouckoms, A. J. (1994). Limbic Surgery for Pain. Textbook of Pain, P. D. Wall and R. Melzack (Eds.), Edinburgh: Churchill Livingston: 1171–87.

           

[pain science; pain disassociation; pain affect]

Dong, W. K., T. Hayashi, V. J. Roberts, and B. M. Fusco (1996). "Behavioral outcome of posterior parietal cortex injury in the monkey." Pain, 64(3).

            [This paper contains important findings relevant for an explanation of pain asymbolia, and shows the importance of certain areas in the posterior parietal cortex for the immediate pain affect.]

Extends previous findings (see record 1995-12570-001) on the role of the posterior parietal cortex in the expression of pain behavior in the monkey. One monkey with a unilateral focal compression of the left posterior parietal cortex was tested with 2 operant behavior tasks designed to assess the relationship of thermal stimulus intensity to escape frequency, thus measuring thermal tolerance; and to determine whether brain trauma affects the ability to utilize non-noxious and noxious thermal cues for reinforcement after altering thermal pain tolerance. Focal compression almost eliminated escape behavior to noxious temperatures applied to the contralateral face region. However, the discriminative aspect of thermosensitivity may have remained intact despite a loss of thermal nociception. The present study provides evidence that trauma to the posterior parietal cortex alters pain sensibility to the contralateral face. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain disassociation; pain affect]

Dong, W. K., E. H. Chudler, K. Sugiyama, and V. J. Roberts (1994). "Somatosensory, multisensory, and task-related neurons in cortical area 7b (PF) of unanesthetized monkeys." Journal of Neurophysiology, 72(2).

            [This paper contains important findings relevant for an explanation of pain asymbolia, and shows the importance of certain areas in the posterior parietal cortex for the immediate pain affect.]

Delimited the sensory response of cortical area 7b neurons and especially the capacity by which somatosensory or multisensory neurons can provide information about stimuli location and intensity applied to facial skin. Three adult monkeys were studied behaviorally and electrophysiologically in a sound-attenuated chamber. Neurons with trigeminal receptive fields were located in the rostral portion of area 7b; no somatotopic representation of the trigeminal nerve subdivisions or visuotopic representation of visual space was evident within this portion of 7b. Among the somatosensory neurons is a large proportion of low-threshold neurons and a smaller proportion of nociceptive neurons. Many of the neurons in both subpopulations are multimodal, responsive to both mechanical and thermal stimuli, and/or multisensory, responsive to both somatosensory and visuosensory stimulation. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain disassociation]

Ploner, M., H. J. Freund, and A. Schnitzler (1999). "Pain affect without pain sensation in a patient with a postcentral lesion." Pain, 81(1/2).

            [Presents a case where affect is present without the sensory-discriminative aspect of pain.]

Reports findings from clinical examination and cutaneous laser stimulation in a 57-yr-old male, who suffered from a right-sided postcentral stroke. This S offered the possibility to study possible dissociations between sensory-discriminative and motivational-affective components of pain perception between 1st and 2nd pain. In this S, the authors were able to demonstrate (1) a dissociation of discriminative and affective components of pain perception and(2) the dependence of sensory-discriminative pain component and 1st pain sensation on the integrity of the lateral pain system. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

[pain science; pain disassociation; pain affect]

White, J. C., and W. H. Sweet (1969). Pain and the Neurosurgeon: A Forty-Year of Experience. Springfield, IL: Charles C. Thomas.

           

[pain science; pain disassociation; pain affect]

Rainville, P., G. H. Duncan, D. D. Price, B. Carrier, and M. C. Bushnell (1997). "Pain Affect Encoded in Human Anterior Cingulate but not Somatosensory Cortex." Science, 277(5328): 968–971.

            [One of the most cited papers for the demonstration of the sensory/affective disassociation.]

Recent evidence demonstrating multiple regions of human cerebral cortex activated by pain has prompted speculation about their individual contributions to this complex experience. To differentiate cortical areas involved in pain affect, hypnotic suggestions were used to alter selectively the unpleasantness of noxious stimuli, without changing the perceived intensity. Positron emission tomography revealed significant changes in pain-evoked activity within anterior cingulate cortex, consistent with the encoding of perceived unpleasantness, whereas primary somatosensory cortex activation was unaltered. These findings provide direct experimental evidence in humans linking frontal lobe limbic activity with pain affect, as originally suggested by early clinical lesion studies.

[pain science; pain disassociation; pain affect]

Rainville, P., B. Carrier, R. K. Hofbauer, M. C. Bushnell, and G. H. Duncan (1999). "Dissociation of sensory and affective dimensions of pain using hypnotic modulation." Pain Forum, 82(2): 159–171.

            [One of the most cited papers for the demonstration of the sensory/affective disassociation.]

[pain science; pain general]

Critchley, M. (1934). "Some aspects of pain." British Medical Journal, 3854.

            The many psychological concomitants of pain are described, such as the apparent increase in time, the existence of "synalgesia" ("colored pain"), individual variability in susceptibility to pain, cessation of pain, etc., and finally the possibility that pain may become a symbol of pleasure in different types of algophilia, especially by sexual association. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

           

[pain science; pain general]

IASP (1986). "Pain Terms: A List with Definitions and Notes on Pain." Pain, 3(Suppl): 216–21.

            Official definition of ‘pain’ and other pain terms.

[pain science; pain general]

Fields, H. L. (1987). Pain. New York: McGraw-Hill.

           

[pain science; pain general]

Melzack, R., and P. D. Wall (1988). The Challenge of Pain. London, England; New York, NY: Penguin Books.

            One of the best popular books on pain written by  two revolutionary pain scientists of the last century.

[pain science; pain history; pain general]

Melzack, R., and P. D. Wall (1962). "On the Nature of Cutaneous Sensory Mechanisms." Brain, 85: 331–356.

            This is a precursor to their ground-breaking article (1965) developing the gate-control theory of pain.  In this paper they go over empirical facts in great detail to clarify what a theory of cutaneous sensory mechanisms need to do to explain them.  It also contains a great deal of history.  A very nice piece where one sees two brilliant scientists working self-consciously theough the history and philosophy of their discipline with an aim to construct a theory.

[pain science; pain general; pain medicine]

Raj, P. P. (1996). Pain Mechanisms. Pain Medicine, P. P. Raj (Ed.), New York: Mosby.

            A nice accessible overview of the masic pain mechanisms in the peripheral as well as central nervous system with an emphasis of how pain medicine works.

[pain science; pain general]

Price, D. D. (1988). Psychological and Neural Mechanisms of Pain. New York: Raven Press.

           

[pain science; pain general]

Price, D. D. (1999). Psychological Mechanisms of Pain and Analgesia. Seattle: IASP Press.

            The best book-length discussion of scientific pain research -- accessible to general audience, although written for medical and scientific community.

[pain science; pain general; pain pathology]

Cross, S. A. (1994). "Pathophysiology of Pain." Mayo. Clin. Proc., 69: 375–383.

            A nice and accessible overview of the basic nervous mechanisms of pain processing with an emphasis of  pain pathologies.

[pain science; pain general]

Chudler, E. H., and W. K. Dong (1995). "The role of the basal ganglia in nociception and pain." Pain, 60(1).

            Explores the role of the striatum, globus pallidus, and substantia nigra in nociceptive sensorimotor integration and suggests several roles of basal ganglia (BG) structures in nociception and pain. Data suggest that the BG may be involved in the (1) sensory-discriminative dimension of pain; (2) affective dimension of pain; (3) cognitive dimension of pain; (4) modulation of nociceptive information; and (5) sensory gating of nociceptive information to higher motor areas. Further experiments that correlate neuronal discharge activity with stimulus intensity and escape behavior in operantly conditioned animals are necessary to understand fully how the BG are involved in nociceptive sensorimotor integration. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain general]

Chapman, C. R., and Y. Nakamura (1999). "A passion of the soul: An introduction to pain for consciousness researchers." Consciousness and Cognition, 8(4): 391–422.

            Pain is an important focus for consciousness research because it is an avenue for exploring somatic awareness, emotion, and the genesis of subjectivity. In principle, pain is awareness of tissue trauma, but pain can occur in the absence of identifiable injury, and sometimes substantive tissue injury produces no pain. The purpose of this paper is to help bridge pain research and consciousness studies. It reviews the basic sensory neurophysiology associated with tissue injury, including transduction, transmission, modulation, and central representation. In addition. it highlights the central mechanisms for the emotional aspects of pain, demonstrating the physiological link between tissue trauma and mechanisms of emotional arousal. Finally, we discuss several current issues in the field of pain research that bear on central issues in consciousness studies, such as sickness and sense of self.

[pain science; pain general]

Millan, M. J. (1999). "The Induction of Pain: An Integrative Review." Progress in Neurobiology, 57: 1–164.

            [The most thorough and detailed up-to-date scientific review, but not so accessible to general audience.]

ABSTRACT.   The highly disagreeable sensation of pain results from an extraordinarily complex and interactive series of mechanisms integrated at all levels of the neuroaxis, from the periphery, via the dorsal horn to higher cerebral structures. Pain is usually elicited by the activation of specific nociceptors (`nociceptive pain'). However, it may also result from injury to sensory fibres, or from damage to the CNS itself (`neuropathic pain'). Although acute and subchronic, nociceptive pain fulfils a warning role, chronic and/or severe nociceptive and neuropathic pain is maladaptive. Recent years have seen a progressive unravelling of the neuroanatomical circuits and cellular mechanisms underlying the induction of pain. In addition to familiar inflammatory mediators, such as prostaglandins and bradykinin, potentially important, pronociceptive roles have been proposed for a variety of `exotic' species, including protons, ATP, cytokines, neurotrophins (growth factors) and nitric oxide. Further, both in the periphery and in the CNS, non-neuronal glial and immunecompetent cells have been shown to play a modulatory role in the response to inflammation and injury, and in processes modifying nociception. In the dorsal horn of the spinal cord, wherein the primary processing of nociceptive information occurs, N-methyl-D-aspartate receptors are activated by glutamate released from nocisponsive afferent fibres.  Their activation plays a key role in the induction of neuronal sensitization, a process underlying prolonged painful states. In addition, upon peripheral nerve injury, a reduction of inhibitory interneurone tone in the dorsal horn exacerbates sensitized states and further enhance nociception. As concerns the transfer of nociceptive information to the brain, several pathways other than the classical spinothalamic tract are of importance: for example, the postsynaptic dorsal column pathway. In discussing the roles of supraspinal structures in pain sensation, differences between its `discriminative-sensory' and `affective-cognitive' dimensions should be emphasized. The purpose of the present article is to provide a global account of mechanisms involved in the induction of pain. Particular attention is focused on cellular aspects and on the consequences of peripheral nerve injury. In the first part of the review, neuronal pathways for the transmission of nociceptive information from peripheral nerve terminals to the dorsal horn, and there-from to higher centers, are outlined. This neuronal framework is then exploited for a consideration of peripheral, spinal and supraspinal mechanisms involved in the induction of pain by stimulation of peripheral nociceptors, by peripheral nerve injury and by damage to the CNS itself. Finally, a hypothesis is forwarded that neurotrophins may play an important role in central, adaptive mechanisms modulating nociception. An improved understanding of the origins of pain should facilitate the development of novel strategies for its more effective treatment. # 1998 Elsevier Science Ltd. All rights reserved.

[pain science; pain general]

Wall, P. D. (2000). Pain : The Science of Suffering. New York: Columbia University Press.

           

[pain science; pain history]

Sufka, K. J., and D. D. Price (in press). "Gate Control Theory Reconsidered." Brain and Mind, 2003.

            It has been 35 years since the publication Melzack and Wall’s Gate Control Theory which hypothesized that nociceptive information was subject to dynamic regulation by mechanisms located in the spinal cord dorsal horn that could ultimately lead to hyperalgesic or hypoalgesic states.  This paper examines Gate Control Theory in light of our current understanding of the neuroanatomical, neurophysiological and neurochemical substrates of nociception and antinociception.  Despite its initial controversies, no one has proposed a more comprehensive overall theory of pain modulation or has successfully refuted most of the basic tenets of this theory.

[pain science; pain imaging]

Jones, A. K. P., W. D. Brown, K. J. Friston, L. Y. Qi, and R. S. J. Frackowiak (1991). "Cortical and Subcortical Localization of Response to Pain in Man using Positron Emission Tomography." Proceedings: Biological Sciences, 244(1309): 39–44.

            A quantitative study of the regional cerebral responses to non-painful and painful thermal stimuli in six normal volunteers has been done by monitoring serial measurements of regional blood flow measured by positron emission tomography (PET). In comparison to a baseline of warm stimulation no statistically significant changes in blood flow were seen in relation to increasing non-painful heat. However, highly significant increases in blood flow were seen in response to painful heat in comparison to non-painful heat. These changes were in the contralateral cingulate cortex, thalamus and lenticular nucleus. These findings are discussed in relation to previous physiological observations of responses to nociceptive stimuli in man and primates.

[pain science; pain imaging]

Talbot, J. D., S. Marrett, A. C. Evans, E. Meyer, M. C. Bushnell, and G. H. Duncan (1991). "Multiple Representations of Pain in Human Cerebral Cortex." Science, 251(4999): 1355–1358.

            The representation of pain in the cerebral cortex is less well understood than that of any other sensory system. However, with the use of magnetic resonance imaging and positron emission tomography in humans, it has now been demonstrated that painful heat causes significant activation of the contralateral anterior cingulate, secondary somatosensory, and primary somatosensory cortices. This contrasts with the predominant activation of primary somatosensory cortex caused by vibrotactile stimuli in similar experiments. Furthermore, the unilateral cingulate activation indicates that this forebrain area, thought to regulate emotions, contains an unexpectedly specific representation of pain.

[pain science; pain imaging]

Jones, A. K. P., K. Friston, R. S. J. Frackowiak, G. H. Duncan, M. C. Bushnell, J. D. Talbot, A. C. Evans, E. Meyer, and S. Marrett (1992). "Localization of Responses to Pain in Human Cerebral Cortex." Science, 255(5041): 215–216.

           

[pain science; pain imaging]

Casey, K. L. (1999). "Forebrain Mechanisms of Nociception and Pain: Analysis through Imaging." Proceedings of the National Academy of Sciences of the United States of America, 96(14): 7668–7674.

            Pain is a unified experience composed of interacting discriminative, affective-motivational, and cognitive components, each of which is mediated and modulated through forebrain mechanisms acting at spinal, brainstem, and cerebral levels. The size of the human forebrain in relation to the spinal cord gives anatomical emphasis to forebrain control over nociceptive processing. Human forebrain pathology can cause pain without the activation of nociceptors. Functional imaging of the normal human brain with positron emission tomography (PET) shows synaptically induced increases in regional cerebral blood flow (rCBF) in several regions specifically during pain. We have examined the variables of gender, type of noxious stimulus, and the origin of nociceptive input as potential determinants of the pattern and intensity of rCBF responses. The structures most consistently activated across genders and during contact heat pain, cold pain, cutaneous laser pain or intramuscular pain were the contralateral insula and anterior cingulate cortex, the bilateral thalamus and premotor cortex, and the cerebellar vermis. These regions are commonly activated in PET studies of pain conducted by other investigators, and the intensity of the brain rCBF response correlates parametrically with perceived pain intensity. To complement the human studies, we developed an animal model for investigating stimulus-induced rCBF responses in the rat. In accord with behavioral measures and the results of human PET, there is a progressive and selective activation of somatosensory and limbic system structures in the brain and brainstem following the subcutaneous injection of formalin. The animal model and human PET studies should be mutually reinforcing and thus facilitate progress in understanding forebrain mechanisms of normal and pathological pain.

[pain science; pain imaging]

Ploner, M., F. Schmitz, H.-J. Freund, and A. Schnitzler (1999). "Parallel activation if primary and secondary somatosensory cortices in human pain processing." Journal of Neurophysiology, 81(6).

            Cerebral processing of pain has been shown to involve primary (SI) and secondary (SII) somatosensory cortices. However, the temporal activation pattern of these cortices in nociceptive processing has not been demonstrated so far. We therefore used whole-head magnetoencephalography to record cortical responses to cutaneous laser stimuli in 6 healthy human Ss (28-38 yr olds). By using selective nociceptive stimuli, our results confirm involvement of contralateral SI and bilateral SII in human pain processing. Beyond they show for the first time simultaneous activation onset of contralateral SI and SII after 130 ms, indicating parallel thalamocortical distribution of nociceptive information. This contrasts to the serial cortical organization of tactile processing in higher primates and instead corresponds to the parallel cortical organization in lower primates and nonprimates. Our finding suggests preservation of the basic mammalian parallel organizational scheme in human pain processing, whereas in the tactile modality parallel organization appears to be abandoned in favor of a serial processing scheme. Functionally, preservation of direct access to SII underscores the relevance of this area in human pain processing, probably reflecting an important role of SII in nociceptive learning and memory. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain imaging]

Timmermann, L., M. Ploner, K. Haucke, F. Schmitz, R. Baltissen, and A. Schnitzler (2001). "Differential coding of pain intensity in the human primary and secondary somatosensory cortex." Journal of Neurophysiology, 86(3).

            In humans, it is unclear how the primary (SI) and secondary (SII) somatosensory cortices contribute to the encoding of nociceptive stimulus intensity. Using magnetoencephalography the current authors recorded responses in SI and SII in 8 healthy Ss (aged 26-33 yrs) to 4 different intensities of selectively nociceptive laser stimuli delivered to the dorsum of the right hand. Ss' pain ratings correlated highly with the applied stimulus intensity. Activation of contralateral SI and bilateral SII showed a significant positive correlation with stimulus intensity. However, the type of dependence on stimulus intensity was different for SI and SII. The relation between SI activity and stimulus intensity resembled an exponential function and matched closely the Ss' pain ratings. SII activity showed an S-shaped function with a sharp increase in amplitude only at a stimulus intensity well above pain threshold. The activation pattern of SI suggests participation of SI in the discriminative perception of pain intensity. In contrast, the all-or-none-like activation pattern of SII points against a significant contribution of SII to the sensory-discriminative aspects of pain perception. Instead, SII may subserve recognition of the noxious nature and attention toward painful stimuli. (PsycINFO Database Record (c) 2002 APA, all rights reserved)

[pain science; pain imaging; pain general]

Treede, R.-D., A. V. Apkarian, B. Bromm, J. D. Greenspan, and F. A. Lenz (1999). "Cortical representation of pain: Functional characterization of nociceptive areas near the lateral sulcus." Pain, 87: 113–119.

            Many lines of evidence implicate the somatosensory areas near the lateral sulcus (Sylvian fissure) in the cortical representation of pain. Anatomical tracing studies in the monkey show nociceptive projection pathways to the vicinity of the secondary somatosensory cortex in the parietal operculum, and to anterior parts of insular cortex deep inside the Sylvian fissure. Clinical observations demonstrate alterations in pain sensation following lesions in these two areas in human parasylvian cortex. Imaging studies in humans reveal increased blood flow in parasylvian cortex, both contralaterally and ipsilaterally, in response to painful stimuli. Painful stimuli (such as laser radiant heat) evoke potentials with a scalp maximum at anterior temporal positions (T3 and T4). Several dipole source analyses as well as subdural recordings have confirmed that the earliest evoked potential following painful laser stimulation of the skin derives from sources in the parietal operculum. Thus, imaging and electrophysiological studies in humans suggest that parasylvian cortex is activated by painful stimuli, and is one of the first cortical relay stations in the central processing of these stimuli. There is mounting evidence for closely located but separate representations of pain (deep parietal operculum and anterior insula) and touch (secondary somatosensory cortex and posterior insula) in parasylvian cortex. This anatomical separation may be one of the reasons why single unit recordings of nociceptive neurons are scarce within regions comprising low-threshold mechanoreceptive neurons. The functional significance (sensory-discriminative, affective-motivational, cognitive-evaluative) of the closely spaced parasylvian cortical areas in acute and chronic pain is only poorly understood. It is likely that some of these areas are involved in sensory-limbic projection pathways that may subserve the recognition of potentially tissue damaging stimuli as well as pain memory. q 2000 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

[pain science; pain imaging; pain general]

Treede, R.-D., D. R. Kenshalo, R. H. Gracely, and A. K. P. Jones (1999). "The cortical representation of pain." Pain, 79: 105–111.

            Anatomical and physiological studies in animals, as well as functional imaging studies in humans have shown that multiple cortical areas are activated by painful stimuli. The view that pain is perceived only as a result of thalamic processing has, therefore, been abandoned, and has been replaced by the question of what functions can be assigned to individual cortical areas. The following cortical areas have been shown to be involved in the processing of painful stimuli: primary somatosensory cortex, secondary somatosensory cortex and its vicinity in the parietal operculum, insula, anterior cingulate cortex and prefrontal cortex. These areas probably process different aspects of pain in parallel. Previous psychophysical research has emphasized the importance of separating pain experience into sensory-discriminative and affective-motivational components. The sensory-discriminative component of pain can be considered a sensory modality similar to vision or olfaction; it becomes more and more evident that it is subserved by its own apparatus up to the cortical level. The affective-motivational component is close to what may be considered ‘suffering from pain’; it is clearly related to aspects of emotion, arousal and the programming of behaviour. This dichotomy, however, has turned out to be too simple to explain the functional significance of nociceptive cortical networks. Recent progress in imaging technology has, therefore, provided a new impetus to study the multiple dimensions of pain.  1999 International Association for the Study of Pain. Published by Elsevier Science

[pain science; pain insensitivity]

Dearborn, G. V. N. (1932). "A case of congenital general pure analgesia." Journal of Nervous & Mental Disease, 75: 612–615.

            A brief presentation of a case of a patient who was unable to recall any pain except headache. The author postulates some sort of structural congenital defect in the central pain mechanism. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Ford, F. M., and L. Wilkins (1938). "Congenital universal insensitiveness to pain." Johns Hopkins Hospital Bulletin, 62.

            These authors report three cases of congenital indifference to potentially painful stimuli in children between the ages of seven and eight. This disorder led to serious injuries. Upon examination, no disorder of the nervous system could be diagnosed. The writers believe that these children do not have true analgesia. Possibly they present a defective reaction to the crude sensation of pain. This may be comparable to congenital color blindness and allied disorders. A few cases are cited from the medical literature. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Boyd, D. A., and L. W. Nie (1949). "Congenital universal indifference to pain." Archives of Neurology & Psychiatry, 61.

            "Congenital universal indifference to pain is apparently a syndrome in which the patient has adequate reception of painful stimuli but is unable to synthesize them into a meaningful, emotionally toned concept with appreciation of unpleasantness and probable danger to self. The nature of the disorder is unknown, and there is no proof regarding its etiology." Two theories are presented to explain this indifferences to pain.

[pain science; pain insensitivity]

Cohen, L. D., D. Kipnis, E. C. Kunkle, and P. E. Kubzansky (1955). "Observations of a person with congenital insensitivity to pain." Journal of Abnormal & Social Psychology, 51.

            A report of the physiological and psychological observations of a 19-year-old college girl of superior intelligence who is congenitally insensitive to pain is presented. No unusual findings are noted on physical examination except insensitivity to pain and mild impairment of several other sensory modalities. Noteworthy was the S's generally flat emotional response to interview, her limited sensitivity in the Rorschach, and her extremely articulate and elaborate sensitivity to sensory qualities revealed in her written and verbal descriptions. Some implications of insensitivity to pain for general psychological functioning are considered. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

McMurray, G. A. (1955). "Congenital insensitivity to pain and its implications for motivational theory." Canadian Journal of Psychology, 9.

            All cases of congenital universal insensitivity to pain reported in the technical literature are considered, and criteria are expounded for the specification of the defect. There is no evidence of consistent defective personality development or lack of normal anxiety in these cases. The implications of normal development without pain for theories of the formation of human motives (Mowrer's, Hebb's, Harlow's, and McClelland's) are discussed. 34 references. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Baxter, D. W., and J. Olszewski (1960). "Congenital universal insensitivity to pain." Brain, 83.

            Clinical history and autopsy findings of a young woman with apparent congenital insensitivity to pain are presented. Pain appreciation was lacking to the extent that she suffered extensive skin and bone trauma contributing directly to her death at age 28 years. Detailed postmortem studies did not demonstrate any gross abnormalities of those nervous structures thought to be concerned with pain impulses. "The possibility that the defect is actually an anatomical one, but in terms of organization rather than structure, is not excluded."

[pain science; pain insensitivity]

Magee, K. R., S. Schneider, and N. Rosenzweig (1961). "Congenital indifference to pain." Journal of Nervous & Mental Disease, 132.

            3 cases of congenital indifference to pain are analyzed and discussed. The 3 males (aged 56, 42, and 67, respectively) showed no subsidence of indifference to pain since childhood. All showed normal nerve endings in the skin, no psychopathology, and were either at the bright, normal, or superior IQ level. Similar background and personality factors were observed. However, it is concluded that "the etiology of congenital indifference to pain is unknown." From Psyc Abstracts 36:01:1BL49M. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Sternbach, R. A. (1963). "Congenital insensitivity to pain: A critique." Psychological Bulletin, 60(3).

            No available reported case of apparent congenital pain insensitivity meets strict requirements for the syndrome. 17 "probable" cases are so neurologically and behaviorally heterogeneous that there appear to be several kinds of insensitivities with variations in the nature and/or locus of their neural deficits. The possible kinds of such deficits are discussed. The ability of these persons to survive is seriously impaired and depends on their ability to use other sensory cues of tissue damage. Normal personality development is rarely affected by the absence of pain. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Swanson, A. G., G. C. Buchan, and E. C. Alvord (1965). "Anatomic changes in congenital insensitivity to pain." Archives of Neurology, 12(1).

            The neuropathalogic findings in a case of congenital insensitivity to pain with anhidrosis are reported. These findings represent almost complete absence of the 1st order afferent system generally considered responsible for pain and temperature sensation. A genetically determined defect in differentiation and migration of neural crest elements in embryogenesis is postulated as the cause of this identical syndrome in siblings. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Kane, F. J., A. W. Downie, D. B. Marcotte, and M. Perez-Reyes (1968). "A Case of Congenital Indifference to Pain: Neurologic and Psychiatric Findings." Diseases of the Nervous System, 29(6).

            Presents a psychiatric and neurological evaluation of a female with congenital indifference to pain. S's neurological picture was found to be similar to other reported cases, but her personality pattern differed considerably from 3 males with the same condition. It is suggested that the influence of biological variation on personality is more closely related to sociocultural factors which are related to sexual role than to the defect itself. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Rapoport, J. L. (1969). "A case of congenital sensory neuropathy diagnosed in infancy." Journal of Child Psychology & Psychiatry & Allied Disciplines, 10(1).

            Studied an infant with congenital absence of pain, temperature, and tactile sensation on his body surface during the age period from 18-36 mo. Observations focused on intellectual and emotional development. Verbal intelligence was normal, although motor development was delayed. The strength of attachment, separation anxiety, and response to positive or negative social stimuli was age appropriate. Maternal attachment was markedly warm. This supports the view that auditory, visual, and kinesthetic stimuli may be sufficient in the absence of tactile stimulation for initiation and maintenance of attachment behavior. (17 ref.) (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Dubovsky, S. L., and S. E. Groban (1975). "Congenital absence of sensation." Psychoanalytic Study of the Child, 30.

            Reports a case study of the psychological development and psychotherapy of an 18-yr-old male with congenital absence of touch, pain, temperature, vibration, joint position sense, stereognosis, and visceral sensation. The role of somatic sensation in the formation of ego functions is discussed, as well as the alteration in the mother-child relationship which occurs when the child is deprived of one or more sense modalities. (56 ref) (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

McMurray, G. A. (1975). "Theories of pain and congenital universal insensitivity to pain." Canadian Journal of Psychology, 29(4).

            Reviews the literature on congenital insensitivity to pain with attention on the clinical entity called congenital universal insensitivity to pain (CUIP). Specificity, pattern, and gate control theories of pain are considered with reference to their ability to subsume research findings on CUIP. These data seem best explained by gate control theory which has the additional advantage of providing a processing model for pain closer to the models being developed in other perceptual systems. Guidelines for research on CUIP based on implications derived from gate control theory are suggested. (French summary) (31/2 p ref) (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Dehen, H. (1978). "Congenital insensitivity to pain and the "morphine-like" analgesic system." Pain, 5(4).

            Compared the effects of naloxone and of placebo in 8 normal Ss and in a patient with congenital insensitivity to pain. In normal Ss, no significant change in the reflex threshold was observed with naloxone or with placebo. In contrast, 2 electrophysiological abnormalities characterized the patient: spontaneous elevation in the nociceptive reflex threshold and a large and rapid fall of this threshold for about 10 min following naloxone. (34 ref) (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity]

Larner, A. J., J. Moss, M. L. Rossi, and M. Anderson (1994). "Congenital insensitivity to pain: A 20 year follow up." Journal of Neurology, Neurosurgery & Psychiatry, 57(8).

            Reports on 20-yr follow-up assessments done on 2 siblings reported by D. C. Thrush (1973) to have a congenital insensitivity to pain. The 2 Ss, males aged 30 and 31 yrs at follow-up, had originally presented with numerous painless injuries, bone fractures, Charcot joints, and autonomic dysfunction; the absence of any relevant lesion on peripheral nerve biopsies suggested that a central neural defect existed in the reticular formation and/or dorsal horn of the spinal cord. Upon reassessment, both Ss showed unequivocal progression of their clinical symptoms: both had developed distal sensory loss to several modalities and had lost tendon reflexes. Current electrophysiological evidence suggests that the Ss have a hereditary sensory and autonomic neuropathy. (PsycINFO Database Record (c) 2000 APA, all rights reserved)

[pain science; pain insensitivity; pain affect]

Brand, P. W., and P. Yancey (1993). Pain: The Gift Nobody Wants. New York: HarperCollins Publishers.

            Describes interesting attempts to develop artificial pain systems for people suffering from leprosy in the hands.  Interesting and philosophically important morals of why the project has failed.

[pain science; pain perception]

Bushnell, M. C., G. H. Duncan, R. K. Hofbauer, B. Ha, J. I. Chen, and B. Carrier (1999). "Pain Perception: Is There a Role for Primary Somatosensory Cortex?" Proceedings of the National Academy of Sciences of the United States of America, 96(14): 7705–7709.

            Anatomical, physiological, and lesion data implicate multiple cortical regions in the complex experience of pain. These regions include primary and secondary somatosensory cortices, anterior cingulate cortex, insular cortex, and regions of the frontal cortex. Nevertheless, the role of different cortical areas in pain processing is controversial, particularly that of primary somatosensory cortex (S1). Human brain-imaging studies do not consistently reveal pain-related activation of S1, and older studies of cortical lesions and cortical stimulation in humans did not uncover a clear role of S1 in the pain experience. Whereas studies from a number of laboratories show that S1 is activated during the presentation of noxious stimuli as well as in association with some pathological pain states, others do not report such activation. Several factors may contribute to the different results among studies. First, we have evidence demonstrating that S1 activation is highly modulated by cognitive factors that alter pain perception, including attention and previous experience. Second, the precise somatotopic organization of S1 may lead to small focal activations, which are degraded by sulcal anatomical variability when averaging data across subjects. Third, the probable mixed excitatory and inhibitory effects of nociceptive input to S1 could be disparately represented in different experimental paradigms. Finally, statistical considerations are important in interpreting negative findings in S1. We conclude that, when these factors are taken into account, the bulk of the evidence now strongly supports a prominent and highly modulated role for S1 cortex in the sensory aspects of pain, including localization and discrimination of pain intensity.

[pain science; pain choice]

Broome, J. (1996). "More Pain or Less?" Analysis, 56(2): 116–118.

            Daniel Kahneman has investigated people's judgments of painful episodes. He has shown that episodes containing more pain may be judged less bad than episodes containing less pain, if they end less badly. Sometimes doctors have to cause their patients pain. They may sometimes be able to prolong the pain unnecessarily, but in doing so reduce it at the end. When this is possible, Kahneman's discovery poses a moral problem for them. Should they prolong the pain in this way? If they do, they will cause more pain, but their patients will judge the whole episode less bad. This paper investigates this problem.

[pain science; pain choice]

Silverstein, H. S. (1998). "More Pain or Less? Comments on Broome." Analysis, 58(2): 146–151.

           

[pain science; pain choice]

Perrett, R. W. (1999). "Preferring More Pain to Less." Philosophical Studies, 93(2): 213–226.

            Plausibly, more pain is worse than less and, hence, we should avoid extending episodes of pain. However, experiments by Kahneman suggest that subjects can evaluate an episode with less pain as worse than one with more. Should, then, physicians performing a painful medical procedure stop causing pain immediately thereafter, or should they add an interval of diminishing pain, knowing that this will subsequently cause the patient to judge the episode as less painful? I argue that the experimental results pose no serious ethical dilemma, though they may have some surprising implications for our prereflective assumptions about pain.

[pain science; pain choice]

Beardman, S. (2000). "The Choice between Current and Retrospective Evaluations of Pain." Philosophical Psychology, 13(1): 97–110.

            Daniel Kahneman and his colleagues have made an interesting discovery about people's preferences. In several experiments, subjects underwent two separate ordeals of pain, identical except that one ended with an added amount of diminishing pain. Subjects generally preferred the longer episode--even though it had a greater objective quantity of pain. These data raise an ethical question about whether to respect such preferences when acting on another's behalf. John Broome thinks that it is wrong to add extra pain in order to satisfy a person's preference for a better ending. His explanation for this intuition is that pain is intrinsically bad. I argue against this explanation and raise several doubts about the moral intuition Broom endorses. In doing so, I offer alternate interpretations of Kahneman's data and show that these each yield different values which are relevant to the ethical question.

[pain science; pain choice]

Gustafson, D. (2000). "Our Choice between Actual and Remembered Pain and Our Flawed Preferences." Philosophical Psychology, 13(1): 111–119.

            In Stephanie Beardman's discussion of the empirical results of Kahneman and Tversky and Kahneman, et al. on pain preference and rational utility decision she argues that an interpretation of these results does not require that false memory for pain episodes yields irrational preferences for future pain events. I concur with her conclusion and suggest that there are reasons from within the pain sciences for agreeing with Beardman's reinterpretation of the Kahneman, et al. data.