Forum Moderators' Current Consensus on Pain

[Jon Newman]

Hello Reg,

I'm still trying to gain a better understanding of "pre-reflective" (it seems to track the philosophical concept of transparency) and whether it adds clarity to our understanding of pain but that could be it's own thread.

More importantly, what are your current thoughts as it pertains to number 3? You originally thought it might benefit from editing but I can't tell what you think at this point in time.

[regnalt deux]

Hello Reg,

I'm still trying to gain a better understanding of "pre-reflective" (it seems to track the philosophical concept of transparency) and whether it adds clarity to our understanding of pain but that could be it's own thread.

More importantly, what are your current thoughts as it pertains to number 3? You originally thought it might benefit from editing but I can't tell what you think at this point in time.

I would rewrite #3 to include perception, but perhaps the arbiters feel it's covered elsewhere.

Re: pre-reflective
It definitely helps clarify the understanding of pain, for me Interestingly, this article from Hodges and Moseley considers whether pain inhibits motor control or vice versa and they use a diagram on page 364 to illustrate the processes involved. I think the concept of pre-reflective nocioceptive sensation and the perception of pain would help to clarify their flowchart, because it would allow them to show how nocioception and pain output are linked, at times, but not a fused couple.

[Jon Newman]

Long post

First off, thanks for the great conversation.

I would rewrite #3 to include perception, but perhaps the arbiters feel it's covered elsewhere.

The arbiters would certainly have to chime in if it's to change. I think I can understand the change you suggest and I could even agree with it but I'll try to lay out where my conceptual confusion (and point of concern) lies.

#3 original: A pain experience may be induced or amplified by both actual and potential threats.

#3 suggested: A pain experience may be induced or amplified by the perception of actual and/or potential threats.

Part 1 of my confusion/concern lies in what is considered to be a threat. In the paper you just linked to they had a parenthetical notation that suggests threat = stress (p. 365). They did use "i.e." instead of "e.g." which is why I think they're equating it rather than simply giving one example of it.

Regardless, I think nociception is threatening to at least local tissues but not necessarily to the organism per se. I'm using "threat" to mean tissue damage, death, or general thwarting of goals related to survival.

Part 2 of my confusion and concern lies in what is considered to be a perception. I'll use blindsight to help explore my issues. In the Wikipedia article they refer to people with blindsight as "perceptually blind". Other sources talk about blindsight as a case of perception without awareness. In most discussions of perception there is an object that is perceived. In the case of blindsight, there are actual obstacles which a person with blindsight is detecting without any experience of having detected it. Nociception in this light would be a perception because there is a mechanical, thermal, or chemical "object" that is perceived. However, perhaps like blindsight, nociception could be perceived without being experienced. It would be a case of perception without sensation. Perception is not based on sensation but does require an object to perceive.

Part 3 of my confusion and concern lies in what is considered to be a sensation. A sensation is typically considered to be the experience of something^*. The experience of pain is something that occurs in the brain. We have argued that it is an output of the brain. It is not the perception of an object "out there." For instance, a fresh baked cookie is an object that we can perceive via olfactory detection but the experience of the smell of a cookies is something that is an output of the brain.

Part 4 of my confusion and concern lies in a different interpretation of sensation as illustrated in this Wikipedia entry. In this entry it is posited that

The goal of sensation is detection, the goal of perception is to create useful information of the surroundings.

In other words, sensations are the first stages in the functioning of senses to represent stimuli from the environment, and perception is a higher brain function about interpreting events and objects in the world.

which is quite the opposite of the description I gave in part 3.

I'm left uncertain about what people mean when they simply use these terms in passing and if we can do without them then I think that's best. I think the popular account used by most here (and yourself) would be that pain is a perception, not a sensation. But I'm less convinced.

Re: pre-reflective
It definitely helps clarify the understanding of pain, for me Interestingly, this article from Hodges and Moseley considers whether pain inhibits motor control or vice versa and they use a diagram on page 364 to illustrate the processes involved. I think the concept of pre-reflective nocioceptive sensation and the perception of pain would help to clarify their flowchart, because it would allow them to show how nocioception and pain output are linked, at times, but not a fused couple.

If you (or anyone) have the skills I'd be very interested in a mark-up of that diagram. We did that with a Bialosky diagram here.


Edit: * Here is the most concise description of this point of view that I'm aware of.

[regnalt deux]

First off, thanks for the great conversation.

The arbiters would certainly have to chime in if it's to change. I think I can understand the change you suggest and I could even agree with it but I'll try to lay out where my conceptual confusion (and point of concern) lies.

#3 original: A pain experience may be induced or amplified by both actual and potential threats.

#3 suggested: A pain experience may be induced or amplified by the perception of actual and/or potential threats.

Part 1 of my confusion/concern lies in what is considered to be a threat. In the paper you just linked to they had a parenthetical notation that suggests threat = stress (p. 365). They did use "i.e." instead of "e.g." which is why I think they're equating it rather than simply giving one example of it.

Regardless, I think nociception is threatening to at least local tissues but not necessarily to the organism per se. I'm using "threat" to mean tissue damage, death, or general thwarting of goals related to survival.

Part 2 of my confusion and concern lies in what is considered to be a perception. I'll use blindsight to help explore my issues. In the Wikipedia article they refer to people with blindsight as "perceptually blind". Other sources talk about blindsight as a case of perception without awareness. In most discussions of perception there is an object that is perceived. In the case of blindsight, there are actual obstacles which a person with blindsight is detecting without any experience of having detected it. Nociception in this light would be a perception because there is a mechanical, thermal, or chemical "object" that is perceived. However, perhaps like blindsight, nociception could be perceived without being experienced. It would be a case of perception without sensation. Perception is not based on sensation but does require an object to perceive.

Part 3 of my confusion and concern lies in what is considered to be a sensation. A sensation is typically considered to be the experience of something. The experience of pain is something that occurs in the brain. We have argued that it is an output of the brain. It is not the perception of an object "out there." For instance, a fresh baked cookie is an object that we can perceive via olfactory detection but the experience of the smell of a cookies is something that is an output of the brain.

Part 4 of my confusion and concern lies in a different interpretation of sensation as illustrated in this Wikipedia entry. In this entry it is posited that

which is quite the opposite of the description I gave in part 3.

I'm left uncertain about what people mean when they simply use these terms in passing and if we can do without them then I think that's best. I think the popular account used by most here (and yourself) would be that pain is a perception, not a sensation. But I'm less convinced.

If you (or anyone) have the skills I'd be very interested in a mark-up of that diagram. We did that with a Bialosky diagram here.

Likewise, Jon, this is fun.

1. Nociception is a sensation in the local tissue, but it’s monitored (I’m avoiding using the word perceived) by the sensorimotor system. At which point nociceptive drive decreases proprioceptive input and, depending on a variety of factors, disrupts or smudges the sensorimotor body schema. The body schema is systemic and local deformation/tissue damage will be responded to throughout the whole body or in other words the whole organism responds to the threat.

2. I’d question how something can be perceived without sensory awareness or without being experienced; especially, when phenomenal experience, in the way I understand it, is a pre-reflective sense or “raw feel” derived from the body schema. For example, in the few documented cases of people with severely damaged body schemas (loss of proprioception) they could move their eyes and extra-ocular muscles likely fed proprioceptive information to the remnants of their body schema or in other words no pre-reflective sensation = no body schema function = fall flat on your face!

Next, does nociception (which I understand to be an interoception) need to be perceived if it’s part of the “I” and immune to misidentification? The objective 3rd person “he” can be fooled through perceptual illusions that trick the higher order brain (i.e. rubber hand illusion), but it’s always the subjective 1st person “I” that is being fed the sensations or “raw feel” from the pre-personal interoceptive experience that reside in the lower-order brain. We’re getting into the world of Ludwig Wittgenstein.

3. A sensation is still a sensation if it stops at the spinal cord, right (i.e. reflex)? If it reaches the DRG? A sensation doesn't need to be interpreted by the higher brain.

The pre-reflective experience is coupled to sensation (symbolic structure of meaning is primordially linked to stimulus-based motor output - no high level thoughts other than suppression from above) and perception is coupled to action (linguistic structure of meaning for events and objects is linked to intention-based action output). At the end of the day perception is a functional output (action).

[Yannick]

Here is another top ten about pain found on noigroup's facebook page ...

http://voices.yahoo.com/the-top-10-t...139.html?cat=5

[Jon Newman]

Reg D,

I think we both agree that threat (whatever that means) may (i.e. under the appropriate circumstances) induce or amplify a pain experience. To my mind, introducing "perceived" adds uneccessary concepts to what would otherwise be a fairly clearly expressed idea.

If I had a vote to change #3 or keep it as is, I'd vote to keep it as it.

I do think the concepts of sensation, perception, and whether there are conscious and non conscious varieties, and whether one is required for the other, etc, are interesting to discuss but extended conversation should be done in a separate thread.

[joebrence9]

Here is another top ten about pain found on noigroup's facebook page ...

That author must be really, really smart...and good looking...

[Diane]

Joe,

You are!

:clap2::thumbs_up

[Jon Newman]

I think we've both made our points about #3 and whether it changes our not will be up to the mods. But that still leaves #8.

8. The corrective neurophysiological mechanisms responsible for resolution are inherent. A therapist need only provide an appropriate environment for their expression.

I'm a little more indifferent about this one.

Shouldn't the moderators be chiming in on this?