Discussions concerning the modularity of the pain system have been focused on questions regarding the cognitive penetrability of pain mechanisms. It has been claimed that phenomena such as placebo analgesia demonstrate that the pain system is cognitively penetrated; therefore, it is not encapsulated from central cognition. However, important arguments have been formulated which aim to show that cognitive penetrability does not in fact entail a lack of modularity of the pain system. This paper offers an alternative way to reject the (...) modularity of the pain system, which is independent from, but consistent with, the presence of cognitive penetration. It is proposed that, given the current knowledge regarding the functioning and the structure of the pain system, there are good reasons to accept that certain central cognitive mechanisms are part of the pain system. It is argued that such a ‘cognitive constitution’ of the pain system entails that the pain system is not modular. (shrink)

There is compelling evidence that pain experience is influenced by cognitive states. We explore one specific form of such influence, namely placebo analgesia, and examine its relevance for the cognitive penetration debate in philosophy of mind. We single out as important a form of influence on experience that we term radical cognitive penetration, and argue that some cases of placebo analgesia constitute compelling instances of this phenomenon. Still, we urge caution in extrapolating from this to broader conclusions about cognitive penetration (...) in perceptual experience. Instead, we suggest that the cognitive penetration of pain raises distinctive psychological, epistemological, and ethical issues. (shrink)

One of the reasons why the Neural Correlates of Consciousness Program could appear attractive in the 1990s was that it seemed to disentangle theoretical and empirical problems. Theoretical disagreements could thus be sidestepped in order to focus on empirical research regarding the neural substrate of consciousness. One of the further consequences of this dissociation of empirical and theoretical questions was that fundamental questions regarding the Mind Body Problem or the “Hard Problem of Consciousness” could remain unresolved even if the search (...) for the neural correlates had been successful.Drawing on historical examples, a widely held consensus in the philosophy of science, and actual NCC research we argue that there is no such independence. Moreover, as the dependence between the theoretical and the empirical level is mutual, empirical progress will go hand in hand with theoretical development. Thus, contrary to what the original NCC program suggested, we conclude that NCC research may significantly take advantage from and contribute to theoretical progress in our explanation and understanding of consciousness. Eventually, this might even contribute to a solution of the Hard Problem of Consciousness. (shrink)

Health care providers are expected both to relieve pain and to provide anticipatory guidance regarding how much a procedure is going to hurt. Fulfilling those expectations is complicated by the cognitive modulation of pain perception. Warning people to expect pain or setting expectations for pain relief not only influences their subjective experience, but it also alters how nociceptive stimuli are processed throughout the sensory and discriminative pathways in the brain. In light of this, I reconsider the characterization of placebo analgesia (...) as pharmacologically inert and the use of it as deceptive. I show that placebo analgesia exploits the same physical mechanisms as proven analgesics and argue that it should be utilized to relieve pain. Additionally, I describe factors to help identify situations in which clinicians have the obligation to disclose the potential for pain coupled with ways of mitigating the risk of high-intensity pain by setting positive expectations. (shrink)

We suggest that pain processing has a modular architecture. We begin by motivating the (widely assumed but seldom defended) conjecture that pain processing comprises inferential mechanisms. We then note that pain exhibits a characteristic form of judgement independence. On the assumption that pain processing is inferential, we argue that its judgement independence is indicative of modular (encapsulated) mechanisms. Indeed, we go further, suggesting that it renders the modularity of pain mechanisms a default hypothesis to be embraced pending convincing counterevidence. Finally, (...) we consider what a modular pain architecture might look like, and question alleged counterevidence to our proposal. (shrink)