Pain, Misc

Phenomenal consciousness appears to be particularly normatively significant. For this reason, sentience-based conceptions of ethics are widespread. In the field of animal ethics, knowing which animals are sentient appears to be essential to decide the moral status of these animals. I argue that, given that materialism is true of the mind, phenomenal consciousness is probably not particularly normatively significant. We should face up to this probable insignificance of phenomenal consciousness and move towards an ethic without sentience.

According to pure imperativism, pain experiences are experiences of a specific phenomenal type that are entirely constituted by imperative content. As their primary argument, proponents of imperativism rely on the biological role that pain experiences fulfill, namely, the motivation of actions whose execution ensures the normal functioning of the body. In the paper, I investigate which specific types of action are of relevance for an imperative interpretation and how close their link to pain experiences actually is. I argue that, although (...) imperative theories constitute an apparently promising version of strong intentionalism, they cannot provide an imperative content that meets their own criteria of both sufficiency and necessity. I further argue that this issue cannot be solved by impure imperative theories either. (shrink)

The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant to force us to (...) substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982. The new definition follows (most of) my recommendations.]. (shrink)

Accounts of the nature of unpleasant pain have proliferated over the past decade, but there has been little systematic investigation of which of them can accommodate its badness. This paper is such a study. In its sights are two targets: those who deny the non-instrumental disvalue of pain's unpleasantness; and those who allow it but deny that it can be accommodated by the view—advanced by me and others—that unpleasant pains are interoceptive experiences with evaluative content. Against the former, I argue (...) that pain's unpleasantness does indeed have noninstrumental disvalue; against the latter I argue both that my critics’ own desire-theoretic accounts of pain's unpleasantness cannot accommodate such disvalue, and that my evaluativist view can—either by appealing to “anti-unpleasantness” desires or by exploiting pain's perceptuality. (shrink)

Tracking representationalism explains the negative affective character of pain, and its capacity to motivate action, by reference to the representation of the badness for us of bodily damage. I argue that there is a more fitting instantiation of the tracking relation – the badness for us of extremely intense stimuli – and use this to motivate a non-reductive approach to the negative affective character of pain. The view of pain proposed here is supported by consideration of three related topics: the (...) pain caused when the body is damaged, reparative pain, and the messenger-shooting objection to tracking representationalism. (shrink)

Learning is fundamentally about action, enabling the successful navigation of a changing and uncertain environment. The experience of pain is central to this process, indicating the need for a change in action so as to mitigate potential threat to bodily integrity. This review considers the application of Bayesian models of learning in pain that inherently accommodate uncertainty and action, which, we shall propose are essential in understanding learning in both acute and persistent cases of pain.

This is a Letter to Editor of _Pain_ recommending revision of a pain term ('nociplastic pain') recently added to the IASP Pain Terms. (With a response from the Taxonomy Committee, Eva Kosek et al. PAIN: June 2018 - Volume 159 - Issue 6 - p 1177–1178.

Over recent decades, pain has received increasing attention as – with ever greater sophistication and rigour – theorists have tried to answer the deep and difficult questions it poses. What is pain’s nature? What is its point? In what sense is it bad? The papers collected in this volume are a contribution to that effort ...

In this thesis I provide an account of the unpleasantness of pain. In doing this, I shed light on the nature of pain and unpleasantness. I propose to understand the unpleasantness of pain based on the determinable-determinate distinction. Unpleasantness is a determinable phenomenal property of mental states that entails badness. I propose that an unpleasant pain experience has two phenomenal properties: i) the phenomenal property of being a pain, and ii) a phenomenal determinate property (u1, u2, u3, etc.) of the (...) unpleasantness determinable. According to this theory unpleasant pains feel bad, and this explains why we are motivated and justified in avoiding them. This explains, for example, why we are motivated and justified to take painkillers. This theory allows us to account for the heterogeneity of unpleasantness, i.e., we can explain how different unpleasant experiences feel unpleasant even if they feel so different. -/- The thesis is organised into seven chapters and divided by three main themes: i) what the unpleasantness of pain consists in, ii) how we can account for the great phenomenal diversity among experiences of unpleasantness, and iii) which cases suggest that there could be pains that are not unpleasant. Broadly, the first two chapters deal with the first theme, where I analyse two reductive accounts of unpleasantness: the content theories and the desire theories. I deal with the second theme in the third and fourth chapter, where I analyse different theories that try to account for the phenomenal property of unpleasantness. In the fifth and sixth chapter, I focus on the third theme, where I consider different cases that suggest the existence of pains that are not unpleasant. In the final chapter, I offer a conclusion of the three main themes by providing my own view on the unpleasantness of pain. (shrink)

The official definition of ‘pain’ by the International Association for the Study of Pain (IASP) hasn’t seen much revision since its publication in 1979. There have been various criticisms of the definition in the literature from different quarters: that the definition implies a dubious metaphysical dualism, that it requires a strong form of consciousness as well as linguistic abilities, that it excludes many vulnerable groups that are otherwise perfectly capable of experiencing pain, that it has therefore unacceptable practical as well (...) as ethical consequences, that it is unhelpful to the health-care professional as an operational definition, that it is too narrow, and many others. In my view, most of these criticisms depend on misunderstandings or on uncharitable interpretations. My aim is to go over the definition, clarify some potential ambiguities, and argue that these criticisms don’t cut much ice. At the end, I will present a few slightly reworded versions of the definition that I claim are more felicitous and capture the original intended meaning by the members of the taxonomic committee in a much better and transparent way that avoids all the major extant criticisms in the literature. (Written for interdisciplinary audiences.). (shrink)

Evaluativism is best thought of as a way of enriching a perceptual view of pain to account for pain’s unpleasantness or painfulness. Once it was common for philosophers to contrast pains with perceptual experiences (McGinn 1982; Rorty 1980). It was thought that perceptual experiences were intentional (or content-bearing, or about something), whereas pains were representationally blank. But today many of us reject this contrast. For us, your having a pain in your toe is a matter not of your sensing “pain-ly” (...) or encountering a sense-datum, but of your having an interoceptive experience representing (accurately or inaccurately) that your toe is in a particular experience-independent condition, such as undergoing a certain “disturbance” or being damaged or in danger (Armstrong 1962; Tye 1995). But even if such representational content makes an experience a pain, a further ingredient seems required to make the pain unpleasant. According to evaluativism, the further ingredient is the experience’s possession of evaluative content: its representing the bodily condition as bad for the subject. In this chapter, I elaborate evaluativism, locate it among alternatives, and explain its attractions and challenges. (shrink)

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. We start by examining (...) the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes. (shrink)

Sometimes the philosophical armchair gets bumped by empirical facts. So it is when thinking about pain. For good or ill (good, actually, as we shall see) most of us are intimately acquainted with physical pain, the kind you feel when you stand on a nail or burn your hand. And, from the armchair, it can seem blindingly obvious that pain is essentially unpleasant. There are of course unpleasant experiences that aren’t pains – nausea or itches, for example – but surely (...) there aren’t pains that don’t hurt, pains that are neutral or even pleasurable rather than unpleasant. Surely, indeed, there couldn’t be. For it is part of the very concept of a pain that a pain be unpleasant. Or so it has seemed to many. Yet over recent decades philosophers’ confidence in these putative truisms has been shaken by some fascinating cases from the clinic, the lab, and life. (shrink)

Patientia, the virtue of enduring physiological pain, poses a problem for Roman elite masculinities. The male body is supposed to be unpenetrated, but when pain is inflicted the body is often cut and pierced. This paper looks at literary and philosophical representations of the moral exemplar Mucius Scaevola to see how Roman writers and philosophers deal with this dilemma.

Pain asymbolia is a rare condition caused by brain damage, usually in adulthood. Asymbolics feel pain but appear indifferent to it, and indifferent also to visual and verbal threats. How should we make sense of this? Nikola Grahek thinks asymbolics’ pains are abnormal, lacking a component that make normal pains unpleasant and motivating. Colin Klein thinks that what is abnormal is not asymbolics’ pains, but asymbolics: they have a psychological deficit making them unresponsive to unpleasant pain. I argue that an (...) illuminating account requires elements of both views. Asymbolic pains are indeed abnormal, but they are abnormal because asymbolics are. I agree with Klein that asymbolics are incapable of caring about their bodily integrity; but I argue against him that, if this is to explain not only their indifference to visual and verbal threat, but also their indifference to pain, we must do the following: (i) take asymbolics’ lack of bodily care not as an alternative to, but as an explanation of their pains’ missing a component, and (ii) claim that the missing component consists in evaluative content. Asymbolia, I conclude, reveals not only that unpleasant pain is composite, but that its ‘hedomotive component’ is evaluative. (shrink)

Compare your pain when immersing your hand in freezing water and your pleasure when you taste your favourite wine. The relationship seems obvious. Your pain experience is unpleasant, aversive, negative, and bad. Your experience of the wine is pleasant, attractive, positive, and good. Pain and pleasure are straightforwardly opposites. Or that, at any rate, can seem beyond doubt, and to leave little more to be said. But, in fact, it is not beyond doubt. And, true or false, it leaves a (...) good deal more to be said: about the nature of sensory affect; its relations to perception, motivation, and rationality; its value; and the mechanisms underlying it. Much is said about these matters in the contributions that follow. Here, in this introductory essay, we map the dialectical landscape and locate our contributors’ papers within it. (shrink)

The unpleasantness of pain motivates action. Hence many philosophers have doubted that it can be accounted for purely in terms of pain’s possession of indicative representational content. Instead, they have explained it in terms of subjects’ inclinations to stop their pains, or in terms of pain’s imperative content. I claim that such “noncognitivist” accounts fail to accommodate unpleasant pain’s reason-giving force. What is needed, I argue, is a view on which pains are unpleasant, motivate, and provide reasons in virtue of (...) possessing content that is indeed indicative, but also, crucially, evaluative. (shrink)

Our preoccupation with pain can seem an eccentricity of philosophers. But just a little reflection leads one into the thickets. When I see a pencil on my desk, I’m aware of a physical thing and its objective properties; but what am I aware of when I feel a pain in my toe? A pain, perhaps? Or my toe’s hurting? But what is the nature of such things? Are they physical? Are they objective? To avoid unexperienced pains, we might say they (...) are subjective, or are themselves experiences. But do those with hurting toes therefore have experiences in their feet? The issues rapidly proliferate. Many of them are addressed in this interesting collection of original essays by philosophers, psychologists, and neuroscientists, edited by Murat Aydede. (shrink)

I argue that the understanding of "pain" as presented in the official medical definition by the IASP is ambiguous and likely a cluster concept.

Perceptualists say that having a pain in a body part consists in perceiving the part as instantiating some property. I argue that perceptualism makes better sense of the connections between pain location and the experiences undergone by people in pain than three alternative accounts that dispense with perception. Turning to fellow perceptualists, I also reject ways in which David Armstrong and Michael Tye understand and motivate perceptualism, and I propose an alternative interpretation, one that vitiates a pair of objections—due to (...) John Hyman—concerning the meaning of ‘Amy has a pain in her foot’ and the idea of bodily sensitivity. Perceptualism, I conclude, remains our best account of the location of pains. (shrink)