??? A Challenge: A definition of pain.

[AdamB]

One of the NOI faculty members, Morten Hoegh, wrote this on his Danish blog at the beginning of NOI 2012:

A challenge:
Can you come up with a definition on pain that live up to these requirements:
1. You must not be able to replace "pain" with "fear" or "anxiety" in the definition.
2. The definition must make sense even if you put "phantom pain" instead of "pain".
3. It can't be identical to already public definitions.

You could include the following ideas:

• pain is (as opposed to other feelings) localised in the body
• Pain relates to reliable information about survival (e.g. if you experience that you are in danger of injury)
• Pain motivates behaviour change

I wrote some suggestions to him, but almost every one of the suggestions was more descriptive of than defining pain as opposed to for example "fear" or "anxiety".

What is your take on this?

[Barrett Dorko]

What is your take on this?

It probably isn't a waste of time for everybody, but I'm not going to put any time into it.

Toward what end?

[joebrence9]

Pain: a neuroimmunological sensory experience caused by a cortical decision to protect tissues based upon multiple variables including but not limited to those which are related to biological, psychological and social threats.

[Bas Asselbergs]

Nice one Joe. I probably would take out "sensory". The experience is more than that and the word appears to introduce that peripheral system.
Then I would not use "tissues" but rather "the living being".

Otherwise - excellent and I couldn't have come with it. Thanks for letting me ride along.

[keithp]

Originally Posted by joebrence9

Pain: a neuroimmunological sensory experience caused by a cortical decision to protect tissues based upon multiple variables including but not limited to those which are related to biological, psychological and social threats.

WAAYYYY better than anything that was bouncing around my head. My only issue was with "tissues" (as the brain can try to "protect" tissues that may not actually exist), but Bas makes a nice suggestion.

Respectfully Impressed,
Keith

[AdamB]

@Barrett: I certainly wouldn't want to waste your time. Your choice.

Great suggestion, Joe. Thank you so much.

I think the question is interesting from a phenomenological/philosophical perspective.

I think that in general we can agree that pain and anxiety are two different "things" (experiences).
The problem comes regarding where they differ.

Allow me to pick apart your definition with all due respect, Joe.

"neuroimmunological" - anxiety could also fit into that category
"sensory" - ditto
"experience" - ditto
"cortical decision" - ditto
"protect" - ditto
"tissues" (/body/organism) - ditto
"multiple variables" - ditto
"biological" - ditto
"psychological" - ditto
"sociological" - ditto
"threats" - ditto

So I am baffled with where these two experiences differ.

If we try to define pain in physiological terms it probably doesn't differ much from the experience of anxiety.

Anxiety is also an experience, is due to cortical processes where various factors can trigger the response, it can also be a sensation described in physical or psychological terms and is a part of the biological stress response to protect the organism.

To be clear a definition is a passage that explains the meaning of a term so that it in a sense can be distinguished from other "terms".

I can se the problem with a lot of people who can readily say to a person in pain - "it is all in your head". Is science at the moment able to come up with a definition that makes sure that pain differs from other "unpleasant experiences"?

I don't have the answer, but I find the question interesting.

[Bas Asselbergs]

The purpose of Morten's exercise is to point out that: we can`t isolate pain from fear or anxiety.

pain is (as opposed to other feelings) localised in the body
Pain relates to reliable information about survival (e.g. if you experience that you are in danger of injury)
Pain motivates behaviour change

These suggestions are indicators that this is an exercise to demonstrate what pain ISN`T.

At least that is what I get out of this. Looks like a neat way to make those unfamiliar with the neuromatrix or modern pain sciences (no one here) to discover through study and thinking, that pain is what it really is (see Joe`s definition).

[Randy Dixon]

I think if we differentiate pain from experiences like emotional pain (sadness, grief, loss, etc) then the elements of fear and pain are similar. Complex, unpleasant, subjective. What is different is that pain is perceived as a physical stimulus and the unpleasant sensation is associated with tissue damage, nociception or a noxious stimulus. I'm not sure which of those is most accurate. Of course, it is only the perception of these physical factors, but the perception is one that is physical.

So perhaps if we take the definition of fear and add "with the unpleasant sensation being perceived as if manifested physically" or "with the perception of (tissue damage, nociception, noxious stimulus) being present".

[Barrett Dorko]

When did we start to ignore any mention of the effect of movement?

If I'm feeling fear moving some body part isn't going to change that.

[zimney3pt]

Originally Posted by joebrence9

Pain: a neuroimmunological sensory experience caused by a cortical decision to protect tissues based upon multiple variables including but not limited to those which are related to biological, psychological and social threats.

I might only add neuroendocrine with neuroimmunological.

[Bas Asselbergs]

For some old and new thoughts on this issue, look at Bronnie's blog:
http://healthskills.wordpress.com/20...sciency-stuff/

[joebrence9]

Revised based upon great suggestions...

Pain: a neuroimmunological experience caused by a cortical decision to protect the body based upon multiple variables including but not limited to those which are related to biological, psychological and social threats.

[gollygosh]

Originally Posted by Barrett Dorko

When did we start to ignore any mention of the effect of movement?

If I'm feeling fear moving some body part isn't going to change that.

As I understand it, the pain of a burn, or cancer would not be effected by motion. If my understanding is correct, then the effect of movement would not apply to the definition of pain.

Geralyn

[Diane]

Originally Posted by joebrence9

Revised based upon great suggestions...

Pain: a neuroimmunological experience caused by a cortical decision to protect the body based upon multiple variables including but not limited to those which are related to biological, psychological and social threats.

Hi Joe,
After thinking about this for awhile, I would replace the word "cortical" with something else.
Todd Hargrove suggests "prerational", while in the past, I've used the term "critter brain".

I think the term "cortical" (as a descriptor) should be reserved for the more rostral parts of brain that can disengage, reflect, and strategize a solution, and also capable of inhibiting the dorsomedial thalamus directly. This boils down to the late-to-arrive-on-the-scene, both evolutionarily and developmentally, dorsolateral prefrontal cortex, the only part that could possibly be considered as "rational" - everything else, pretty much, varying by shades and degrees, being pretty much categorizable as "pre" rational.

[Marc]

"Pain is an unpleasant, individual, multifactorial, conscient experience, felt somewhere in the body and which serves to protect this part of the body."

This definition has been given by Lorimer Moseley in Paris last week-end.

[Gil Haight]

What is wrong with the definition from the IASP?
Gil

sorry, I just saw the part about not using existing definitions. I'm with Barrett. What is the sense of this exercise if it has already been done.

[AdamB]

Well, wouldn't you say there is a difference between pain and fear/anxiety, Gil?

What then, is that difference in physiological or phenomenological terms?
I still think that that is the purpose of Mortens "challenge". I don't think he has an answer, but I can see the relevance from a philosophical perspective.

A relevant issue in the clinic is trying to understand why the patient is in pain.
When the patient informs us of his pain it would be relevant to "break down" the experience into clinical relevant patterns that guides the treatment/handling/care/management.
That is why a definition of pain should include categories that are exclusive to pain and not to fear/anxiety, anger or love.
After all most would probably argue that there is a difference in how we treat pain and how we treat fear/anxiety (- although the difference probably isn't always that big according to the role of the limbic system and other "critter"-elements.)

Respectfully

[Gil Haight]

Adam,
Thoughtful points and they remind me of our exchange recently on the output=defense thread. Anxiety/ fear are obviously on the L hand side of the NM as is nociception. Care is not restricted to correcting this side only.

"A relevant issue in the clinic is trying to understand why the patient is in pain."

Certainly, this can be true, but all care is not limited to this view. If output is seen as corrective why would we want to get rid of it? This was my point on the defense topic. It has been my experience that if patients experience a way of moving which relieves pain they will also experience a reduction in anxiety. By anxiety I mean the lack of choice. If patients were unaware of the way to move to relieve their pain and with a certain kind of handling experienced this "analgesic movement", then we could quite easily "kill two birds with one stone".
Gil

[Diane]

I see it as a useful exercise. It gives people a chance to be inventive, start to actually think about what it all means. Once they see the definition arrived at by IASP is actually pretty good given the current state of knowledge, and is still capable of further evolution depending on what is discovered next, they may invest in it much more, because it has now become a neurotag they can accept. They've learned to "do by doing." They can see the official definition is more verb than noun.

[Milehigh]

I really like that definition and the resulting conversation. Perhaps I focus more on the communicative aspect of pain aka Wittgenstein.

Pain is word which is used to communicate an unpleasant, threatening or potentially threatening experience. The sensory stimulus (input) responsible for such an experience are multimodal and multivariate. The behavioral, neurological, immunological and biological response (output) to this experience is multivariate. The processing between (input) and (output) is unique to each individual's genetics, neural architecture and priori of previous experiences.