“Pain and perception” – some questions and answers

Argument:

Imagine I see a white rose. The rose is white, not my seeing of it. Right? To think my seeing of the rose is white is to confuse what is perceived, with my perceiving of it. It’s a category mistake.

Now, compare: ‘I feel a burning pain’. To think my feeling of the pain is what burns is, again, to confuse what is perceived, with my perceiving of it.

The pain is what burns, not the feeling of it. Therefore, pain is not a perception.

---

Question: Whether the pain ‘burns’ or not is down to the perception of the person feeling the pain. It could just as easily be perceived as a ‘stinging’ sensation, a ‘grazing’ sensation, or any other way they wish to describe it. Just because something feels like a burn, doesn’t mean it is, and doesn’t mean it should be treated as such.

Reply: Let me try a different tack: how do you know that you have a pain? Suppose you say, ‘I know I have a pain because I feel (perceive) it’. Makes sense. But ‘I feel it’ means the same as ‘I have it’. Feeling a pain is having a pain. Therefore, ‘I know I am in pain because I feel it’ says no more than ‘I know I have a pain because I have a pain’, which doesn’t explain how you know that you have a pain.

I am arguing that knowledge of pain is not a form of perceptual knowledge (unlike perceiving a white rose). Again: When I feel a pain, there are not two things involved: the pain, and my feeling the pain. There is just the pain. Therefore, pain is not a perception.

---

Question: Your pain is the perception of it. That is how it works. If you don’t perceive it, it isn’t there. Our reality is constructed from our perceptions and doesn’t exist with them. There is no notion of pain without our perception of it. Pain does not exist independently of our perception of it so I’m not sure what you’re referring to when you say ‘just the pain’.

Reply: I am arguing that pain is not analogous to perceiving a white rose, or to perception of any object in the external environment. Pain is not an ‘object’. Not so long ago, pain was widely identified with the noxious stimulus. Nowadays, some researchers identify pain with a neural activation pattern. Failure to verify pathology can lead to some patients with pain being stigmatised by HCPs.

When I perceive a white rose, there is the rose, and my perceiving it. But ‘pain perception’ is not like this, because feeling a pain is just having a pain (and vice versa). To say that ‘I know I am in pain because I feel it’ just says ‘I know I have a pain because I have a pain’, which doesn’t explain how you know that you have a pain (compare ‘How do you know that you see a rose?’).

The phrase ‘pain perception’ obscures this difference, and understanding this point can help us be a little clearer about the ‘meaning’ of pain.

---

Question: But aren’t there two (or more things) involved? Say you get a paper cut. There is the cut, with mechanical and chemical nociceptors sending signals to the CNS, and your brain’s perception of the cut and those signals. Your brain perceives a threat and creates pain. There is a rose, and your brain’s perception of the light reflecting off the rose into your eyes, and your brain creates “white”.

Reply: Nice observation! But, my argument doesn’t rely on knowledge of mechanism, but personal experience. That doesn’t limit the clinical relevance of the argument, since clinical decisions are often based on scientific knowledge and personal understanding (‘prior experience’, ‘intuition’, ‘gut feelings’).

Advertisement

Mental Imagery in Chronic Pain: An Access to Meaning Beyond Words

Chantal Berna

Collage by Alexey Kondakov

Abstract
Mental images are cognitions, which take the form of sensory experiences in the absence of a direct percept. Images can be opposed to verbal thoughts, i.e. cognitions in the form of words. From the perspective of clinical cognition, verbal thoughts and mental images are different phenomena, with mental images having tighter connections to emotion than verbal thoughts. Recently, cognitive psychology research has focused on spontaneous mental imagery, i.e. involuntary intrusions of often vivid mental images that appear in one’s mind. Spontaneous mental imagery is now viewed as an important part of psychopathological processes across psychological disorders, a potential emotional amplifier and a therapeutic target in its own right.

Pain is a personal experience, so exploring and understanding the patient’s thoughts about pain might contribute to therapeutic success and favour personalized care. In the field, thoughts about pain have been mostly studied as verbal thoughts. Yet, a growing literature is investigating thoughts about pain in the form of imagery.

Clinical Implications
Studying chronic pain patients’ mental imagery provides unique insight into their personal experience, integrating information about somatosensory perceptions, emotional experience and meanings of pain. The study of imagery in pain also gives insight into possible reinforcing mechanisms of pain, and a basis for a powerful, individualized therapeutic approach through different mental imagery therapy techniques.

This chapter describes current knowledge about mental imagery as intrusive cognitions in the context of pain, considers the neuroscientific investigations that have been undertaken, and discusses the therapeutic potential it yields.

Request a pdf copy here.
Published in Meanings of Pain, Volume I. Purchase here.

Further Reading
Berna C, Tracey I, Holmes EA. How a better understanding of spontaneous mental imagery linked to pain could enhance imagery-based therapy in chronic pain. Journal of experimental psychopathology. 2012 Apr;3(2):258-73.

The Observer is the Observed: Towards Integrating Pain Phenomenology and Third-Person Methods in the Scientific Study of Pain (2014)

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Humans beings are persons and organisms

Sculpture by Fabio Viale

As organisms, human beings interact with the world and each other through causal mechanisms that control us and every other physical thing. As persons, we act in the world through our thoughts, emotions, attitudes, or desires.

Accordingly, human beings are describable in two distinct, but complementary ways: in terms of the way the world is, through scientific descriptions of the causal mechanisms and laws that explain physical things, or, in terms of the way the world seems, through descriptions of personal experiences and meanings.

One or the other way of describing human beings comes into focus depending on the questions we ask about ourselves or the world. The features of personal experience—thought, feeling, speech and action—are amenable to standard scientific explanation as specific changes in the body. Traditionally, scientific research has had much to say about the physical nature of pain, but much less about the personal experience or meaning of pain. Indeed, the meaning of pain remains a blind spot in knowledge.

---

A description of a human being as a person means that there is a way of understanding of human beings in which personal experience and meaning, rather than physical causation alone, is needed to answer the question, “What is happening?”

Human persons can distinguish between how things are in the world and how things seem to me. I can recognise within myself a perspective or point of view on the world and identify it as belonging to me. Every person has such a unique perspective; this is partly what it means to be a person rather than a physical thing. In contrast, a scientific description of the world does not presuppose any personal point of view. Physical science does not use words like “I”, “here,” or “now”. Does this mean that “persons” are unobservable to standard quantitative science?

Possibly. Imagine a complete explanation of pain according to the final neurophysiology of pain—whatever it turns out to be. Such an explanation of pain would, to put it very crudely, accurately map specific neurophysiological changes in physical parts in the living human organism and all their true causal interactions across time. However invaluable such an explanation would be to pain medicine, it could not describe the way pain seems to the person who experiences it, for which of the physical objects described in this explanation is me with pain, here, now? Immediate pain always seems a certain way to persons, and this “seeming” determines the experience of the person with pain. In describing personal pain, human beings use language with other meanings than the language used in neurophysiology. The final neurophysiological explanation of pain therefore could explain only one dimension of pain in human beings—the physical dimension—in language that could not capture the personal experience, burden, or meaning of pain.

---

A philosophical assumption of neurophysiology is that a person is identical with his or her body. Person and body are one and the same thing. In terms of personal experience, however, the identity between person and body escapes personal understanding. For example, when I feel a pain, there is no information or evidence, or nothing that I could discover about my body subsequent to the experience of pain, that could demonstrate it to be false. When I feel a pain, I simply know that I am in pain.

In person to person interactions, we commonly respond to each other as though we are not identical with the human body, but in a compelling sense operating “through” the body, which seems to be a vehicle of thought, emotion, pain or suffering. We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which peers out through the face. The human face is the social instrument of persons. In seeking to understand you, or adjust how the world or your experience seems to you, I interact with you through your embodied perspective.

In pain experience, it is my loss of personal control over my body, and its dominion over me, that create the compelling sense, for me and for others, of an “incarnate” person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person, and the person’s significant others, feel answerable for what he or she experiences.

---

Should investigators introspect on their own pain experiences as study co-participants? – Simon van Rysewyk and Carl L. von Baeyer

van Rysewyk S, von Baeyer CL. Should investigators introspect on their own pain experiences as study co-participants? In: van Rysewyk S (2016). Meanings of Pain. Springer International Publishing AG: Switzerland.

Abstract

The question of investigators introspecting on their own personal pain experiences in pain studies has received little attention in the literature. Study of this question may reflect ethical reservations about the many points at which self-interest may lead us to introspect on personal experiences through personal biases that in turn impair professional decision-making and perception. Despite this valid concern about research co-participation, we offer three reasons why investigators can introspect on personal pain as co-participants in their own pain studies. First, there is historical precedent for investigator participation and co-participation in scientific pain research using introspection as a study method. Second, general concerns about variability in self-report based on introspection on pain experience partly derive from true fluctuations in personal pain experience and perceived interests in self-reporting pain, not simply error in its scientific measurement. Third, the availability of the Experiential-Phenomenological Method, a mixed research method for the study of human experiences, allows investigators to co-participate with naïve participants in their own studies by encouraging passive introspection on personal pain experiences.

Download a copy of the chapter here.