Dear Thomas

Conventional pain is part of an alarm system of the body. It alerts us to the fact that something is hurting us. She makes solicit help. Pain immobilizes us when we are wounded , so that healing can occur.

It is difficult to define " pain " satisfactorily.

I have selected 3 settings

1 ) Pain is a sensory experience caused by the stimulus that damages tissues or threatens to destroy them , introspectively experience defined by each, as that hurts , (Mountcastle 1980 ) .

2 ) Pain is an abstraction that means:

  - An intimate personal feeling of evil ;

  - A noxious stimulus that signals a tissue injury

   actual or imminent;

- A reaction scheme designed to preserve the body of evil, ( Sternbach , 1968).

3 ) Pain is an unpleasant sensory and emotional experience , associated with actual tissue damage . (Merskey et al. 1979)

Because the pain of being an intimate, personal , impossible to know the exact feeling another's pain . Thus the diversity of painful experiences , it explains why it has been impossible , until now , find a definitive and satisfactory definition of the word pain .A pain represents a category of phenomena comprising a multitude of different and unique experiences , with different causes and characterized by different qualities , varying according to a number of criteria : somatosensory , visceral , emotional , cultural and cognitive .A pain has various intensities , termed by the individual himself . It can be mild , discomforting , desolating , horrible and atrocious. These adjectives serve as " tags " to determine overall pain intensity.

Interesting question/questions

Other dimension to your question is the intersection of pain and arts, for example:

Representations of Pain in Art and Visual Culture (Routledge Advances in Art and Visual Studies) Maria Pia Di Bella (Editor), James Elkins (Editor)

-Intersection of pain and philosophy, for example:

Arne Vetlesen in A Philosophy of Pain, " Vetlesen addresses pain in many forms, including the pain inflicted during torture; the pain suffered in disease; the pain accompanying anxiety, grief, and depression; and the pain brought by violence... He examines the dual nature of pain: how we attempt to avoid it as much as possible in our daily lives, and yet conversely, we obtain a thrill from seeking it."

Or spirituality/religion and pain:

Can J Nurs Res. 2007 Jun;39(2):66-86.

Spirituality, religion, and pain.

Unruh AM.

"Spiritual views can have a substantial impact on patients' understanding of pain and decisions about pain management"

Dear Thomas

Conventional pain is part of an alarm system of the body. It alerts us to the fact that something is hurting us. She makes solicit help. Pain immobilizes us when we are wounded , so that healing can occur.

It is difficult to define " pain " satisfactorily.

I have selected 3 settings

1 ) Pain is a sensory experience caused by the stimulus that damages tissues or threatens to destroy them , introspectively experience defined by each, as that hurts , (Mountcastle 1980 ) .

2 ) Pain is an abstraction that means:

  - An intimate personal feeling of evil ;

  - A noxious stimulus that signals a tissue injury

   actual or imminent;

- A reaction scheme designed to preserve the body of evil, ( Sternbach , 1968).

3 ) Pain is an unpleasant sensory and emotional experience , associated with actual tissue damage . (Merskey et al. 1979)

Because the pain of being an intimate, personal , impossible to know the exact feeling another's pain . Thus the diversity of painful experiences , it explains why it has been impossible , until now , find a definitive and satisfactory definition of the word pain .A pain represents a category of phenomena comprising a multitude of different and unique experiences , with different causes and characterized by different qualities , varying according to a number of criteria : somatosensory , visceral , emotional , cultural and cognitive .A pain has various intensities , termed by the individual himself . It can be mild , discomforting , desolating , horrible and atrocious. These adjectives serve as " tags " to determine overall pain intensity.

Where we feel the pain "really"? What are symptoms of pain? when you say that "I am in pain" and most of all why we feel it ? For me the pain can be presented in different ways. It depends on the person. The pain is the unspoken words, is techniques used by the body to translate those "Unspoken words". It can be translated by breath taken, crying....

"Your pain is the breaking of the shell that encloses your understanding."

Khalil Gibran

In medicine pain relates to a sensation that hurts. If you feel pain it hurts, you feel discomfort, distress and perhaps agony, depending on the severity of it. Pain can be steady and constant, in which case it may be an ache. It might be a throbbing pain - a pulsating pain. The pain could have a pinching sensation, or a stabbing one.

The English word 'pain' probably comes from Old French (peine), Latin (poena - meaning punishment pain), or Ancient Greek (poine - a word more related to penalty), or a combination of all three.

Only the person who is experiencing the pain can describe it properly. Pain is a very individual experience.

The NIH (National Institutes of Health) National Pain Consortium estimates that the public health burden of pain affects one third of America's population at a cost of between $560 billion and $635 billion each year.

The British Pain Society quoted England's Chief Medical Officer, who said that annually more than five million people in the UK develop chronic pain. Unfortunately, one third of them do not recover. 11% of adults and 8% of children in the UK suffer severe pain.

Because perception and tolerance of pain vary widely from individual to individual, pain is difficult to define and describe. Essentially, pain is the way your brain interprets information about a particular sensation that your body is experiencing. Information (or "signals") about this painful sensation are sent via nerve pathways to your brain. The way in which your brain interprets these signals as "pain" can be affected by many outside factors, some of which can be controlled by special techniques.

Acute pain is of short duration, usually the result of an injury, surgery or illness. This type of pain includes acute injuries, post-operative pain and post-trauma pain.

Chronic pain is an ongoing condition, such as back and neck pain, headaches, complex regional pain syndrome Type 1 (reflex sympathetic dystrophy), neuropathic pain (nerve injury pain), musculoskeletal pain, and pain related to illness. Your physician may refer you to the Pain Management Center because your chronic pain condition has not responded to conventional therapies.

Treatments for acute and chronic pain are generally quite different. In some cases, pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain--such as cancer--cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychological and rehabilitation techniques.

I would like point to the IASP (International Association for the Study of Pain) description of what pain is:

"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

So, therefore, pain is not always associated with actual tissue damage and should not be mixed up with nociception. Pain is always a complex, subjective, interpretation of our brain based on a barage of information present. The interpretation happens outside of our conciousness and pain is always, 100% an output from the brain, not an input to the brain. Pain is not only sensory, and in fact it has been proven that also nociception in not always necessary nor sufficient for pain.

We might have tissue damage without pain and we might just as well have pain without any tissue damage.

Thank you all for interesting answers.

Nelson, I agree that your three points of view pain as sensory experience, as an abstraction and as an unpleasant sensory and emotional experience play an important role in our discussion. I also agree with your idea of the relevance of the subjectivity problem and also with your pluralistic approach that pain perhaps is not one phenomenon but a category of phenomena.

But one question comes up with that. Is our used concept of pain built on abductive logic (like some medical, especially psychiatric diagnoses)? In medical approaches symptoms are often summarized / combined by the use of ‘and-‘ or ‘or-’ operations. Alternatively seeing pain as one category / entity means that a specific / defining aspect is necessary, that belongs to all forms of pain (We could call it core of definition).

Rolando, I agree totally with your idea that we also should take into account the intersection of pain and arts or philosophy. Both represent non-medicalized approaches. And the medicalization of pain suffers from a lot of reductionisms.

Zeiri I agree with your statement that pain expression is much more than words. This underpins the statement of Rolando that arts and philosophy play an important role. I would add music and poetry (as arts).

Mehdi I like your etymological approach. It opens a genealogical perspective. You also brought up the problem of pain tolerance, which varies widely. We can observe this e.g. in a lot ‘painful’ rituals like thaipusam or or American indian sun dances.

To draw some preliminary conclusions:

• Our concept of pain is rather complex.

• It perhaps is a rather summative or abductive concept.

• It is hard to find the defining core of the concept.

• It perhaps is much more than what we can express in language.

One problem still remains unsolved: Is pain always unpleasant? Remember the feeling when your baby teeth fell out. To play with them before falling out was sometimes a mixture of ‘pain’ and ‘lust’. This probably also plays a role in some sexual perversions or in some of the mentioned rituals.

Regards Thomas

Hi Thomas,

The widely accepted scientific definition of pain is that “Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.” A key feature of this definition is that it goes on to say, “pain is always subjective.” (G. F. Gebhart, Iowa University)

Best regards,

Islam

Hi Islam,

I totally agree that pain is a subjective experience. But also observation is a subjective experience and e.g. hearing and smelling too. But that does not imply that there are no objective aspects. A weak definition of objectivity means inter-subjectivity (Kant for example can be understood in this way). But I agree if it is meant that talking about pain is really different form the pain experience. There is an epistemological problem that is widely discussed e.g. in positivism or linguistic philosophy of how language fits to experience or facts or reality.

So my question is, what is the consequence of the assumption that pain is a subjective experience?

Regards Thomas

As an add on to the previous comment, I believe that when describing pain in terms such as "subjective" and "objective" you're really having a conflict of language and definitions. For example, if you say that pain is subjective in that each person's perception is different most pain specialists would agree with you. However, if you make the claim that pain is subjective in that it cannot be measured or is a product of "the mind" compared to "the brain" (a false dichotomy which is unfortunately still made) you run into issues. For example, some doctors will write Fibromyalgia patients as those who have emotional or attachment issues, not a concrete pain issue. This prevents them the patients from attaining the proper therapy as well as prevents the pain from being taken seriously. However, studies have shown that these patients have thinning of the cortex, an observation which is objective in the sense that it is quantifiable and measurable. Whether the thinning causes the pain or vice versa is not known but this doesnt change the fact that there is a neurobiological structural correlate to this chronic pain condition which is not subjective, meaning it is a commonality between a plethora of patients.

Going back to the issue of objectivity vs subjectivity I believe that pain in many ways can be objective and objectively measured. For example, if one was to put a person suffering pain in an fMRI or other functional scanning technique, they would see areas in the pain matrix becoming activated, with a positive correlation between intensity of activation and intensity of pain. This activation may differ between patients but its existence should not be denied.

Dear Thomas

In lay terms, I explain that pain is the alarm system of the body. If the alarm system of the body is working, pain is a normal and expected experience. But when the alarm system is broken, pain is dysfunctional and not serving any purpose, it is when the symptom became the disease.

Andrea