Originally posted on HealthSkills Blog:

Sticks and stones my break my bones, but words will never harm me – yeah right! Words have power when we’re looking for treatment, or we’re giving treatments for pain. I’ve written about the staying power of language used to describe back pain here.

But let’s look at a more distinct problem: diagnoses.

Diagnoses are, in the words of Annemarie Jutel, “the classification tools of medicine…” Sociologically, they segment and order bodily states, indicating what is and isn’t normal. “A diagnosis is integral to medicine because it organises illness, identifies treatment options, predicts outcomes and provides an explanatory framework (Jutel, 2009). ”

Diagnoses also give people permission to be ill. Being diagnosed replaces mystery with — well, something else depending on the label.

Getting a diagnosis indicating that chronic pain was not likely to be alleviated was a striking finding from my PhD research, and supported by numerous qualitative…

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From the Centre for Medical Humanities:

“We are delighted to offer Simon van Rysewyk and Matthijs Pontier‘s progressive new book ‘Machine Medical Ethics’ for review (Springer, 2015). Expressions of interest are welcome from all angles of the medical humanities, and may be of particular interest to those working at the intersection of medical ethics and clinical innovation.

The essays in this book, written by researchers from both humanities and sciences, describe various theoretical and experimental approaches to adding medical ethics to a machine in medical settings.

Medical machines are in close proximity with human beings, and getting closer: with patients who are in vulnerable states of health, who have disabilities of various kinds, with the very young or very old, and with medical professionals. In such contexts, machines are undertaking important medical tasks that require emotional sensitivity, knowledge of medical codes, human dignity, and privacy. As machine technology advances, ethical concerns become more urgent: should medical machines be programmed to follow a code of medical ethics? What theory or theories should constrain medical machine conduct? What design features are required? Should machines share responsibility with humans for the ethical consequences of medical actions? How ought clinical relationships involving machines to be modeled? Is a capacity for empathy and emotion detection necessary? What about consciousness?

This collection is the first book to address these 21st-century concerns.

If you would like to write a review on ‘Machine Medical Ethics’ (approximately 1,000-1,500 words in length),  then please email our reviews editor with a short explanation of why you are well placed to review the book.”

Here.

Research Blogging

While awareness of qualitative research of lived pain is slowly increasing in the field of pain, it is far from established and needs cultivating from within the field by pain researchers (Mitchell & MacDonald, 2009; Osborn & Rodham, 2010; Price & Barrell, 2012). Pain research has traditionally been dominated by quantitative research methods, which have their roots in physiology, physics, biology, and psychophysics, arising from mathematics, statistics, and psychometrics (Price et al. 2002; Price & Aydede, 2005; Price & Barrell, 2012). This trend continues unabated today, and perhaps explains why Osborn and Rodham (2010) found that many individual pain researchers have not yet accumulated a significant body of qualitative pain research. A body of qualitative pain research would enable researchers to develop their arguments in more depth concerning the nature and types of personal meanings apparent in pain experience, especially clinical pain experiences across the lifespan. The rationale for conducting qualitative pain research is likely not clear to many in the field of pain, and researchers are probably unaware of the potential richness of qualitative pain data to uniquely describe lived pain or the diverse tools available for analyzing qualitative data. In line with this, Osborn & Rodham (2010) found that many of the qualitative pain studies they reviewed used only one type of analysis (i.e., data analysis was not triangulated), description rather than interpretation prevailed in discussion of data meaning, and research methods were not thoroughly described.

A powerful reason to conduct more qualitative pain research is the common complaint from clinical pain patients that they feel they have never had an opportunity to fully explore their lived pain experiences with health care professionals, that no one has ever fully understood what is wrong with them and, most importantly, that no one appears to be listening (e.g., Melzack, 1990; Hoffmann & Tarzian, 2001; Hansson et al. 2011; McGee et al. 2011; Thacker & Moseley, 2012; De Ruddere et al. 2014). Clinical failure to sufficiently appreciate patient pain and its felt meanings can result in profound patient dissatisfaction, exacerbation of feelings of isolation and confusion, among other negative existential appreciations, and cause up-regulation of nociception (Butler et al. 2003). Despite this significant problem in the treatment and management of clinical pain, some pain researchers (e.g., Apkarian et al. 2011; Wortolowska, 2011) and government agencies (e.g., National Research Council of the National Academies, 2008; National Institutes of Health, 2011) have argued for replacing first-person patient experiential pain data with brain-imaging data.

Although qualitative research alone cannot solve these challenges, because of its exploratory nature, it can complement quantitative clinical pain research to describe lived pain and the psychosocial factors that improve or worsen the efficacy of pain interventions, as well as core intervention components that are associated with desired or undesired patient outcomes (Price et al. 2002; Price & Aydede, 2005; Price & Barrell, 2012; Thacker & Moseley, 2012).

References

Apkarian, A. V., Hashmi, J. A., & Baliki, M. N. (2011). Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain, 152(3 Suppl), S49–64.

De Ruddere, L., Goubert, L., Stevens, M. A. L., Deveugele, M., Craig, K. D., & Crombez, G. (2014). Health Care Professionals” Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences. The Journal of Pain, 15(3), 262–270.

Hoffmann, D. E., & Tarzian, A. J. (2001). The girl who cried pain: a bias against women in the treatment of pain. The Journal of Law, Medicine & Ethics, 28(s4), 13–27.

McGee, S. J., Kaylor, B. D., Emmott H., & Christopher, M. J. (2011). Defining chronic pain ethics. Pain Medicine, 12, 1376–1384.

Melzack, R. (1990). The tragedy of needless pain. Scientific American, 262(2), 27–33.

National Institutes of Health. (2011). Biomarkers for chronic pain using functional brain connectivity. Common Fund NIH Government.

National Research Council of the National Academies. Emerging cognitive neuroscience and related technologies. (2008). Washington, DC: National Academies Press.

Price, D. D., & Aydede, M. (2005). The experimental use of introspection in the scientific study of pain and its integration with third-person methodologies: The experiential-phenomenological approach. In M. Aydede (Ed.), Pain: New Essays on its Nature and the Methodology of its Study (pp. 243–273). Cambridge, Mass.: MIT Press.

Price, D. D., & Barrell, J. J. (2012). Inner Experiences and Neuroscience. Merging the two perspectives. Cambridge, Mass.: MIT Press.

Price, D. D., Barrell, J. J., & Rainville, P. (2002). Integrating experiential-phenomenological methods and neuroscience to study neural mechanisms of pain and consciousness.

Thacker, M. A., & Moseley, G. L. (2012). First-person neuroscience and the understanding of pain. The Medical Journal of Australia, 196(6), 410–411.

Wortolowska, K. (2011). How neuroimaging can help us to visualise and quantify pain? European Journal of Pain, 5, 323–327.

<span class=”Z3988″ title=”ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.jtitle=http%3A%2F%2Fsimonvanrysewyk.wordpress.com&rft_id=info%3A%2F&rfr_id=info%3Asid%2Fresearchblogging.org&rft.atitle=Towards+raising+awareness+of+qualitative+pain+research&rft.issn=&rft.date=2014&rft.volume=&rft.issue=&rft.spage=&rft.epage=&rft.artnum=http%3A%2F%2Fsimonvanrysewyk.wordpress.com%2F2014%2F10%2F29%2Fraising-awareness-of-qualitative-pain-research%2F&rft.au=Simon+van+Rysewyk&rfe_dat=bpr3.included=1;bpr3.tags=Health%2Cpain%2C+chronic+pain%2C+qualitative+research%2C+phenomenology%2C+philosophy%2C+psychology%2C+neuroscience%2C+pain+medicine”>Simon van Rysewyk (2014). Towards raising awareness of qualitative pain research <span style=”font-style: italic;”>https://simonvanrysewyk.wordpress.com</span></span&gt;

Abstract

The perceived weaknesses of philosophical normative theories as machine ethic candidates have led some philosophers to consider combining them into some kind of a hybrid theory. This chapter develops a philosophical machine ethic which integrates “top-down” normative theories (rule-utilitarianism and prima-facie deontological ethics) and “bottom-up” (case-based reasoning) computational structure. This hybrid ethic is tested in a medical machine whose input-output function is treated as a simulacrum of professional human ethical action in clinical medicine. In six clinical medical simulations run on the proposed hybrid ethic, the output of the machine matched the respective acts of human medical professionals. Thus, the proposed machine ethic emerges as a successful model of medical ethics, and a platform for further developments.

Here.

The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” The IASP definition of pain includes in its notes, “Pain is always subjective”. The term “subjective” emphasizes that pain is a conscious experience rather than simply a causal result of unconscious nociceptive processing. The intuition underlying the IASP definition of pain is that if a pain is not being consciously felt by its owner then it does not exist.

Up until the late twentieth century, it was widely believed by pain researchers that conscious pain could not be felt by humans in sleep because sleep is an unconscious state. This pre-scientific intuition about pain has since been undermined by numerous scientific studies showing that both stimulus-induced and non-stimulus induced pain reported during rapid eye movement (REM) sleep does not always result in subject wakefulness and that pain can also feature in dreams (e.g., Nielsen et al. 1993; Zadra et al. 1998; Raymond et al. 2002; Knoth & Schredl, 2011). Concerning dream pain, Zadra et al. (1998) found that 48.2% of subjects reported that they have had at least one pain dream in their lives, although only 0.62% of recorded dreams in home diary studies contain clear reference to pain feelings and meanings. In some subjects, dream pain continues to be felt following wakefulness; in other subjects, it is rapidly terminated after awakening. These divergent findings prompt the causal question: Why does dream pain exist and have the nature it does?

To explain dream pain, Schredl (2003) proposed that there is continuity between wakeful and dream pain such that pain regularly felt when awake is causally efficacious concerning its occurrence in dreams. Raymond et al. (2002) investigated Schredl’s “continuity hypothesis” in hospitalized burn patients and healthy control subjects and found that patients reported a significantly higher rate of dreamed pain than controls. The burn patients also reported marginally more intense pain during wakeful medical procedures, a finding which was interpreted by Raymond et al. (2002) to support the continuity hypothesis. The patients reported constant pain during wakefulness, which further supports the continuity hypothesis. However, there are three further competing interpretations of the data presented in Raymond et al. (2002). Since dreamed pain was not always reported as located in injured body regions or in bodily areas patients reported pain in during the night and following awakening, Raymond et al. (2002) speculated that dream pain might not be causally continuous with wakeful pain experiences, but with a personal pain memory trace formed after wakeful pain experiences. In support of this interpretation of the data, Jantsch et al. (2009) showed the existence of a reliable long-term memory trace for experimentally induced pain sensations. This finding would explain the rarity of reported dream pain in controls since pain is rare in their everyday experience. A competing causal explanation of the data in Raymond et al. (2002) is that some dreamers report pain they had never experienced in real life (e.g., dream pain in a fictional fight situation) (Schredl, 2011). In support of this view, Danziger et al. (2009) found that people with congenital insensitivity to pain show patterns of brain activation in shared-circuits for “self” and “other” pain while observing pain in other persons. This finding leads to the proposal that pain observed externally in others or in electronic media might also explain dream pain (Borsook & Beccera, 2009).

Thus, the three explanations on offer to explain why dream pain occurs are: (1) Dream pain is causally continuous with wakeful pain experiences; (2) Dream pain is causally continuous with personal pain memories formed after wakeful pain experiences; and (3) Dream pain is causally continuous with pain observed externally in others or in electronic media during wakefulness. These competing explanations show that the task of explaining why dream pain occurs is still very much an open question in the field, and more research on the topic is needed.

References

  1. Borsook D, Becerra L. Emotional Pain without Sensory Pain-Dream On? Neuron 2009; 61(2):153–155.
  2. Danziger N, Faillenot I, Peyron R. Can We Share a Pain We Never Felt? Neural Correlates of Empathy in Patients with Congenital Insensitivity to Pain. Neuron 2009; 61(2):203–212.
  3. Jantsch HHF, Gawlitza M, Geber C, Baumgärtner U, et al. Explicit episodic memory for sensory discriminative components of capsaicin–induced pain: Immediate and delayed ratings. Pain 2009; 143(1–2):97–105.
  4. Nielsen TA, McGregor DL, Zadra A, et al. Pain in dreams. Sleep 1993; 16: 490–498.
  5. Raymond I, Nielsen TA, Lavigne G, et al. Incorporation of pain in dreams of hospitalized burn victims. Sleep 2002; 25: 765–770.
  6. Schredl M, Erlacher, D. Lucid dreaming frequency and personality. Personality and Individual Differences 2004; 37(7): 1463–1473.
  7. Schredl M. Continuity between waking and dreaming: a proposal for a mathematical model. Sleep and Hypnosis 2003; 5: 38–52.
  8. Zadra AL, Nielsen TA, Germain A, et al. The nature and prevalence of pain in dreams. Pain Research and Management 1998; 3: 155–161.
  9. Zappaterra M, Jim L, and Pangarkar, S. Chronic pain resolution after a lucid dream: A case for neural plasticity? Medical hypotheses 2014; 82(3): 286–290.

Originally posted on Why Evolution Is True:

RememberTheTime99 has a series of videos about religious people indoctrinating their kids in faith; this short one (8.5 minutes long) was published on Friday shows a bunch of new footage of revivals, people being “slain in the spirit,” and other such horrors.  An excerpt from the notes:

Evangelical Christians around the globe are increasingly holding large children’s revivals where they practice a disturbing ritual called “anointing by the holy spirit,” “being slain by the holy spirit,” “catching the holy ghost,” or “falling out.”

It is intimidating, physically coercive, deeply stressful, and emotionally manipulative. Children are under tremendous pressure to cooperate, to mimic the adults’ bizarre behaviors, and to avoid being judged unworthy, disappointing, or worse, under satan’s spell.

The older children and teens are under great peer pressure to fit in. The youngest simply don’t understand they’re supposed to fall over. Their purity and honesty shines through.

Some of these…

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Originally posted on Why Evolution Is True:

There is no explicit statement in the Qur’an (I don’t know about the hadith) urging or sanctioning “honor killings,” but it’s now become a feature of Islamic culture, and has been justified on religious grounds (in Jordan, attempts to strengthen laws against honor killing were opposed and turned back by Muslim leaders for religious reasons).

Virtually every case  (I’ll add here “that I know of”) of “honor killing” is done by Muslims, and is committed against women, either for being raped (the excuses here are that a raped woman must have been a temptress, provoking the uncontrollable lust of men, or that a raped woman is no longer a virgin and thus not a candidate for marriage), for consorting with an apostate, for having extramarital or premarital sex, and so on. Often young members of the family, like boys, are assigned to do the deed, with the idea that they’d get off easier if they…

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Philosophical Thesis  Type Identity
Theory 
Eliminative
Materialism
Realism – Pain is real. Yes No
Materialism – Pain is neurophysiological. Yes Yes
Minimal Reductionism – Pain is nothing more than neurophysiological mechanism. Yes Yes
Identity – Pain is identical to a
neurophysiological mechanism.
Yes No
Naturalistic – Philosophies of pain are both metaphysical and scientific theories. Yes Yes
Theoretical – Metaphysical theories of pain can
be assessed according to their theoretical virtues (e.g., simplicity), and competing empirical predictions.
Yes Yes

 

Polger, T. W. (2011). Are sensations still brain processes? Philosophical Psychology, 24(1), 1-21.

 

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