Forum Moderators' Current Consensus on Pain

[regnalt deux]

It will be up to the current moderators to modify the Forum Moderators' Current Consensus on Pain. Perhaps it should the Current Forum Moderators' Current Consensus on Pain. But I'll add my thoughts on your thoughts.

As it pertains to number 3, I don't think an actual threat needs to be perceived, only sensed.

Number 8 is interesting. Ultimately, the output of the nervous system must change if pain is to resolve. This will, I think, involve a change in active/inactive neural networks and the neural cells from which they are made. Whether this can happen in the absence of non-neural physiological processes is unlikely I think.

What do others think?

re: #3
The topic of sensation-perception is a fascinating one, IMO, and actually very complex as well. I’d suggest that if pain is not perceived, it doesn't exist. At which point the phenomenal sensations of danger/threat, below the level of perception, lead to nocioceptive gain that decreases proprioceptive drive and can elicit a protective mechanical output from the brain that still isn't necessarily perceived and/or pain.

[Jon Newman]

It sounds like you're saying something interesting but I'm not following what it might be. I have a hard time making my own thoughts clear to others and always hope people will ask me to clarify, but not everyone does. Can you clarify your previous post?

[regnalt deux]

It sounds like you're saying something interesting but I'm not following what it might be. I have a hard time making my own thoughts clear to others and always hope people will ask me to clarify, but not everyone does. Can you clarify your previous post?

Sure, Jon. I'll clarify my thoughts and post something over the weekend. I look forward to the dialogue.

[Jon Newman]

re: #3
The topic of sensation-perception is a fascinating one, IMO, and actually very complex as well. I’d suggest that if pain is not perceived, it doesn't exist. At which point the phenomenal sensations of danger/threat, below the level of perception, lead to nocioceptive gain that decreases proprioceptive drive and can elicit a protective mechanical output from the brain that still isn't necessarily perceived and/or pain.

I look forward to your clarification.

Would an example be someone who limps or who displays some other antalgic appearing gait while simultaneously denying (truthfully) pain? In such cases the person may even be unaware of having an altered gait.

[regnalt deux]

It sounds like you're saying something interesting but I'm not following what it might be. I have a hard time making my own thoughts clear to others and always hope people will ask me to clarify, but not everyone does. Can you clarify your previous post?

The difference between sensation (pre-reflective) and perception (awareness of sensory patterns) is often overlooked and thus, the words are used interchangeably. It’s important to make this distinction to avoid infinite regress or in other words sensations provides an anchor to an objective reality and perceptions are virtual illusions. The linguistic challenge is deepened when you consider that we don’t have the words to truly describe the experience of pain.

Nocioception is a sensation and if/when your brain determines it to be a threat it will output pain. Of course, centralized pain is an output without the need for a body sensation. In both cases pain requires your attention to exist and is experienced in the (virtual) body image that is held by the brain (the body schema is involved, but it seems unlikely to be the origin). Attention precedes conscious awareness. Awareness is the ability to perceive, feel, and/or be conscious of what’s taking place. At which point I don’t see how you can sense pain without perceiving it as well.

For instance, a distraction (i.e. no pain) doesn’t mean that the pain is there waiting to emerge, but rather due to shift in circumstances, that might be short-lived or sustained in its duration, the output of pain has either been overruled (shark attack = no time for pain) or supplanted (therapeutic intervention) by a different output. In other words pain does not exist; at any moment in time, if it’s not perceived and what people are really referring to is its action potential and level of sensitization.

Would an example be someone who limps or who displays some other antalgic appearing gait while simultaneously denying (truthfully) pain? In such cases the person may even be unaware of having an altered gait.

I don’t think someone with a limp needs to either be aware of the altered gait or be in pain. I think you’re alluding to the origin of the altered biomechanics, but even then nociceptive drive is enough to alter proprioceptive input and motor planning (reorganization of the body schema) beneath the level of perception and without experiencing pain.

[Bas Asselbergs]

Todd, that clarified your ideas a lot for me. And I find myself in full agreement with your explanations.

[Barrett Dorko]

Todd,

I can appreciate how difficult that was to write. I agree as well. May I use it one day? Full attribution of course.

Wonderful job.

[Jon Newman]

Hi Todd,

Thanks for the clarification. I agree that the difference between sense and perception is interesting and complicated. In fact, it's complicated enough that much of the detail is simply beyond my ability to teach myself about it but I continue to try.

Do you think nociception can be considered an actual threat?

[Barrett Dorko]

These days I teach the concepts in conjunction with an image of Lennie Briscoe. He often decides to enter an apartment by announcing that he's perceived "exigent circumstances."

Does that work?

[Jon Newman]

Nocioception is a sensation and if/when your brain determines it to be a threat it will output pain.

What it is I'm trying to unpack, as it pertains to #3, can be captured in the above.

In my lights, the process of your brain determining nociception = threat is pre-reflective.

[Jon Newman]

Hi Reg,

The difference between sensation (pre-reflective) and perception (awareness of sensory patterns) is often overlooked and thus, the words are used interchangeably.

When I first read this I understood "pre-reflective" to mean nonconscious but after reading a bit I realize that is not what it means necessarily. Can you explain what it means in this context or point to a source that characterizes sensation as pre-reflective?

Here is one source I found.

For those interested, Aydede argues against certain perceptualist claims about regarding pain.

Both papers gave me a headache.

[Jon Newman]

Some more helpful resources I found as it pertains to the concept of "pre-reflective" versus "reflective" were authored by Shaun Gallaher, et. al.

The Phenomenal Mind (link to Google books)

and

Philosophical conceptions of the self.

Both were pretty readable.

[regnalt deux]

Todd, that clarified your ideas a lot for me. And I find myself in full agreement with your explanations.

Thanks, Bas. I'm glad Jon asked me to elaborate, because the old adage is true and the more you write about a topic the better you get at it.

[regnalt deux]

Todd,

I can appreciate how difficult that was to write. I agree as well. May I use it one day? Full attribution of course.

Wonderful job.

Of course, Barrett!

I’m working on a integrative framework and look forward to further dialogue on the topic.

[regnalt deux]

Some more helpful resources I found as it pertains to the concept of "pre-reflective" versus "reflective" were authored by Shaun Gallaher, et. al.

The Phenomenal Mind (link to Google books)

and

Philosophical conceptions of the self.

Both were pretty readable.

Here's my take: the threat is part of a pre-reflective “bottom up” driven process that results in a hormonal orchestra, of sorts, which increases the sympathetic tone in the ANS. At which point your adaptive potential, or lack thereof, will determine if your sensitized nervous system will cross your personal threshold and transition from sensing a threat to perceiving a painful conscious experience.

My understanding is that proprioceptive information is non-conscious and pre-reflective and I think nocioception is as well.