This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
I have created an archive of the old discussions. I have copied back to this page all recent conversations. In case anyone needs to know in the future, I used the Move Page method to preserve the edit history. Everything below is a cut-and-paste copy of the 2008 discussions. (I think I got them all...) WhatamIdoing ( talk) 22:28, 29 March 2008 (UTC)
There are many good things about this article, but its major problem (in my view) is the constant implicit focus on human beings as the sole objects of this topic. Apart from a brief few lines at the end, this article suffers (no pun intended) from extreme anthropocentrism. Pain is not something specific to our species; rather, it is something we experience because we happen to be animals. I would recommend rewording and/or reorganising the article, so as the show the aspects of pain shared by all animal beings (humans included), followed by subparts dealing with specifically human aspects (insofar as it may make sense to speak of specifically human forms of pain). Aridd ( talk) 13:23, 28 January 2008 (UTC)
Has anyone gone over the precise arrangement of nerves in the spinothalamic pathways versus the perceived acupuncture "meridians"/"qi channels"? It seems pretty obvious that the referral of pain from the heart to the left arm and neck could have contributed to the idea of these meridians, and I see reference to it on the Web [1], but on PubMed I didn't quickly find any detailed treatment of the idea, pro or con. Wnt ( talk) 23:34, 25 February 2008 (UTC)
This seems out of place, like it was taken straight out of a lecture in a nursing course (which is why it needs a citation). I don't think it adds anything to the page (i.e. what is pain, what are the types, etc. as opposed to what do nurses do when someone is in pain), and I opt for deleting the whole section. Anyone strongly disagree? Zickx009 ( talk) 02:26, 26 February 2008 (UTC)
Never heard of it. Fibromyalgia, maybe? Zickx009 ( talk) 02:22, 26 February 2008 (UTC)
I think there is a very bad mix up here. The correct term for pain that is pathological is "maladaptive", where as physiological pain is "adaptive". For example, chronic infection will cause a chronic pain... by definition. However this pain is adaptive and thus physiological. NGF associated central sensitisation however will cause chronic pain that is maladaptive and hence pathological. Does this make sense? User:mubinchoudhury —Preceding comment was added at 11:33, 1 May 2008 (UTC)
removed material
"Experts in pain have proposed a variety of definitions. These definitions illustrate the multi-facetted nature of pain.
"Pain is whatever the experiencing person says it is; existing whenever he or she says it does.” [1] — Margo McCaffrey, RN MS
"Pain is a category of complex experiences, not a single sensation produced by a single stimulus". [2] - Ronald Melzack and Patrick Wall
These quotes definitely do not define pain by any means. One talks about the subjective nature of pain, and the other merely mentions that pain happens to be complex and not simple. Delete section? Zickx009 ( talk) 02:48, 26 February 2008 (UTC)
I agree that "it's a set of complex experiences" is not a definition. However the McCaffrey quote is, within the context of nursing education, the definition that is being used. I support your removal of the section "Definitions of pain" unless we can find more and hopefully a secondary or tertiary source commenting on the different definitions. (At one stage I found a behaviorist psychology definition of pain but then lost the source. I believe that other definitions exist too.) I think your idea of a section on the essentially subjective nature of pain is great. SmithBlue ( talk) 12:42, 22 March 2008 (UTC)
There's a lot of work on defining pain outside of the reported emotional/psychological experience. For example, various researchers have looked at neurotransmitter levels, a variety of physiologic responses like changes in oxygen saturation, skin conductance, heart rate or blood pressure, and behavioral observations like facial expressions. I'd be surprised if there wasn't quite a bit more than these examples. Much of this work focuses on people who can't communicate usefully about their pain: critically ill, very young, or severely disabled people. Some of it is focused on people who might not be motivated to accurately report their pain (people addicted to opiods, for example).
I also expect that there is a substantial body of work on pain in the context of veterinary work. Surely a snake can be said to perceive the pain of being injured even though snakes are widely believed to have no true psychological response to anything. WhatamIdoing ( talk) 20:27, 24 March 2008 (UTC)
Well, we could start with a normal dictionary defintion, like "a basic bodily sensation induced by a noxious stimulus" or "an unpleasant sensation" rather than leading with the current technical definition. For that matter, once you leave the ultraspecialists, pain becomes much more familiar to the average person even in authoritative medical references. In the words of Stedman's Medical Dictionary, it is "an unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder"; Dorland's Medical Dictionary says pain is "a more or less localized sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings." [3] These focus on the sensory aspect instead of the psychologic -- that is, on what the normal person calls pain, instead of on what the psychologists used to call pain affect before they decided that pain was the affect.
In addition to introducing a much broader definition, I think there are three things that might be useful: <split into three subsections for ease of editing> WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
The IASP's definition is not only just one among many now; it's a relatively new one by any reasonable standard. This series of pages has some interesting, although not very detailed, information about pain. It has a good summary of some historical changes. I think the definition of pain has changed materially in the last quarter-to-half century. What a 17th century physician called "pain and suffering" seems to have been renamed in the 20th century as "nociception and pain." The early use of pain had a lot more to do with (what we call) nerve signals, and suffering had to do with your response to it: in the famous Descartes drawing, pain is what happens to your foot when you stick it in the fire, and suffering is your response to it. Indeed, if you look at the definition of suffering on Wikipedia, it bears striking resemblance to the IASP's definition of pain.
There is more historical information at the NIH, and just a bit here in the introductory material to the first link.
This link, which covers a lot of territory, has an interesting short section. Search down to see what Helm says, which covers the basic practical problems with defining pain as an emotional response: "writhing and screaming fail to signify that one is suffering pain" during torture, because if you want to die, then signs that you're getting what you want must be pleasurable. This may not really fit into this article, however. WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
The AVMA has some information about the difficulty of defining pain in animals. Mammals are believed to be similar to humans. The USDA directly defines pain in animals as whatever produces pain in humans. Here is a source claiming that fish are neurologically incapable of experiencing pain (using pain in IASP terms), and here is a BBC story about some UK research that concludes that it doesn't matter whether fish have a neocortex (and thus the capacity for having any kind of psychological response), because "profound behavioural and physiological changes" demonstrate the existence of a clear response to nociception. This magazine article has something about the "hierarchy of pain consciousness," which I think of as the obvious extension of the doctor calling it "some discomfort" while the patient calls it "nearly intolerable pain:" human pain is very real, and dog pain is pretty real, and fish pain is not real, and cockroach pain is foolish. (Did you know that birds find grape flavoring to be painful?) WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
As for the "other side," it might be interesting to include the pain overlap theory, entirely focused on the psychological response to loneliness. This is not a sensory experience in IASP terms, but they make a case for it still being painful, and social exclusion often is "described in terms of such damage" [associated with actual or potential tissue damage], which means that it meets the IASP definition of pain.
I'd be interested in hearing your thoughts. WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
I'm not sure this section adds anything to this article except a huge collection of wikilinks. (Hypnosadist) 06:52, 20 March 2008 (UTC)
I'm adding the pain specific wikilinks here to keep track of them; Neck pain Back pain Breast pain Chest pain Shoulder pain Abdominal pain. (Hypnosadist) 10:17, 21 March 2008 (UTC)
I think the above links should be in the article but i'm not sure about the long list of diseases, this article should cover things like provoking factors and alleviating factors. (Hypnosadist) 10:23, 21 March 2008 (UTC)
My suggestions are pretty basic, but here they are:
WLU ( talk) 21:41, 29 March 2008 (UTC)
A complex request or 5:
I'm wondering if this section should be removed and a sentence or two added to the section Genotype and Pain. There is already a separate article (Congenital insensitivity to pain) on this topic, and two separate mentions in this article as well. Sisyphus ( talk) 20:15, 31 March 2008 (UTC)
I am also curious if this section should be moved to Genotype and Pain. -- DavidD4scnrt ( talk) 04:35, 11 April 2008 (UTC)
The section on "Referral pain" duplicates information in the long "Visceral pain" bullet point in the previous section. Do we want to merge the two sections, or do a much more organized split? I'm currently leaning towards a split, although it's more work. WhatamIdoing ( talk) 02:57, 1 April 2008 (UTC)
I have been unhappy with the lead because it's so limited: It jumps directly to the specialized definition by the IASP, without even acknowledging that nearly everyone else in the world uses the word differently. A toddler can't even make the distinction between the physical and psychological sides of it, but surely every adult here believes that even a three year old will recognize and be able to name pain in the common sense. So here's my proposed expansion of the lead:
From there, I think the lead should continue as it's already written. Does that work for everyone? WhatamIdoing ( talk) 03:32, 1 April 2008 (UTC)
Pain, as commonly used, refers to an unpleasant or distressing sensation of the type that is associated with a disease or injury. [4] [5] Although pain is more commonly associated with a bodily sensation, the term is also used to describe mental or emotional distress or suffering. [4] [5] When the term is applied to a bodily sensation, pain results from the stimulation of specialized nerves and functions as a warning system to prevent tissue damage by promoting avoidance. [4] [6]
In scientific research, a more precise definition is used. Pain is defined by the International Association for the Study of Pain (IASP) as as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. [7] This is distinguished from nociception, which is activity in the nervous system resulting from the stimulation of nociceptors (pain receptors).
"Houston, we have a problem", the source [ cited(IASP Pain Terminology)] doesn't actually provide a def for "nociception". (Nociceptor is defined) Anyone got one - hopefully an RS without complexities such as "sensation", "perception", "physiological pain", "psychological pain", "physical pain", and "sense", all of which have "non-common use", counter-intuitive meanings in this context. [ Definition of Pain and Distress and Reporting Req...] is not clear enough I think. SmithBlue ( talk) 10:47, 1 April 2008 (UTC)
Also the following from IASP Core Curriculum for Professional Education in Pain, 3rd edition, Chapter 7: Pain Measurement in Humans. Careful interpretation is required. -- Robert Daoust ( talk) 22:23, 2 April 2008 (UTC)
I. Know that pain is a subjective, multidimensional experience unique to the individual (Clark et al. 2002; Kumar et al. 2002).
- A. Understand the distinction between pain and nociception.
- 1. Appreciate that pain is a conscious, aversive aspect of somatic awareness, the product of complex, central, nociception-induced processing, and not a primitive sensation.
- 2. Appreciate that nociception is never conscious and engages sensory, emotional, and cognitive processing areas of the brain.
- B. Understand that pain is multidimensional.
- 1. Appreciate that the pain experience may have sensory, emotional, and cognitive aspects.
- 2. Appreciate the potential impact of pain on function, affective status, and quality of life.
Section#Sources of pain uses term "(The experience of) physiological pain" without defining it. This needs to be done otherwise its very hard for a naive reader to follow. In addition (as I understand it - with one errror in place) nociception = physical pain = physiological pain so the phrase "The experience of physiological pain", is nonsensical as nociception is not experienced. Thinking we need a "Language of Pain" section to clarify the multiple different ways in which pain is classified/studied/named?
SmithBlue (
talk) 13:37, 1 April 2008 (UTC)
Just checking that we are all using "physical pain" to refer to the experience of pain localized to an area of the experienced body? (Just wishing I was joking) Seriously. Anyone got a better quick definition of "physical pain"? SmithBlue ( talk) 03:30, 3 April 2008 (UTC) strike thru added SmithBlue ( talk) 14:52, 5 April 2008 (UTC)
Can anyone explain to me what this paragraph under localization means? "This subjective localization of pain to an area of the body defines some kind of pain as neck pain, cutaneous pain, kidney pain, or the painful uterine contractions occurring during childbirth. This common usage of pain is not entirely consistent with the scientists' model of pain being a subjective experience." I'd like to edit this but I'm not sure which point the writer is trying to make. Sisyphus ( talk) 12:25, 2 April 2008 (UTC)
Reading the section I think "Localisation" needs to be defined and related to pain - at present the reader is assumed to know what it means in relation to pain. SmithBlue ( talk) 00:56, 3 April 2008 (UTC)
possible article lists:
Split articles
(Please feel free to add to the above lists.)
This topic is vast; the language complexities, historical and cultural perspectives, science and medicine discoveries and nomenclature make splitting this into a wide range of articles a necessity. This area probably needs its own project. Already tensions between "common usage" and latest scientific definition are showing. What suggestions do editors have as to how to best use our time here? SmithBlue ( talk) 01:35, 3 April 2008 (UTC)
From Wikipedia:To-do_list:
What a to-do list is:
- A Place to help give the page clear direction
- General goals for the page
- New sections to be added
- A place to note facts which need to be found or checked for the article
- A place to note sections which need expansion or other alterations
It may be noted that the to-do list here has priority 2: that means that the article Pain has a number of "What links here" references near 500, which is the top priority 1 line. My mistake: there are about 900 "What links here". Normally the to-do list goes at the top of the page, but I wanted to introduce it here before moving it up... --
Robert Daoust (
talk) 16:44, 3 April 2008 (UTC)
To conform with WP:TODO, I moved the to-do list at the top of this page, and I removed from it matters for discussion. I left one task that I suppose can be safely considered as consensual. Here follow some tasks that could figure in the to-do list.
Can we consider that the following does not need to be mentioned because it will be covered through the tasks above?
-- Robert Daoust ( talk) 20:54, 12 April 2008 (UTC)
While this article is WP:MCOTW, can we also please have a discussion about moving it back to pain? The present title constitutes a flagrant violation of general naming conventions, and nociception could be either its own article (pain is the experience, nociception is the neurobiological system that mediates this experience) or a redirect to this article. JFW | T@lk 12:07, 30 March 2008 (UTC)
Consensus was split
I have just completed the split. I have basically moved all the neurobiological stuff away to nociception. This is primarily because in practice nobody who suffers or treats pain is really interested in which nerve fibers are conducting the stimuli they try to abrogate with their painkillers, TENS machines and other modalities.
The article, by the nature of its subject, will be full of generalisations. That means we need a very peculiar type of source that is not very easy to find: the sources that are so well-informed that they are able to take a birds' eye view of the entire field of pain medicine. Perhaps medical textbooks (I'm thinking Harrison's) may come in useful here. JFW | T@lk 23:06, 3 April 2008 (UTC)
Whoa - thats a rather interesting claim - I'm at loss for words and think it best to relax for now. Please consider this statement carefully. SmithBlue ( talk) 01:13, 4 April 2008 (UTC)
Here is a rough draft for reorganizing the article: http://en.wikipedia.org/wiki/Talk:Pain/TempDraft. Modifications are welcome. Very wild modifications could be the subject of another draft page. —Preceding unsigned comment added by Robert Daoust ( talk • contribs) 15:35, 4 April 2008 (UTC)
http://en.wikipedia.org/wiki/Talk:Pain/TempDraft has been blanked by me. I am not sure if I am supposed to do something else with that page, according to technical procedures. Content of the page is now at Pain (physical). -- Robert Daoust ( talk) 18:04, 16 April 2008 (UTC)
The 1st sentence cites IASP. IASP: Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. WP:Pain is the unpleasant sensory and emotional experience when a person perceives actual, or potential, tissue damage to their body.
WP def means something quite different to IASP def.
WP says "Pain is the perception of damage. IASP says that pain is in some way associated with damage, but makes no statement that pain is the perception of damage.
I believe that "physical pain" is normally triggered by nociception. But again, this is not what the WP:def states. Others? SmithBlue ( talk) 10:19, 5 April 2008 (UTC)
Current definition: "the unpleasant sensory and emotional experience an individual has when they perceive actual or potential, tissue damage to their body" - suggests that we are categorizing the horror of percieving your locally anesaetetised finger getting hit with a hammer as "pain" within the meaning of this article. Please discuss. SmithBlue ( talk) 11:22, 8 April 2008 (UTC)
Without any claim to seeing the direction we could best take here, I point out that "imagined pain" as long as it is imagined as "bodily pain" fits the working nursing definition given in this article of, "Pain is whatever the experiencing person says it is, and exists whenever he says it does", very well. Psychogenic pain fits within this nursing definition? (I assume here that psychogenic pain is localized within the body?) If so then the "or spoken about in such terms" of the IASP would adress this. (Not saying we cant come up with a better definition than IASP but I think they had many experts working on it for years.) Still as long as we don't wonder too far from "the subjective experience of perceiving apparent tissue damage normally triggered by nociception" it may be fruitful. SmithBlue ( talk) 11:18, 9 April 2008 (UTC)
Here are the main ICD10 pain codes I could find...
Just wondering if chronic Paresthesia is regarded as a type of pain, and since it I am not sure if it is covered by nociceptors, if it is pain and , if so, are there other examples LeeVJ ( talk) 21:59, 6 April 2008 (UTC)
PARESTHESIA. An abnormal sensation, whether spontaneous or evoked. Note: Compare with dysesthesia. After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those which are unpleasant.
DYSESTHESIA. An unpleasant abnormal sensation, whether spontaneous or evoked. Note: Compare with pain and with paresthesia. Special cases of dysesthesia include hyperalgesia and allodynia. A dysesthesia should always be unpleasant and a paresthesia should not be unpleasant, although it is recognized that the borderline may present some difficulties when it comes to deciding as to whether a sensation is pleasant or unpleasant. It should always be specified whether the sensations are spontaneous or evoked.
For our convenience, here is the complete paragraph on pain in IASP Pain Terminology. Quotations above on paresthesia and dysesthesia belong to the same text as this quotation (the latter source is more authoritative). -- Robert Daoust ( talk) 13:46, 7 April 2008 (UTC)
PAIN. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.
Closely linked and well written ( with refs!) see Itch, has some crossover subjects in the article as well LeeVJ ( talk) 22:58, 6 April 2008 (UTC)
Now the pain / nociception split has settled, at least a little, I am almost afraid to do it, but I have a couple of merges to suggest... LeeVJ ( talk) 01:09, 8 April 2008 (UTC)
My first suggestion is to merge the section on treatment into pain management. Reason: 'pain management' is referenced by any of the various types of articles that involve pain. Potentially the medical diagnosis might go there as well, LeeVJ ( talk) 01:09, 8 April 2008 (UTC)
My second suggestion is to merge
chronic pain into the article. Reason:All pain is subjective ( both articles point this out ) and I don't see how you can have a whole article with the only difference being chronic pain is pain beyond the normally accepted healing period (from 'chronic pain' article). It does have a more thorough management section, but it covers general pain too and, as above, could be merged into the
pain management article. - ok three merges, I'll stop now !
LeeVJ (
talk) 01:09, 8 April 2008 (UTC)
Would like to see the empirically measurable, objective nature of nociception explicitly contrasted with the "not empirically verifiable", "in consciousness only", "subjective experience" of pain that this Pain article limits itself to addressing. At present in the language quagmire of this subject, I'd guess that some 80% of readers would read this article but still think that pain is the awareness of pain receptors firing. I know we are not here to educate but I do think that explicitly relating/contrasting the natures of nociception and pain is appropriate in this article. Others thoughts? SmithBlue ( talk) 02:26, 10 April 2008 (UTC)
The language trolls are at work here too. No critisism of any editor is implied - I can't see any alternative at present either. Sensation - "In psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a sensory organ, which then leads to perception,..."
(For other uses, see Sensation (disambiguation). - but no other medical/scientific definition is obviously linked from that page.)
At present a naive reader could easily think that we are using the psychology definition - its the only one we suply - which, in our language, from our disambiguation statement, (see title of this talk section), would mean this article claims to be about nociception. SmithBlue ( talk) 03:17, 10 April 2008 (UTC)
Here follows an excerpt taken on the site of a good pain scientist, Marshall Devor. His use of the term 'percept' allows to avoid the ambiguity of 'sensation', because perception is always conscious, but it remains inappropriate, seemingly, to speak of percept in the absence of a stimulus. I reiterate my question: in the hatnote, would it be better to use 'pain as a sensory experience'? -- Robert Daoust ( talk) 18:57, 10 April 2008 (UTC)
"Pain is a private percept that arises in a conscious brain, typically in response to a noxious provoking stimulus, but sometimes in the absence of a stimulus. The relation of the percept to the stimulus is variable, and depends on the individual's prior expectations and beliefs, and on his/her cognitive and emotional state, not just on the nature of the stimulus itself. The nervous system may react to noxious stimuli with autonomic changes (e.g. in blood pressure), and even with adaptive behavioral responses, in the absence of a conscious pain percept. Likewise, there are circumstances in which the presence of pain is ambiguous, such as when the individual is unable to report on his/her conscious percept, or with reference to animals. In these situations, the word "nociception" is used instead of the word "pain" to express that the nervous system has detected the noxious stimulus without necessarily implying that a pain percept was evoked."
I suppose that we agree that this article is about PAIN-AS-A-SENSORY-EXPERIENCE. Now, readers will come to this article by typing 'pain'. A hatnote should tell them what this article is about, and where to go for other senses of the word. It seems clear to me that the only other 'important' sense they might be looking for is pain in the broader sense. They should not have to go in the body of the article to find the reference to PAIN-IN-A-BROAD-SENSE, that is to say to SUFFERING-WHICH-IS-A-SYNOMYM-OF-PAIN-IN-A-BROAD-SENSE, all the more so since the article about pain as a sensory experience can have, yes, a section on suffering which refers to the main article on suffering, BUT that section should deal exclusively with pain-as-a-sensory experience in relation to suffering. -- Robert Daoust ( talk) 17:29, 11 April 2008 (UTC)
How interesting!;-) We are touching the all important primary issue of the scope of the article, so let us make it clear. You say 'this article should include everything'? What do you mean exactly? Please give an example of something that you would include that would not fit under 'pain as a sensory experience'. Incidentally, imho, 'pain as a sensory experience' cannot be equated to 'pain as a conscious interpretation of nociception', because 'pain as a sensory experience' may occur without a stimulus, and thus does not always involve nociception. -- Robert Daoust ( talk) 19:46, 11 April 2008 (UTC)
First, I would like us to acknowledge that people always distinguish clearly between 'physical pain', which has a peculiar sensory quality that is readily recognized as 'sensory pain', and 'emotional pain', which is certainly an embodied experience and can be felt sensorially if you wish, but which has not the peculiar sensory quality of 'sensory pain' and is thus not confused with it. Of course a 'heartache' may be accompanied by a 'sensory pain' in the area of the heart muscle, but not necessarily: it may be accompanied rather by a 'sensory pain' in the belly, or by a 'sensory unpleasantness' like nausea. As you know, not all unpleasant sensation are considered or identified as 'pain'. So, there is 'physical pain' on the one hand. And on the other hand there is 'emotional pain', which is something different, because it lacks the typical sensory quality of 'physical pain', but is also something alike, because it shares a same character of felt unpleasantness. Same word is used, but concepts and things under the word differ (it is not just a matter, as SmithBlue says, of "the only(?) difference between physical pain and emotional pain is the difference in attributed cause. So pain is felt and named as "emotional" or "physical" depending on the perceived cause."). One more point: I have noticed that when scientists or philosophers are hard pressed on such matters, they switch to the use of the word 'unpleasant(ness)', and I noticed also that when they do so they escape the dilemma but leave the problem whole: nobody cares about dealing with unpleasantness any longer after the discussion is over, so that the muddle continues between pain, unpleasantness, and suffering. I guess the word unpleasantness plays the role of a deus ex machina that allows everybody to be happy in escaping apparently a quagmire.
So, I agree with WhatamIdoing that emotional pain does not fit under 'pain as a sensory experience'. The question is whether we should deal with emotional pain in the same article as physical pain. I guess it's impossible if we want the encyclopedia to be consistent, avoid duplication, have a coherent system of links. Then, what will we be doing? A few solutions may be offered. What will the average reader look for? It is my experience as a reader on the subject of pain that people more usually use pain in the sense of physical pain. So I suggest that when they look for pain, they are brought to the article Pain that deals with physical pain. But then, a hatnote should tell them what this article is about, and where to go for other senses of the word. There are perhaps two other 'important' senses (formerly I thought there was only one other sense, but…): emotional pain, and pain in the broadest sense. I think the latter should be equated with suffering. As for emotional pain, I am not sure how we could deal with it, what would be the scope of such an article, and how it would relate to other topics in WP. As for the scope of an article on pain in the broadest sense, it is necessarily the same as an article on suffering, isn't it? -- Robert Daoust ( talk) 17:19, 12 April 2008 (UTC)
I am afraid your simplest solution, WhatamIdoing, does not address the complexity of the problem at all! Do you admit that 'physical sensory pain' is important enough to have its own exclusive article? If yes, we cannot deal with other topics under that article, even if those topics are also called 'pain', all the more since those topics are such important matters by themselves as emotional pain and suffering!!! The body or introduction of the article Pain is not the place to resolve terminological ambiguities, because those ambiguities belong not to the topic 'physical pain', but to the topic pain in the broad sense. There might be another solution, perhaps more elegant than those that have been proposed until now. It is still a bit scary solution nevertheless. Let's have the article Pain to include everything (this means that the article Suffering would be quite abridged and would mostly refer here). Let's have also the article Pain (physical), the article Pain (mental), or any other such articles that might be needed. The main drawback, in my opinion, would be that the word pain is mostly used, throughout history and nowadays, to mean physical pain, and much less to mean pain in the broad sense, or even less yet to mean emotional pain. Moreover, since we want to go in a direction that alleviates confusion, shouldn't we take advantage of using suffering, a different word than pain, to mean pain in the broadest sense? Then, I would rather favor something like this: "This article deals with physical pain. For pain in a broad sense, see Suffering. See also Pain (mental). For other uses, see Pain (disambiguation)." -- Robert Daoust ( talk) 20:14, 12 April 2008 (UTC)
Sigh! I was almost ready to put a split template on the article, when I had second thoughts and checked a few things.
We are looking for a solution and we have in reality three choices: a disambiguation page, a summary article, or a hatnote.
We have already a Pain (disambiguation) page. What links there? Almost nothing, except the 'Pain' article. In any case, a standard short DAB page is not what we are looking for. I cannot see what is meant by an 'elaborate' or 'overall' or 'special' disambiguation page", except perhaps if it means a summary article.
A summary article according to Wikipedia:Summary_style is explained thus: "Wikipedia articles tend to grow in a way which lends itself to the natural creation of new articles. The text of any article consists of a sequence of related but distinct subtopics. When there is enough text in a given subtopic to merit its own article, that text can be summarized from the present article and a link provided to the more detailed article." The problem we have now is that we have a lot of stuff to say on physical pain, but not much on emotional pain or pain in a broad sense. And in fact, different concepts or things should not be treated in the same article just because they come under the same name. The idea of a summary article could not be to cover 'pain in every sense' (like 'mercury in every sense'). (Or if it could, see here under the solution that I propose: an article called Pain (general)).
Incidentally, I'd like to know, when I asked WhatamIdoing: "Please give an example of something that you would include that would not fit under 'pain as a sensory experience'.", the answer was: "Sure: emotional pain, like grief, is not (always) a sensory experience." Good. But what else? The only other thing I can see is 'pain in a broad sense', like (fictive example) "War brought pain to the population". Is there any other example possible?
By curiosity, I looked closely at http://en.wikipedia.org/?title=Special:AllPages&from=Paige_Kreegel. I noticed two things, beside the fact that most pages refer to songs. First I noticed that there are pages called Pain (biological), Pain (biology), Pain physiology, Pain and nociception. They all redirect to Pain. Second, there are pages called Pain (Medicine), Pain medecine, Pain relief, Pain therapy. They all redirect to Pain (management). There are also, from 'what links here' at the article Pain: Physical pain, Acute pain.
I looked also into http://en.wikipedia.org/wiki/Wikipedia:Disambiguation. The important question is: "When readers enter a given term in the Wikipedia search box and pushes "Go", what article would they most likely be expecting to view as a result?" Given that almost every link from pain in WP is meant to refer to physical pain, can we agree that the response to this question is 'Pain' in the sense of physical pain?
So, I now propose that the best solution is a hatnote like the following: "This article is about physical pain. For other uses of pain as an unpleasant experience, see Pain (general). For other uses, see Pain (disambiguation)."
Such a hatnote would avoid a costly and risky or ill-advised split, and would answer the objection of WhatamIdoing to the effect that: "This article needs to acknowledge more than the physical sensory aspect of pain. This article cannot pretend that the only kind of pain that truly deserves the name (and therefore space in the article) is the physical sensory kind. This article -- not Pain (physical) -- is exactly the right place to talk about the difficulties of definition and the various overlapping, contradictory, and metaphorical ways that people use (or have used) this word. Where else could you do it if not in Pain itself?" -- Robert Daoust ( talk) 19:06, 15 April 2008 (UTC)
I think the "Pain" that people type into the search box is the same stuff that I find so intertwined and inconsistent. One word, many related concepts. I think a top article titled Pain is the clearest way to facilitate an understanding of the various types of "Pain" and the variety of models. By having one top we will be forced to "make explicit"/document the differences in usages and understandings - something that "For a broader sense of pain see article suffering" avoids, implying that "they're different so they're in different articles" without showing how they are different (or how they are the similar). SmithBlue ( talk) 06:34, 16 April 2008 (UTC)
Sherrington seems to have been onto this some 100 years ago - prob needs to be in article From[ The ethics of research involving aniamls] Pain, suffering and distress: meaning and function in animals and humans The basic evolutionary functions of pain and ways of relieving it 4.11 In evolutionary terms, pain has evolved from nociception as an aversive sensory mechanism that warns of harmful experiences. Pain has three main functions: First, it allows animals and humans to avoid dangerous situations, as painful experiences usually prompt an immediate impulse to withdraw and escape from situations that cause harm, usually in the form of tissue damage. Secondly, as pain is associated closely with the environmental context in which it occurred, its experience can help to prevent repeated damage. Pain-causing experiences will be avoided through learning when a similar environment is encountered again. Thirdly, pain promotes the healing of injuries, as affected body parts are not used in normal activities, as far as possible.
Also evolutionary view of pain supression etc etc. SmithBlue ( talk) 04:16, 10 April 2008 (UTC)
Does anyone mind if I create a Pain (medicine) that focuses on causes, diagnosis, and treatment of pain as a human medical symptom? WhatamIdoing ( talk) 15:34, 16 April 2008 (UTC)
I created Pain (physical). I'd like to know if another page name would be more appropriate, before beginning playing with hyperlinks. Would for instance Physical pain be easier or more natural? -- Robert Daoust ( talk) 18:13, 16 April 2008 (UTC)
As I said repeatedly, and I'm adamant on that, physical pain is way much too important to be only a section of 'Pain'. Pain (physical) is a subarticle of Pain, and the latter should only 'summarize' the former, among other matters relating to pain in general that it must present or summarize. Of course Pain (physical) is presently too long, but it will have to be expanded yet, and of course subarticles will have to be made. I strongly disagree with you about there being anything 'non-physical' in the present version of Pain (physical). If you see such a thing, please point it out with precision. As to the rest of your view, I believe it misses what is at stakes. -- Robert Daoust ( talk) 21:53, 16 April 2008 (UTC)
And as I said in a section above: unless you want Wikipedia to be a medical encyclopedia, the article 'Pain (physical)' is the article where pain-as-a-medical-condition must be presented, where symptoms, causes, diagnosis, treatment are 'summarized', before being the subjects eventually of other subarticles. -- Robert Daoust ( talk) 22:01, 16 April 2008 (UTC)
For reasons that seems obvious to me, since we chose to deal in this article with pain in general rather than with physical pain, I propose replacing eventually the content of the present Pain page with the content of this provisional Pain page. Is there any objection?
My own objection is that it would make more sense to replace the present Pain page with the Pain (physical) page (on which a different hatnote and a different lead beginning would figure of course), and to use the provisional Pain page for the page Pain (general). But I am curious to hear your thoughts. -- Robert Daoust ( talk) 15:22, 17 April 2008 (UTC)
My concern is that the present User:Robert Daoust/pain (general) contains
But ignoring these specifics, when compared to the present "Pain" article (which still retains a physical pain definition and a great emphasis on the medical aspects of pain), "User:Robert Daoust/pain (general)" does offer a glimpse through mist of what a top "Pain" article might look like. SmithBlue ( talk) 05:02, 18 April 2008 (UTC)
Thanks for your thoughtful remarks, folks. I made modifications toward satifying your concerns. This is only a beginning, but it is already a progress, isn't it? Terminology of pain is a complex little tangle, as you might appreciate if you compare Clarification on uses of terms and Clarification on the use of pain terms. BTW, I got tired of typing the wikilink to 'Pain (physical)' (I find it unnatural or cumbersome to type it), and I thought of all those who will have in the future to type this link which will be much more frequent than the link to pain, so I moved the content of Pain (physical) to Physical pain. I hope this is correct, before we get some day into correcting the redirects. -- Robert Daoust ( talk) 11:41, 18 April 2008 (UTC)
I get the idea we are getting somewhere, although I do now have concerns that as pain is subdivided up, talk on the subject will be decentralized. What should we do - direct all talk to one page, make a subpage just to cover article division and crossovers, or maybe form a taskforce in Project Medicine ? LeeVJ ( talk) 01:53, 21 April 2008 (UTC)
Melzack's and Wall's theory must have its own article given the importance it has in scientific literature. Maybe user:Medos2 is suggesting in fact to mention adequately the theory in this article. If this is so, I agree of course. However, I would first mention the theory in the article Physical pain, and then under the section in this article that summarizes 'Physical pain'.
I want to point out again to a foreseeable problem that we might avoid right now. User Medos2 suggests to merge Gate control theory here, while it should be merged rather, if at all, into 'Physical pain'. It is foreseeable that ninety percent of the times people will refer to 'Pain' when in fact they mean 'Physical pain'. That is why I hesitate to make the definitive move that we have been talking of lately. I still feel that there should not be an article 'Physical pain', but that the article 'Pain' should be about physical pain, and the article ' Pain (general)' should be about pain in general. Is not there a way for us to have a wider WP community decision about it all? -- Robert Daoust ( talk) 16:16, 22 April 2008 (UTC)
I take that point. It was possibly a bit hasty of me to suggest the merge, but it was mainly to initiate discussion. I also appreciate you pointing out the Physical pain article as I unaware it existed. I agree that when people refer to pain they mean physical pain primarily as was my intention. I know that the treatments for physical pain differ from neuropathic pain and I'm not entirely sure if the gate theory applies to neuropathic pain but I did have physical pain in mind. I've read over the two articles and agree with your suggestion as it accomodates what people would expect if they were to type in Pain as a search word. Medos ( talk • contribs) 22:09, 22 April 2008 (UTC)
I think more discussion and more data would be preferable to a poll at this stage. I think differentiating the "pains" and understandings/models will take a lot of space and that readers queries may consist of the common understanding of pain which seems to lump them all together. I want clearer data on what peolpe are looking for when they search WP for "pain". I am not convinced that "physical pain" is the overwhelming meaning. A Google search for (pain back -love) gives 10,300000 hits, (pain back love) gives 3,600,000 hits, (pain love) gets 13,900,000 hits, (pain back) gives 15,300,000 hits. (These results vary wildy by the minute which is strange.) So at least a suggestion that Google is finding comparable pages adressing "love and pain" as for "back pain". Any other data would be appreciated. SmithBlue ( talk) 05:28, 23 April 2008 (UTC)
This is a summary of the options for article content being discussed: please feel free to edit in situ:
1
Pain - General Pain
2
Pain - Physical Pain with larger section summarising General Pain
3
Suffering - General Pain and Suffering
4
Pain - physical pain + non-physical pain (i.e., suffering + emotional pain + philosophy + other stuff already in this article) with several {{ Main}} pointers to articles like:
Suffering - (to include emotional pain)
Pain (disambiguation) - Pain in every sense, including links to Physical pain, Emotional pain, and Pain in the broad sense (i.e. Suffering, i.e General Pain).
As a contribution and an incentive to have this article in better shape, I have made a move per WP:BRD. The article Physical pain now redirects here, as its content was moved to Pain. -- Robert Daoust ( talk) 15:46, 29 April 2008 (UTC
I completed today the revision of the article. I removed the empty section "Psychological analysis" with its empty subsections "Sensory dimension", "Emotional, affective, motivational dimension", and "Cognitive dimension". These matters should be developed in the future, along with other aspects such as
Some or all of these could be included within To-do list here at top of the page. -- Robert Daoust ( talk) 15:46, 9 May 2008 (UTC)
Good morning! As long as the article
Scrambler therapy is accepted in Wikipedia - that is, as long as it is not deleted, relevant links to and from this article should be allowed. It would be a very strange situation if we would have some kind of "second-class" articles: the article can be here, but you cannot link to it. So my suggestion is that you put some kind of label on Scrambler therapy stating that it is questionable, or may be a label that you think the article should be deleted. Groetjes,
Lova Falk (
talk) 05:54, 26 May 2008 (UTC)
I changed my mind about the deletion. Of course, anybody stumbling across the term "Scrambler therapy" and wanting to know more about it, should be able to find an article on it in Wikipedia. But the article should reflect that this is just a theory and not an evidence-based treatment (yet?). Lova Falk ( talk) 06:08, 26 May 2008 (UTC)
Hi Robert. I've just read through the above. Wow. I suppose one needs a bit of heat to forge good metal. I'm with you when it comes to making a clear distinction between "pain" meaning "bodily" or "embodied" pain and "pain" meaning "suffering". And I think the page is developing nicely as a description of the former. But since most people are happy to, and often do, use the term with either meaning, I'm with WhatamIdoing in thinking that every sense of the word should be well covered here. I know that, where one word is an exact synonym of another, all good dictionaries and encyclopedias will, rather than repeat, redirect the reader to the synonym but this is a special case. The second use of pain (suffering) is born out of a neurological fact that you and I are both quite familiar with. I think this would be a very appropriate place to introduce the general reader in easy laymans terms to Eisenberger and Lieberman's (2005) pain overlap theory.
(I so wish they had not used the term "social pain". More recently Eisenberger has been using the far less ambiguous term "social distress". "Distress" captures "suffering and the urge to escape suffering" quite well.)
Re: Pain meaning suffering
When "pain" is used to mean suffering it gets used in a narrower range of situations than does "suffering". When I hear "the pain of his dreadful loss" I actually think of loss induced bodily pain. Some losses, separations, disappointments, anxieties, rejections are so severe they evoke actual locatable pain somewhere in the body. This phenomenon, notwithstanding a hundred years of psychoanalysis and seventy years of behaviourism, is real. In these situations people feel actual embodied pain. I have no doubt that this aspect of pain needs to be addressed thoroughly on a page entitled "pain".
Then there is the question of difficult to locate or broadly and vaguely distributed pain. If a psychosocial or psychological event induces bodily pain which is indistinctly located (some visceral pain is of this type) the sufferer may not claim to feel "actual" pain (because, for it to be pain, you need to be able to answer "where does it hurt?") but be unable to resist using the term "pain" - because that is in fact what it is.
Some people have lower pain thresholds than others (Jason, Giesbrecht & Battié, 2005.) And, within an individual, the pain threshold varies from time to time. Eisenberger and colleagues (2006) have shown that people with lower levels of social support experience more pain than those with higher levels of social support, and that "experiences that heighten social distress will heighten sensitivity to physical pain as well" (p. 132).
What she seems to be showing, but not yet stating explicitly, is that your sense of belonging, your sense of safe, warm attachment to society, to some extent determines your global pain threshold. If someone you love rejects you or they decline your application to join the tennis club, this will lower your pain threshold, and an ongoing stimulus in your body that was just below the pain threshold for that stimulus would appear above the pain threshold, like an island at low tide, and be felt as (and actually be) physical pain; or any pain you might presently be experiencing would be amplified by a tear in your social fabric.
Finally, regarding "What is pain?"
In 1968 Ronald Melzack (co-author of the gate control theory) and Kenneth Casey divided the pain experience into three "dimensions": sensory, affective-motivational and central control. The sensory dimension involves the location and intensity of pain over time; by "affective-motivational" they meant the unpleasantness "that forces the organism into action"; and under "central control" they included the higher cognitive activities that influence pain, such as anticipation, anxiety, attention, suggestion, placebos, cultural background, appraisal, hypnosis, early experience and prior conditioning.
"Pain varies along both sensory-discriminative and motivational-affective dimensions. The ... intensity along these dimensions, moreover, is influenced by cognitive activities, such as evaluation of the seriousness of the injury." P. 434.
Their tripartite pain system has been born out by modern neuroscience. The network of brain activity that represents the aversive drive and unpleasantness of pain is fairly distinct from the sensory-discriminative matrix, and higher cognitive activity in the more recently evolved frontal lobes modulates both the perceived intensity and unpleasantness of pain. So, not only does it make psychological and behavioral sense, this model now makes solid biological sense. So I think it deserves a place on the page somewhere.
Of course Eisenberger is giving flesh to a 4th dimension: social. (There exists a body of literature on the biopsychosocial model of pain which I have yet to explore in any detail but, the few forays into it I have made leave me thinking it's all about operant conditioning. I.e. "don't reinforce your husband's pain behaviour Mrs Jones, or he'll never go back to work.")
What do you reckon, mate?
Anthony ( talk) 12:38, 25 July 2008 (UTC)
References
Eisenberger, N., Jarcho, J., Lieberman,M., & Nabiloff, B (2006). An experimental study of shared sensitivity to physical pain and social rejection. Pain, 126, 132-138.
Eisenberger, N., & Lieberman, M. (2005). Why it hurts to be left out: The neurocognitive overlap between physical and social pain. In K. D. Williams, J. P. Forgas, & W. von Hippel (Eds.), The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127). New York: Cambridge University Press.
Jason, R., Giesbrecht, S, and Battié, M. (2005). A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain. Physical therapy, 85 (10), 1085-1092
Melzack, R., & Casey, K. (1968) Sensory, Motivational, and Central Control Determinants of Pain. In Kenshalo, D. (Ed.), The Skin Senses (pp. 423-439). Springfield, Ill: Charles C. Thomas Publisher.
HI Robert. I think we're pretty much in accord here. It's this synonym/homonym combo that is hard to get the head around and hard to express. I'm away from the net at the moment. But when I get back from the bush I might compose an essay about the sensory/affective/cognitive/social dimensions of pain. I'll put it up here first and we can tussle over it if you like. Regards Anthony ( talk) —Preceding undated comment was added at 10:11, 5 August 2008 (UTC)
The present version of the article includes this claim under the In other species section: "It is not scientifically possible to prove whether an animal, or a human for that matter, experiences pain or not." The claim is not sourced. There is, immediately after the sentence, the following claim which is sourced: "However, the presence of pain can be inferred through physical and behavioral reactions." Given that the second sentence here seems to be true, I wonder whether that by itself doesn't call into question the truth of the first sentence, considering the fact that "inferences" from behavioral reactions are (I suspect) the very "proof" that's routinely given for saying that a certain individual is feeling pain. Surely, this is "proof" enough; isn't it? Of course, it's not mathematical proof, but there is such a thing as other forms of proof. I would say that most of what we know is proven based on the same kind of inference that is involved in inferences from behavioral reactions - i.e., non-mathematical proof. It's still a kind of proof. In any case, I would move to strike the first sentence I quoted, unless someone can find a reliable source that actually makes that specific claim. Isokrates ( talk) 01:21, 31 July 2008 (UTC)
The
Part of a series on |
Utilitarianism |
---|
Philosophy portal |
infobox in the section Pain/Society and culture appears to vastly overweight Utilitarianism in this section. I sugest removing this box before this section balloons out with infoboxes for Buddism/The Five Precepts, Gnostism/The false body etc etc.
The infobox could better be replaced with a single sentence or so stating the importance of pain to a wikilinked Utilitarianism. If no further discusion I will do this in the near future.. SmithBlue ( talk) 11:30, 19 December 2008 (UTC)
{{
cite web}}
: Text "Pain Definitions" ignored (
help)
This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
I have created an archive of the old discussions. I have copied back to this page all recent conversations. In case anyone needs to know in the future, I used the Move Page method to preserve the edit history. Everything below is a cut-and-paste copy of the 2008 discussions. (I think I got them all...) WhatamIdoing ( talk) 22:28, 29 March 2008 (UTC)
There are many good things about this article, but its major problem (in my view) is the constant implicit focus on human beings as the sole objects of this topic. Apart from a brief few lines at the end, this article suffers (no pun intended) from extreme anthropocentrism. Pain is not something specific to our species; rather, it is something we experience because we happen to be animals. I would recommend rewording and/or reorganising the article, so as the show the aspects of pain shared by all animal beings (humans included), followed by subparts dealing with specifically human aspects (insofar as it may make sense to speak of specifically human forms of pain). Aridd ( talk) 13:23, 28 January 2008 (UTC)
Has anyone gone over the precise arrangement of nerves in the spinothalamic pathways versus the perceived acupuncture "meridians"/"qi channels"? It seems pretty obvious that the referral of pain from the heart to the left arm and neck could have contributed to the idea of these meridians, and I see reference to it on the Web [1], but on PubMed I didn't quickly find any detailed treatment of the idea, pro or con. Wnt ( talk) 23:34, 25 February 2008 (UTC)
This seems out of place, like it was taken straight out of a lecture in a nursing course (which is why it needs a citation). I don't think it adds anything to the page (i.e. what is pain, what are the types, etc. as opposed to what do nurses do when someone is in pain), and I opt for deleting the whole section. Anyone strongly disagree? Zickx009 ( talk) 02:26, 26 February 2008 (UTC)
Never heard of it. Fibromyalgia, maybe? Zickx009 ( talk) 02:22, 26 February 2008 (UTC)
I think there is a very bad mix up here. The correct term for pain that is pathological is "maladaptive", where as physiological pain is "adaptive". For example, chronic infection will cause a chronic pain... by definition. However this pain is adaptive and thus physiological. NGF associated central sensitisation however will cause chronic pain that is maladaptive and hence pathological. Does this make sense? User:mubinchoudhury —Preceding comment was added at 11:33, 1 May 2008 (UTC)
removed material
"Experts in pain have proposed a variety of definitions. These definitions illustrate the multi-facetted nature of pain.
"Pain is whatever the experiencing person says it is; existing whenever he or she says it does.” [1] — Margo McCaffrey, RN MS
"Pain is a category of complex experiences, not a single sensation produced by a single stimulus". [2] - Ronald Melzack and Patrick Wall
These quotes definitely do not define pain by any means. One talks about the subjective nature of pain, and the other merely mentions that pain happens to be complex and not simple. Delete section? Zickx009 ( talk) 02:48, 26 February 2008 (UTC)
I agree that "it's a set of complex experiences" is not a definition. However the McCaffrey quote is, within the context of nursing education, the definition that is being used. I support your removal of the section "Definitions of pain" unless we can find more and hopefully a secondary or tertiary source commenting on the different definitions. (At one stage I found a behaviorist psychology definition of pain but then lost the source. I believe that other definitions exist too.) I think your idea of a section on the essentially subjective nature of pain is great. SmithBlue ( talk) 12:42, 22 March 2008 (UTC)
There's a lot of work on defining pain outside of the reported emotional/psychological experience. For example, various researchers have looked at neurotransmitter levels, a variety of physiologic responses like changes in oxygen saturation, skin conductance, heart rate or blood pressure, and behavioral observations like facial expressions. I'd be surprised if there wasn't quite a bit more than these examples. Much of this work focuses on people who can't communicate usefully about their pain: critically ill, very young, or severely disabled people. Some of it is focused on people who might not be motivated to accurately report their pain (people addicted to opiods, for example).
I also expect that there is a substantial body of work on pain in the context of veterinary work. Surely a snake can be said to perceive the pain of being injured even though snakes are widely believed to have no true psychological response to anything. WhatamIdoing ( talk) 20:27, 24 March 2008 (UTC)
Well, we could start with a normal dictionary defintion, like "a basic bodily sensation induced by a noxious stimulus" or "an unpleasant sensation" rather than leading with the current technical definition. For that matter, once you leave the ultraspecialists, pain becomes much more familiar to the average person even in authoritative medical references. In the words of Stedman's Medical Dictionary, it is "an unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder"; Dorland's Medical Dictionary says pain is "a more or less localized sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings." [3] These focus on the sensory aspect instead of the psychologic -- that is, on what the normal person calls pain, instead of on what the psychologists used to call pain affect before they decided that pain was the affect.
In addition to introducing a much broader definition, I think there are three things that might be useful: <split into three subsections for ease of editing> WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
The IASP's definition is not only just one among many now; it's a relatively new one by any reasonable standard. This series of pages has some interesting, although not very detailed, information about pain. It has a good summary of some historical changes. I think the definition of pain has changed materially in the last quarter-to-half century. What a 17th century physician called "pain and suffering" seems to have been renamed in the 20th century as "nociception and pain." The early use of pain had a lot more to do with (what we call) nerve signals, and suffering had to do with your response to it: in the famous Descartes drawing, pain is what happens to your foot when you stick it in the fire, and suffering is your response to it. Indeed, if you look at the definition of suffering on Wikipedia, it bears striking resemblance to the IASP's definition of pain.
There is more historical information at the NIH, and just a bit here in the introductory material to the first link.
This link, which covers a lot of territory, has an interesting short section. Search down to see what Helm says, which covers the basic practical problems with defining pain as an emotional response: "writhing and screaming fail to signify that one is suffering pain" during torture, because if you want to die, then signs that you're getting what you want must be pleasurable. This may not really fit into this article, however. WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
The AVMA has some information about the difficulty of defining pain in animals. Mammals are believed to be similar to humans. The USDA directly defines pain in animals as whatever produces pain in humans. Here is a source claiming that fish are neurologically incapable of experiencing pain (using pain in IASP terms), and here is a BBC story about some UK research that concludes that it doesn't matter whether fish have a neocortex (and thus the capacity for having any kind of psychological response), because "profound behavioural and physiological changes" demonstrate the existence of a clear response to nociception. This magazine article has something about the "hierarchy of pain consciousness," which I think of as the obvious extension of the doctor calling it "some discomfort" while the patient calls it "nearly intolerable pain:" human pain is very real, and dog pain is pretty real, and fish pain is not real, and cockroach pain is foolish. (Did you know that birds find grape flavoring to be painful?) WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
As for the "other side," it might be interesting to include the pain overlap theory, entirely focused on the psychological response to loneliness. This is not a sensory experience in IASP terms, but they make a case for it still being painful, and social exclusion often is "described in terms of such damage" [associated with actual or potential tissue damage], which means that it meets the IASP definition of pain.
I'd be interested in hearing your thoughts. WhatamIdoing ( talk) 05:58, 27 March 2008 (UTC)
I'm not sure this section adds anything to this article except a huge collection of wikilinks. (Hypnosadist) 06:52, 20 March 2008 (UTC)
I'm adding the pain specific wikilinks here to keep track of them; Neck pain Back pain Breast pain Chest pain Shoulder pain Abdominal pain. (Hypnosadist) 10:17, 21 March 2008 (UTC)
I think the above links should be in the article but i'm not sure about the long list of diseases, this article should cover things like provoking factors and alleviating factors. (Hypnosadist) 10:23, 21 March 2008 (UTC)
My suggestions are pretty basic, but here they are:
WLU ( talk) 21:41, 29 March 2008 (UTC)
A complex request or 5:
I'm wondering if this section should be removed and a sentence or two added to the section Genotype and Pain. There is already a separate article (Congenital insensitivity to pain) on this topic, and two separate mentions in this article as well. Sisyphus ( talk) 20:15, 31 March 2008 (UTC)
I am also curious if this section should be moved to Genotype and Pain. -- DavidD4scnrt ( talk) 04:35, 11 April 2008 (UTC)
The section on "Referral pain" duplicates information in the long "Visceral pain" bullet point in the previous section. Do we want to merge the two sections, or do a much more organized split? I'm currently leaning towards a split, although it's more work. WhatamIdoing ( talk) 02:57, 1 April 2008 (UTC)
I have been unhappy with the lead because it's so limited: It jumps directly to the specialized definition by the IASP, without even acknowledging that nearly everyone else in the world uses the word differently. A toddler can't even make the distinction between the physical and psychological sides of it, but surely every adult here believes that even a three year old will recognize and be able to name pain in the common sense. So here's my proposed expansion of the lead:
From there, I think the lead should continue as it's already written. Does that work for everyone? WhatamIdoing ( talk) 03:32, 1 April 2008 (UTC)
Pain, as commonly used, refers to an unpleasant or distressing sensation of the type that is associated with a disease or injury. [4] [5] Although pain is more commonly associated with a bodily sensation, the term is also used to describe mental or emotional distress or suffering. [4] [5] When the term is applied to a bodily sensation, pain results from the stimulation of specialized nerves and functions as a warning system to prevent tissue damage by promoting avoidance. [4] [6]
In scientific research, a more precise definition is used. Pain is defined by the International Association for the Study of Pain (IASP) as as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. [7] This is distinguished from nociception, which is activity in the nervous system resulting from the stimulation of nociceptors (pain receptors).
"Houston, we have a problem", the source [ cited(IASP Pain Terminology)] doesn't actually provide a def for "nociception". (Nociceptor is defined) Anyone got one - hopefully an RS without complexities such as "sensation", "perception", "physiological pain", "psychological pain", "physical pain", and "sense", all of which have "non-common use", counter-intuitive meanings in this context. [ Definition of Pain and Distress and Reporting Req...] is not clear enough I think. SmithBlue ( talk) 10:47, 1 April 2008 (UTC)
Also the following from IASP Core Curriculum for Professional Education in Pain, 3rd edition, Chapter 7: Pain Measurement in Humans. Careful interpretation is required. -- Robert Daoust ( talk) 22:23, 2 April 2008 (UTC)
I. Know that pain is a subjective, multidimensional experience unique to the individual (Clark et al. 2002; Kumar et al. 2002).
- A. Understand the distinction between pain and nociception.
- 1. Appreciate that pain is a conscious, aversive aspect of somatic awareness, the product of complex, central, nociception-induced processing, and not a primitive sensation.
- 2. Appreciate that nociception is never conscious and engages sensory, emotional, and cognitive processing areas of the brain.
- B. Understand that pain is multidimensional.
- 1. Appreciate that the pain experience may have sensory, emotional, and cognitive aspects.
- 2. Appreciate the potential impact of pain on function, affective status, and quality of life.
Section#Sources of pain uses term "(The experience of) physiological pain" without defining it. This needs to be done otherwise its very hard for a naive reader to follow. In addition (as I understand it - with one errror in place) nociception = physical pain = physiological pain so the phrase "The experience of physiological pain", is nonsensical as nociception is not experienced. Thinking we need a "Language of Pain" section to clarify the multiple different ways in which pain is classified/studied/named?
SmithBlue (
talk) 13:37, 1 April 2008 (UTC)
Just checking that we are all using "physical pain" to refer to the experience of pain localized to an area of the experienced body? (Just wishing I was joking) Seriously. Anyone got a better quick definition of "physical pain"? SmithBlue ( talk) 03:30, 3 April 2008 (UTC) strike thru added SmithBlue ( talk) 14:52, 5 April 2008 (UTC)
Can anyone explain to me what this paragraph under localization means? "This subjective localization of pain to an area of the body defines some kind of pain as neck pain, cutaneous pain, kidney pain, or the painful uterine contractions occurring during childbirth. This common usage of pain is not entirely consistent with the scientists' model of pain being a subjective experience." I'd like to edit this but I'm not sure which point the writer is trying to make. Sisyphus ( talk) 12:25, 2 April 2008 (UTC)
Reading the section I think "Localisation" needs to be defined and related to pain - at present the reader is assumed to know what it means in relation to pain. SmithBlue ( talk) 00:56, 3 April 2008 (UTC)
possible article lists:
Split articles
(Please feel free to add to the above lists.)
This topic is vast; the language complexities, historical and cultural perspectives, science and medicine discoveries and nomenclature make splitting this into a wide range of articles a necessity. This area probably needs its own project. Already tensions between "common usage" and latest scientific definition are showing. What suggestions do editors have as to how to best use our time here? SmithBlue ( talk) 01:35, 3 April 2008 (UTC)
From Wikipedia:To-do_list:
What a to-do list is:
- A Place to help give the page clear direction
- General goals for the page
- New sections to be added
- A place to note facts which need to be found or checked for the article
- A place to note sections which need expansion or other alterations
It may be noted that the to-do list here has priority 2: that means that the article Pain has a number of "What links here" references near 500, which is the top priority 1 line. My mistake: there are about 900 "What links here". Normally the to-do list goes at the top of the page, but I wanted to introduce it here before moving it up... --
Robert Daoust (
talk) 16:44, 3 April 2008 (UTC)
To conform with WP:TODO, I moved the to-do list at the top of this page, and I removed from it matters for discussion. I left one task that I suppose can be safely considered as consensual. Here follow some tasks that could figure in the to-do list.
Can we consider that the following does not need to be mentioned because it will be covered through the tasks above?
-- Robert Daoust ( talk) 20:54, 12 April 2008 (UTC)
While this article is WP:MCOTW, can we also please have a discussion about moving it back to pain? The present title constitutes a flagrant violation of general naming conventions, and nociception could be either its own article (pain is the experience, nociception is the neurobiological system that mediates this experience) or a redirect to this article. JFW | T@lk 12:07, 30 March 2008 (UTC)
Consensus was split
I have just completed the split. I have basically moved all the neurobiological stuff away to nociception. This is primarily because in practice nobody who suffers or treats pain is really interested in which nerve fibers are conducting the stimuli they try to abrogate with their painkillers, TENS machines and other modalities.
The article, by the nature of its subject, will be full of generalisations. That means we need a very peculiar type of source that is not very easy to find: the sources that are so well-informed that they are able to take a birds' eye view of the entire field of pain medicine. Perhaps medical textbooks (I'm thinking Harrison's) may come in useful here. JFW | T@lk 23:06, 3 April 2008 (UTC)
Whoa - thats a rather interesting claim - I'm at loss for words and think it best to relax for now. Please consider this statement carefully. SmithBlue ( talk) 01:13, 4 April 2008 (UTC)
Here is a rough draft for reorganizing the article: http://en.wikipedia.org/wiki/Talk:Pain/TempDraft. Modifications are welcome. Very wild modifications could be the subject of another draft page. —Preceding unsigned comment added by Robert Daoust ( talk • contribs) 15:35, 4 April 2008 (UTC)
http://en.wikipedia.org/wiki/Talk:Pain/TempDraft has been blanked by me. I am not sure if I am supposed to do something else with that page, according to technical procedures. Content of the page is now at Pain (physical). -- Robert Daoust ( talk) 18:04, 16 April 2008 (UTC)
The 1st sentence cites IASP. IASP: Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. WP:Pain is the unpleasant sensory and emotional experience when a person perceives actual, or potential, tissue damage to their body.
WP def means something quite different to IASP def.
WP says "Pain is the perception of damage. IASP says that pain is in some way associated with damage, but makes no statement that pain is the perception of damage.
I believe that "physical pain" is normally triggered by nociception. But again, this is not what the WP:def states. Others? SmithBlue ( talk) 10:19, 5 April 2008 (UTC)
Current definition: "the unpleasant sensory and emotional experience an individual has when they perceive actual or potential, tissue damage to their body" - suggests that we are categorizing the horror of percieving your locally anesaetetised finger getting hit with a hammer as "pain" within the meaning of this article. Please discuss. SmithBlue ( talk) 11:22, 8 April 2008 (UTC)
Without any claim to seeing the direction we could best take here, I point out that "imagined pain" as long as it is imagined as "bodily pain" fits the working nursing definition given in this article of, "Pain is whatever the experiencing person says it is, and exists whenever he says it does", very well. Psychogenic pain fits within this nursing definition? (I assume here that psychogenic pain is localized within the body?) If so then the "or spoken about in such terms" of the IASP would adress this. (Not saying we cant come up with a better definition than IASP but I think they had many experts working on it for years.) Still as long as we don't wonder too far from "the subjective experience of perceiving apparent tissue damage normally triggered by nociception" it may be fruitful. SmithBlue ( talk) 11:18, 9 April 2008 (UTC)
Here are the main ICD10 pain codes I could find...
Just wondering if chronic Paresthesia is regarded as a type of pain, and since it I am not sure if it is covered by nociceptors, if it is pain and , if so, are there other examples LeeVJ ( talk) 21:59, 6 April 2008 (UTC)
PARESTHESIA. An abnormal sensation, whether spontaneous or evoked. Note: Compare with dysesthesia. After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those which are unpleasant.
DYSESTHESIA. An unpleasant abnormal sensation, whether spontaneous or evoked. Note: Compare with pain and with paresthesia. Special cases of dysesthesia include hyperalgesia and allodynia. A dysesthesia should always be unpleasant and a paresthesia should not be unpleasant, although it is recognized that the borderline may present some difficulties when it comes to deciding as to whether a sensation is pleasant or unpleasant. It should always be specified whether the sensations are spontaneous or evoked.
For our convenience, here is the complete paragraph on pain in IASP Pain Terminology. Quotations above on paresthesia and dysesthesia belong to the same text as this quotation (the latter source is more authoritative). -- Robert Daoust ( talk) 13:46, 7 April 2008 (UTC)
PAIN. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.
Closely linked and well written ( with refs!) see Itch, has some crossover subjects in the article as well LeeVJ ( talk) 22:58, 6 April 2008 (UTC)
Now the pain / nociception split has settled, at least a little, I am almost afraid to do it, but I have a couple of merges to suggest... LeeVJ ( talk) 01:09, 8 April 2008 (UTC)
My first suggestion is to merge the section on treatment into pain management. Reason: 'pain management' is referenced by any of the various types of articles that involve pain. Potentially the medical diagnosis might go there as well, LeeVJ ( talk) 01:09, 8 April 2008 (UTC)
My second suggestion is to merge
chronic pain into the article. Reason:All pain is subjective ( both articles point this out ) and I don't see how you can have a whole article with the only difference being chronic pain is pain beyond the normally accepted healing period (from 'chronic pain' article). It does have a more thorough management section, but it covers general pain too and, as above, could be merged into the
pain management article. - ok three merges, I'll stop now !
LeeVJ (
talk) 01:09, 8 April 2008 (UTC)
Would like to see the empirically measurable, objective nature of nociception explicitly contrasted with the "not empirically verifiable", "in consciousness only", "subjective experience" of pain that this Pain article limits itself to addressing. At present in the language quagmire of this subject, I'd guess that some 80% of readers would read this article but still think that pain is the awareness of pain receptors firing. I know we are not here to educate but I do think that explicitly relating/contrasting the natures of nociception and pain is appropriate in this article. Others thoughts? SmithBlue ( talk) 02:26, 10 April 2008 (UTC)
The language trolls are at work here too. No critisism of any editor is implied - I can't see any alternative at present either. Sensation - "In psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a sensory organ, which then leads to perception,..."
(For other uses, see Sensation (disambiguation). - but no other medical/scientific definition is obviously linked from that page.)
At present a naive reader could easily think that we are using the psychology definition - its the only one we suply - which, in our language, from our disambiguation statement, (see title of this talk section), would mean this article claims to be about nociception. SmithBlue ( talk) 03:17, 10 April 2008 (UTC)
Here follows an excerpt taken on the site of a good pain scientist, Marshall Devor. His use of the term 'percept' allows to avoid the ambiguity of 'sensation', because perception is always conscious, but it remains inappropriate, seemingly, to speak of percept in the absence of a stimulus. I reiterate my question: in the hatnote, would it be better to use 'pain as a sensory experience'? -- Robert Daoust ( talk) 18:57, 10 April 2008 (UTC)
"Pain is a private percept that arises in a conscious brain, typically in response to a noxious provoking stimulus, but sometimes in the absence of a stimulus. The relation of the percept to the stimulus is variable, and depends on the individual's prior expectations and beliefs, and on his/her cognitive and emotional state, not just on the nature of the stimulus itself. The nervous system may react to noxious stimuli with autonomic changes (e.g. in blood pressure), and even with adaptive behavioral responses, in the absence of a conscious pain percept. Likewise, there are circumstances in which the presence of pain is ambiguous, such as when the individual is unable to report on his/her conscious percept, or with reference to animals. In these situations, the word "nociception" is used instead of the word "pain" to express that the nervous system has detected the noxious stimulus without necessarily implying that a pain percept was evoked."
I suppose that we agree that this article is about PAIN-AS-A-SENSORY-EXPERIENCE. Now, readers will come to this article by typing 'pain'. A hatnote should tell them what this article is about, and where to go for other senses of the word. It seems clear to me that the only other 'important' sense they might be looking for is pain in the broader sense. They should not have to go in the body of the article to find the reference to PAIN-IN-A-BROAD-SENSE, that is to say to SUFFERING-WHICH-IS-A-SYNOMYM-OF-PAIN-IN-A-BROAD-SENSE, all the more so since the article about pain as a sensory experience can have, yes, a section on suffering which refers to the main article on suffering, BUT that section should deal exclusively with pain-as-a-sensory experience in relation to suffering. -- Robert Daoust ( talk) 17:29, 11 April 2008 (UTC)
How interesting!;-) We are touching the all important primary issue of the scope of the article, so let us make it clear. You say 'this article should include everything'? What do you mean exactly? Please give an example of something that you would include that would not fit under 'pain as a sensory experience'. Incidentally, imho, 'pain as a sensory experience' cannot be equated to 'pain as a conscious interpretation of nociception', because 'pain as a sensory experience' may occur without a stimulus, and thus does not always involve nociception. -- Robert Daoust ( talk) 19:46, 11 April 2008 (UTC)
First, I would like us to acknowledge that people always distinguish clearly between 'physical pain', which has a peculiar sensory quality that is readily recognized as 'sensory pain', and 'emotional pain', which is certainly an embodied experience and can be felt sensorially if you wish, but which has not the peculiar sensory quality of 'sensory pain' and is thus not confused with it. Of course a 'heartache' may be accompanied by a 'sensory pain' in the area of the heart muscle, but not necessarily: it may be accompanied rather by a 'sensory pain' in the belly, or by a 'sensory unpleasantness' like nausea. As you know, not all unpleasant sensation are considered or identified as 'pain'. So, there is 'physical pain' on the one hand. And on the other hand there is 'emotional pain', which is something different, because it lacks the typical sensory quality of 'physical pain', but is also something alike, because it shares a same character of felt unpleasantness. Same word is used, but concepts and things under the word differ (it is not just a matter, as SmithBlue says, of "the only(?) difference between physical pain and emotional pain is the difference in attributed cause. So pain is felt and named as "emotional" or "physical" depending on the perceived cause."). One more point: I have noticed that when scientists or philosophers are hard pressed on such matters, they switch to the use of the word 'unpleasant(ness)', and I noticed also that when they do so they escape the dilemma but leave the problem whole: nobody cares about dealing with unpleasantness any longer after the discussion is over, so that the muddle continues between pain, unpleasantness, and suffering. I guess the word unpleasantness plays the role of a deus ex machina that allows everybody to be happy in escaping apparently a quagmire.
So, I agree with WhatamIdoing that emotional pain does not fit under 'pain as a sensory experience'. The question is whether we should deal with emotional pain in the same article as physical pain. I guess it's impossible if we want the encyclopedia to be consistent, avoid duplication, have a coherent system of links. Then, what will we be doing? A few solutions may be offered. What will the average reader look for? It is my experience as a reader on the subject of pain that people more usually use pain in the sense of physical pain. So I suggest that when they look for pain, they are brought to the article Pain that deals with physical pain. But then, a hatnote should tell them what this article is about, and where to go for other senses of the word. There are perhaps two other 'important' senses (formerly I thought there was only one other sense, but…): emotional pain, and pain in the broadest sense. I think the latter should be equated with suffering. As for emotional pain, I am not sure how we could deal with it, what would be the scope of such an article, and how it would relate to other topics in WP. As for the scope of an article on pain in the broadest sense, it is necessarily the same as an article on suffering, isn't it? -- Robert Daoust ( talk) 17:19, 12 April 2008 (UTC)
I am afraid your simplest solution, WhatamIdoing, does not address the complexity of the problem at all! Do you admit that 'physical sensory pain' is important enough to have its own exclusive article? If yes, we cannot deal with other topics under that article, even if those topics are also called 'pain', all the more since those topics are such important matters by themselves as emotional pain and suffering!!! The body or introduction of the article Pain is not the place to resolve terminological ambiguities, because those ambiguities belong not to the topic 'physical pain', but to the topic pain in the broad sense. There might be another solution, perhaps more elegant than those that have been proposed until now. It is still a bit scary solution nevertheless. Let's have the article Pain to include everything (this means that the article Suffering would be quite abridged and would mostly refer here). Let's have also the article Pain (physical), the article Pain (mental), or any other such articles that might be needed. The main drawback, in my opinion, would be that the word pain is mostly used, throughout history and nowadays, to mean physical pain, and much less to mean pain in the broad sense, or even less yet to mean emotional pain. Moreover, since we want to go in a direction that alleviates confusion, shouldn't we take advantage of using suffering, a different word than pain, to mean pain in the broadest sense? Then, I would rather favor something like this: "This article deals with physical pain. For pain in a broad sense, see Suffering. See also Pain (mental). For other uses, see Pain (disambiguation)." -- Robert Daoust ( talk) 20:14, 12 April 2008 (UTC)
Sigh! I was almost ready to put a split template on the article, when I had second thoughts and checked a few things.
We are looking for a solution and we have in reality three choices: a disambiguation page, a summary article, or a hatnote.
We have already a Pain (disambiguation) page. What links there? Almost nothing, except the 'Pain' article. In any case, a standard short DAB page is not what we are looking for. I cannot see what is meant by an 'elaborate' or 'overall' or 'special' disambiguation page", except perhaps if it means a summary article.
A summary article according to Wikipedia:Summary_style is explained thus: "Wikipedia articles tend to grow in a way which lends itself to the natural creation of new articles. The text of any article consists of a sequence of related but distinct subtopics. When there is enough text in a given subtopic to merit its own article, that text can be summarized from the present article and a link provided to the more detailed article." The problem we have now is that we have a lot of stuff to say on physical pain, but not much on emotional pain or pain in a broad sense. And in fact, different concepts or things should not be treated in the same article just because they come under the same name. The idea of a summary article could not be to cover 'pain in every sense' (like 'mercury in every sense'). (Or if it could, see here under the solution that I propose: an article called Pain (general)).
Incidentally, I'd like to know, when I asked WhatamIdoing: "Please give an example of something that you would include that would not fit under 'pain as a sensory experience'.", the answer was: "Sure: emotional pain, like grief, is not (always) a sensory experience." Good. But what else? The only other thing I can see is 'pain in a broad sense', like (fictive example) "War brought pain to the population". Is there any other example possible?
By curiosity, I looked closely at http://en.wikipedia.org/?title=Special:AllPages&from=Paige_Kreegel. I noticed two things, beside the fact that most pages refer to songs. First I noticed that there are pages called Pain (biological), Pain (biology), Pain physiology, Pain and nociception. They all redirect to Pain. Second, there are pages called Pain (Medicine), Pain medecine, Pain relief, Pain therapy. They all redirect to Pain (management). There are also, from 'what links here' at the article Pain: Physical pain, Acute pain.
I looked also into http://en.wikipedia.org/wiki/Wikipedia:Disambiguation. The important question is: "When readers enter a given term in the Wikipedia search box and pushes "Go", what article would they most likely be expecting to view as a result?" Given that almost every link from pain in WP is meant to refer to physical pain, can we agree that the response to this question is 'Pain' in the sense of physical pain?
So, I now propose that the best solution is a hatnote like the following: "This article is about physical pain. For other uses of pain as an unpleasant experience, see Pain (general). For other uses, see Pain (disambiguation)."
Such a hatnote would avoid a costly and risky or ill-advised split, and would answer the objection of WhatamIdoing to the effect that: "This article needs to acknowledge more than the physical sensory aspect of pain. This article cannot pretend that the only kind of pain that truly deserves the name (and therefore space in the article) is the physical sensory kind. This article -- not Pain (physical) -- is exactly the right place to talk about the difficulties of definition and the various overlapping, contradictory, and metaphorical ways that people use (or have used) this word. Where else could you do it if not in Pain itself?" -- Robert Daoust ( talk) 19:06, 15 April 2008 (UTC)
I think the "Pain" that people type into the search box is the same stuff that I find so intertwined and inconsistent. One word, many related concepts. I think a top article titled Pain is the clearest way to facilitate an understanding of the various types of "Pain" and the variety of models. By having one top we will be forced to "make explicit"/document the differences in usages and understandings - something that "For a broader sense of pain see article suffering" avoids, implying that "they're different so they're in different articles" without showing how they are different (or how they are the similar). SmithBlue ( talk) 06:34, 16 April 2008 (UTC)
Sherrington seems to have been onto this some 100 years ago - prob needs to be in article From[ The ethics of research involving aniamls] Pain, suffering and distress: meaning and function in animals and humans The basic evolutionary functions of pain and ways of relieving it 4.11 In evolutionary terms, pain has evolved from nociception as an aversive sensory mechanism that warns of harmful experiences. Pain has three main functions: First, it allows animals and humans to avoid dangerous situations, as painful experiences usually prompt an immediate impulse to withdraw and escape from situations that cause harm, usually in the form of tissue damage. Secondly, as pain is associated closely with the environmental context in which it occurred, its experience can help to prevent repeated damage. Pain-causing experiences will be avoided through learning when a similar environment is encountered again. Thirdly, pain promotes the healing of injuries, as affected body parts are not used in normal activities, as far as possible.
Also evolutionary view of pain supression etc etc. SmithBlue ( talk) 04:16, 10 April 2008 (UTC)
Does anyone mind if I create a Pain (medicine) that focuses on causes, diagnosis, and treatment of pain as a human medical symptom? WhatamIdoing ( talk) 15:34, 16 April 2008 (UTC)
I created Pain (physical). I'd like to know if another page name would be more appropriate, before beginning playing with hyperlinks. Would for instance Physical pain be easier or more natural? -- Robert Daoust ( talk) 18:13, 16 April 2008 (UTC)
As I said repeatedly, and I'm adamant on that, physical pain is way much too important to be only a section of 'Pain'. Pain (physical) is a subarticle of Pain, and the latter should only 'summarize' the former, among other matters relating to pain in general that it must present or summarize. Of course Pain (physical) is presently too long, but it will have to be expanded yet, and of course subarticles will have to be made. I strongly disagree with you about there being anything 'non-physical' in the present version of Pain (physical). If you see such a thing, please point it out with precision. As to the rest of your view, I believe it misses what is at stakes. -- Robert Daoust ( talk) 21:53, 16 April 2008 (UTC)
And as I said in a section above: unless you want Wikipedia to be a medical encyclopedia, the article 'Pain (physical)' is the article where pain-as-a-medical-condition must be presented, where symptoms, causes, diagnosis, treatment are 'summarized', before being the subjects eventually of other subarticles. -- Robert Daoust ( talk) 22:01, 16 April 2008 (UTC)
For reasons that seems obvious to me, since we chose to deal in this article with pain in general rather than with physical pain, I propose replacing eventually the content of the present Pain page with the content of this provisional Pain page. Is there any objection?
My own objection is that it would make more sense to replace the present Pain page with the Pain (physical) page (on which a different hatnote and a different lead beginning would figure of course), and to use the provisional Pain page for the page Pain (general). But I am curious to hear your thoughts. -- Robert Daoust ( talk) 15:22, 17 April 2008 (UTC)
My concern is that the present User:Robert Daoust/pain (general) contains
But ignoring these specifics, when compared to the present "Pain" article (which still retains a physical pain definition and a great emphasis on the medical aspects of pain), "User:Robert Daoust/pain (general)" does offer a glimpse through mist of what a top "Pain" article might look like. SmithBlue ( talk) 05:02, 18 April 2008 (UTC)
Thanks for your thoughtful remarks, folks. I made modifications toward satifying your concerns. This is only a beginning, but it is already a progress, isn't it? Terminology of pain is a complex little tangle, as you might appreciate if you compare Clarification on uses of terms and Clarification on the use of pain terms. BTW, I got tired of typing the wikilink to 'Pain (physical)' (I find it unnatural or cumbersome to type it), and I thought of all those who will have in the future to type this link which will be much more frequent than the link to pain, so I moved the content of Pain (physical) to Physical pain. I hope this is correct, before we get some day into correcting the redirects. -- Robert Daoust ( talk) 11:41, 18 April 2008 (UTC)
I get the idea we are getting somewhere, although I do now have concerns that as pain is subdivided up, talk on the subject will be decentralized. What should we do - direct all talk to one page, make a subpage just to cover article division and crossovers, or maybe form a taskforce in Project Medicine ? LeeVJ ( talk) 01:53, 21 April 2008 (UTC)
Melzack's and Wall's theory must have its own article given the importance it has in scientific literature. Maybe user:Medos2 is suggesting in fact to mention adequately the theory in this article. If this is so, I agree of course. However, I would first mention the theory in the article Physical pain, and then under the section in this article that summarizes 'Physical pain'.
I want to point out again to a foreseeable problem that we might avoid right now. User Medos2 suggests to merge Gate control theory here, while it should be merged rather, if at all, into 'Physical pain'. It is foreseeable that ninety percent of the times people will refer to 'Pain' when in fact they mean 'Physical pain'. That is why I hesitate to make the definitive move that we have been talking of lately. I still feel that there should not be an article 'Physical pain', but that the article 'Pain' should be about physical pain, and the article ' Pain (general)' should be about pain in general. Is not there a way for us to have a wider WP community decision about it all? -- Robert Daoust ( talk) 16:16, 22 April 2008 (UTC)
I take that point. It was possibly a bit hasty of me to suggest the merge, but it was mainly to initiate discussion. I also appreciate you pointing out the Physical pain article as I unaware it existed. I agree that when people refer to pain they mean physical pain primarily as was my intention. I know that the treatments for physical pain differ from neuropathic pain and I'm not entirely sure if the gate theory applies to neuropathic pain but I did have physical pain in mind. I've read over the two articles and agree with your suggestion as it accomodates what people would expect if they were to type in Pain as a search word. Medos ( talk • contribs) 22:09, 22 April 2008 (UTC)
I think more discussion and more data would be preferable to a poll at this stage. I think differentiating the "pains" and understandings/models will take a lot of space and that readers queries may consist of the common understanding of pain which seems to lump them all together. I want clearer data on what peolpe are looking for when they search WP for "pain". I am not convinced that "physical pain" is the overwhelming meaning. A Google search for (pain back -love) gives 10,300000 hits, (pain back love) gives 3,600,000 hits, (pain love) gets 13,900,000 hits, (pain back) gives 15,300,000 hits. (These results vary wildy by the minute which is strange.) So at least a suggestion that Google is finding comparable pages adressing "love and pain" as for "back pain". Any other data would be appreciated. SmithBlue ( talk) 05:28, 23 April 2008 (UTC)
This is a summary of the options for article content being discussed: please feel free to edit in situ:
1
Pain - General Pain
2
Pain - Physical Pain with larger section summarising General Pain
3
Suffering - General Pain and Suffering
4
Pain - physical pain + non-physical pain (i.e., suffering + emotional pain + philosophy + other stuff already in this article) with several {{ Main}} pointers to articles like:
Suffering - (to include emotional pain)
Pain (disambiguation) - Pain in every sense, including links to Physical pain, Emotional pain, and Pain in the broad sense (i.e. Suffering, i.e General Pain).
As a contribution and an incentive to have this article in better shape, I have made a move per WP:BRD. The article Physical pain now redirects here, as its content was moved to Pain. -- Robert Daoust ( talk) 15:46, 29 April 2008 (UTC
I completed today the revision of the article. I removed the empty section "Psychological analysis" with its empty subsections "Sensory dimension", "Emotional, affective, motivational dimension", and "Cognitive dimension". These matters should be developed in the future, along with other aspects such as
Some or all of these could be included within To-do list here at top of the page. -- Robert Daoust ( talk) 15:46, 9 May 2008 (UTC)
Good morning! As long as the article
Scrambler therapy is accepted in Wikipedia - that is, as long as it is not deleted, relevant links to and from this article should be allowed. It would be a very strange situation if we would have some kind of "second-class" articles: the article can be here, but you cannot link to it. So my suggestion is that you put some kind of label on Scrambler therapy stating that it is questionable, or may be a label that you think the article should be deleted. Groetjes,
Lova Falk (
talk) 05:54, 26 May 2008 (UTC)
I changed my mind about the deletion. Of course, anybody stumbling across the term "Scrambler therapy" and wanting to know more about it, should be able to find an article on it in Wikipedia. But the article should reflect that this is just a theory and not an evidence-based treatment (yet?). Lova Falk ( talk) 06:08, 26 May 2008 (UTC)
Hi Robert. I've just read through the above. Wow. I suppose one needs a bit of heat to forge good metal. I'm with you when it comes to making a clear distinction between "pain" meaning "bodily" or "embodied" pain and "pain" meaning "suffering". And I think the page is developing nicely as a description of the former. But since most people are happy to, and often do, use the term with either meaning, I'm with WhatamIdoing in thinking that every sense of the word should be well covered here. I know that, where one word is an exact synonym of another, all good dictionaries and encyclopedias will, rather than repeat, redirect the reader to the synonym but this is a special case. The second use of pain (suffering) is born out of a neurological fact that you and I are both quite familiar with. I think this would be a very appropriate place to introduce the general reader in easy laymans terms to Eisenberger and Lieberman's (2005) pain overlap theory.
(I so wish they had not used the term "social pain". More recently Eisenberger has been using the far less ambiguous term "social distress". "Distress" captures "suffering and the urge to escape suffering" quite well.)
Re: Pain meaning suffering
When "pain" is used to mean suffering it gets used in a narrower range of situations than does "suffering". When I hear "the pain of his dreadful loss" I actually think of loss induced bodily pain. Some losses, separations, disappointments, anxieties, rejections are so severe they evoke actual locatable pain somewhere in the body. This phenomenon, notwithstanding a hundred years of psychoanalysis and seventy years of behaviourism, is real. In these situations people feel actual embodied pain. I have no doubt that this aspect of pain needs to be addressed thoroughly on a page entitled "pain".
Then there is the question of difficult to locate or broadly and vaguely distributed pain. If a psychosocial or psychological event induces bodily pain which is indistinctly located (some visceral pain is of this type) the sufferer may not claim to feel "actual" pain (because, for it to be pain, you need to be able to answer "where does it hurt?") but be unable to resist using the term "pain" - because that is in fact what it is.
Some people have lower pain thresholds than others (Jason, Giesbrecht & Battié, 2005.) And, within an individual, the pain threshold varies from time to time. Eisenberger and colleagues (2006) have shown that people with lower levels of social support experience more pain than those with higher levels of social support, and that "experiences that heighten social distress will heighten sensitivity to physical pain as well" (p. 132).
What she seems to be showing, but not yet stating explicitly, is that your sense of belonging, your sense of safe, warm attachment to society, to some extent determines your global pain threshold. If someone you love rejects you or they decline your application to join the tennis club, this will lower your pain threshold, and an ongoing stimulus in your body that was just below the pain threshold for that stimulus would appear above the pain threshold, like an island at low tide, and be felt as (and actually be) physical pain; or any pain you might presently be experiencing would be amplified by a tear in your social fabric.
Finally, regarding "What is pain?"
In 1968 Ronald Melzack (co-author of the gate control theory) and Kenneth Casey divided the pain experience into three "dimensions": sensory, affective-motivational and central control. The sensory dimension involves the location and intensity of pain over time; by "affective-motivational" they meant the unpleasantness "that forces the organism into action"; and under "central control" they included the higher cognitive activities that influence pain, such as anticipation, anxiety, attention, suggestion, placebos, cultural background, appraisal, hypnosis, early experience and prior conditioning.
"Pain varies along both sensory-discriminative and motivational-affective dimensions. The ... intensity along these dimensions, moreover, is influenced by cognitive activities, such as evaluation of the seriousness of the injury." P. 434.
Their tripartite pain system has been born out by modern neuroscience. The network of brain activity that represents the aversive drive and unpleasantness of pain is fairly distinct from the sensory-discriminative matrix, and higher cognitive activity in the more recently evolved frontal lobes modulates both the perceived intensity and unpleasantness of pain. So, not only does it make psychological and behavioral sense, this model now makes solid biological sense. So I think it deserves a place on the page somewhere.
Of course Eisenberger is giving flesh to a 4th dimension: social. (There exists a body of literature on the biopsychosocial model of pain which I have yet to explore in any detail but, the few forays into it I have made leave me thinking it's all about operant conditioning. I.e. "don't reinforce your husband's pain behaviour Mrs Jones, or he'll never go back to work.")
What do you reckon, mate?
Anthony ( talk) 12:38, 25 July 2008 (UTC)
References
Eisenberger, N., Jarcho, J., Lieberman,M., & Nabiloff, B (2006). An experimental study of shared sensitivity to physical pain and social rejection. Pain, 126, 132-138.
Eisenberger, N., & Lieberman, M. (2005). Why it hurts to be left out: The neurocognitive overlap between physical and social pain. In K. D. Williams, J. P. Forgas, & W. von Hippel (Eds.), The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127). New York: Cambridge University Press.
Jason, R., Giesbrecht, S, and Battié, M. (2005). A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain. Physical therapy, 85 (10), 1085-1092
Melzack, R., & Casey, K. (1968) Sensory, Motivational, and Central Control Determinants of Pain. In Kenshalo, D. (Ed.), The Skin Senses (pp. 423-439). Springfield, Ill: Charles C. Thomas Publisher.
HI Robert. I think we're pretty much in accord here. It's this synonym/homonym combo that is hard to get the head around and hard to express. I'm away from the net at the moment. But when I get back from the bush I might compose an essay about the sensory/affective/cognitive/social dimensions of pain. I'll put it up here first and we can tussle over it if you like. Regards Anthony ( talk) —Preceding undated comment was added at 10:11, 5 August 2008 (UTC)
The present version of the article includes this claim under the In other species section: "It is not scientifically possible to prove whether an animal, or a human for that matter, experiences pain or not." The claim is not sourced. There is, immediately after the sentence, the following claim which is sourced: "However, the presence of pain can be inferred through physical and behavioral reactions." Given that the second sentence here seems to be true, I wonder whether that by itself doesn't call into question the truth of the first sentence, considering the fact that "inferences" from behavioral reactions are (I suspect) the very "proof" that's routinely given for saying that a certain individual is feeling pain. Surely, this is "proof" enough; isn't it? Of course, it's not mathematical proof, but there is such a thing as other forms of proof. I would say that most of what we know is proven based on the same kind of inference that is involved in inferences from behavioral reactions - i.e., non-mathematical proof. It's still a kind of proof. In any case, I would move to strike the first sentence I quoted, unless someone can find a reliable source that actually makes that specific claim. Isokrates ( talk) 01:21, 31 July 2008 (UTC)
The
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infobox in the section Pain/Society and culture appears to vastly overweight Utilitarianism in this section. I sugest removing this box before this section balloons out with infoboxes for Buddism/The Five Precepts, Gnostism/The false body etc etc.
The infobox could better be replaced with a single sentence or so stating the importance of pain to a wikilinked Utilitarianism. If no further discusion I will do this in the near future.. SmithBlue ( talk) 11:30, 19 December 2008 (UTC)
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