Talk:Pain/Archive 1

This is an archive of past discussions about Pain. 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.

Archive 1

Archive 2

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Archive 5

Invertebrates and Vertebrates

I think there needs to be some information regarding what specific animals feel pain and to what extent. My understanding is that most scientists (and people for that matter) believe most if not all invertebrates are incapable of feeling pain due to their lack of central nervous system and the lack of evolutionary necessity.

I would think that many people would search pain in wikipedia trying to get information on things like insects and pain as well as the issue of boiling live lobsters.

Here are two internet links for some info on the pain in vertebrates/invertebrates debate:

http://www.cbsnews.com/stories/2005/02/14/tech/main673989.shtml http://www.parl.gc.ca/37/2/parlbus/commbus/senate/Com-e/lega-e/witn-e/shelly-e.htm

One is a CBS news story on a study in Norway and the other is the conclusions from a Canadian inquest. U R A GR8 M8 05:00, 23 November 2006 (UTC)

My pharmacology text also specifies Cancer pain, vascular pain and reffered pain and the specification of acute and chronic. I think they should also be included here.

Wrinkleworm 06:37, 5 October 2006 (UTC)

Under 'types of pain' -- I can't figure out why "Neuralgia" links to "Neurasthenia", unless it's because the neuralgia page didn't exist or didn't have much content when the bit about neuralgia was added to this page? I don't think the link to neurasthenia is quite appropriate, and not what I would expect from a link labeled "Neuralgia." But, I don't want to change it if I don't understand why it's this way. (Is there any way to grep through all versions of a page to find where certain text was added or removed??) Also, scales of pain perceived intensity/severity---I know they exist but I didn't see mention of them on the page... ~os~ / User:os

Agree - need some pain scales; here's a couple links following; the Wong-Baker FACES scale (Pasero C (1997). "Using the Faces scale to assess pain". Am J Nurs. 97 (7): 19–20. PMID 9247377.) (use of image would require permission [1]); The link http://www.intelihealth.com/IH/ihtIH/WSIHW000/29721/32087.html lists FACES, the very common numerical 0 (no pain) to 10 (worse possible pain), and others. MeekMark 11:14, 19 June 2006 (UTC)

I think somebody should really add a section about pain and pleasure. I'd do it myself, but I don't really think I could do it justice. Especially since I know only a little bit about S&M, from experience. However, I do think that it's a significant subject, and should be examined in detail. The section should look at a) how pain relates to S&M, but not too much, as it is only part of it, and b) The effects of orgasm on the pain threshold.

~Sartas Regem~

EntmootsOfTrolls would have liked this article to be part of User:EntmootsOfTrolls/WikiProject Body, Cognition and Senses, which provides guidelines for articles on those topics, and seeks stronger cross-linkage and cross-cultural treatment of all of these topics.

Given that sense of pain is in fact a sense, this is a central article in that project. The main impact of that project on this article will be to neutralize language and avoid assuming the biomedical model too much. Pain for instance had no link to pain control methods other than drugs, and actually said that biomedical causes exist for pain. That is just not always true, at least not so we can prove. The WikiProject is just about removing this sort of culturally-biased claim, adding mention of other approaches or beliefs from other cultures, and trying to cross-link a lot.

Chronic pain is primarily rooted in biomedical causes, however. The only other option is that it's psychosomatic, which is quite rare. This article shouldn't state beliefs from other cultures unless they are part of a common treatment method used. It should simply be stated that a certain treatment is used without explanation of it as it's not directly relevant to this article. It certainly shouldn't just mention drugs though, there are a variety of other medical treatments available. I'll consider adding some others in like physical therapy, TENS stimulation, accupunctre, bio-feedback/meditation, etc... -Nathan

LOL@picture of Chuck Norris

I've read that chrnoic pain sufferers don't generally become addicted to painkillers, even such as morphine. Then again, it was the opinion of a chronic pain support association of some sort. But there's certainly a large body of chronic pain sufferes who feel they need stronger medication. http://familydoctor.org/handouts/122.html -- "difference between "physical dependence" and "psychological addiction.""

It's true, psychological addiction is rare among chronic pain patients. It's chemical dependency (physical addiction/depdendency) that's common. Keep in mind that chronic pain users are using the medication to treat legitimate pain, which is why it's uncommon to become psychologically addicted. I know many people with chronic pain (myself included) and the idea of using the drugs prescribed for a very serious medical disorder for fun is appaling to them. This is complicated by the fact that if they do get psychologically addicted their doctor will refuse to prescribe them medication, meaning that they would be left with tons of untreated pain (that is a VERY strong deterrant to recreational use). Many people taking the medications don't even get a high/buzz/whatever. In fact, some have very negative reactions to them. -Nathan

Could someone write information about non-human pain: animal pain. The requirements for pain: a nervous system, nociceptors, etc. What is pain's evolutionary significance.

That seems to be well handled now. And it would be better to write an article on the more objectively observable phenomenon: irritation. We can't say that an oyster feels pain, but we can say it does react to something irritating it, to produce something that is useful to us, and not to it. We can also say that an amoeba avoids a pin we poke it with, but not how much it feels this. Irritation is apparently the only universal sense!

Philosophical issues are interesting, but an article heavily focused on philosphy seems to take an anthrocentric approach. Our linquistically constructed speculations about the meaning of pain might not contribute to knowledge of what we share with other animals as well as might a simple description of the functions of pain mechanisms. The linguistic construction of the bio-medical model has some limitations, but there is probably no reason to omit the perspective of the vast majority of medical practitioners in favor of esoteric philosophical considerations that do not find prominant discussion in any popular venue or professional literature in which the topic of pain is regularly considered. I would rather see philosophy disussed in an article perhaps titled Pain (philosophy), and which more thouroghly surveys historical and perhaps non-Western philosophies of pain. Along those lines, articles would do well to comment on how widely received are esoteric views of pain and pleasure, and by whom they are so accepted and rejected.

My gut reaction in reading this page was that I was being preached at in a persuasive effort to influence my perception of Western culture. I wouldn't mind so much considering esoteric views of pain if the aritcle acurately preached standard taxonomy. The heavy hand of a contributor who wants to spread a non-biomedical approach reminds me of the Church's early campaigns against the development of a standard taxonomy for describing the human body. The church's problem was that such descriptive language tended to weaken the church's authority in declaring the nature of human reality.

Speculative approaches in authoritatarian language also fail to rise to the NPOV standard widely accepted here. The claim that "it (pain) may well be an evolutionary artifact that does us little good any more" leaves Wikipedia speculating against the wisdom of millions of years of evolution. Who is declaring how well it may be? Nobody, as written, beyond the anonymous authority of Wikipedia. It also may well be that the human species would not long survive without the biological tools it inherited from its animal ancestors. (have to say that I agree a simply example would be that withou physical pain, we would'nt notice ourselves being injured at all times and the injury would worsen without care, it's a warning system, and let's face it, it's a dangerous world out there)

Pain most certainly does have direct links to pain control methods, and they start in the brains of most species with the endogenous endorphin system. Historic pain control methods directly exploid chemicals related to the biological pain control system. The discussion of pain and pleasure needs to address some of the more difficult biomechanical issues about the role of endorphins both in pain regulation and in the subjective experience of pleasure. An understanding of endorphin systems can provide a better basis for readers to make their own judgements about esoteric philosophical issues related to law and societies' implicit threat of pain to acheive social compliance. Further, the assertion that pain is a primary tool for social control might exhibit some neurological naivitee. Fear is a different neurological response than pain, and training of fear responses is probably more recognized as the standard tool of social control (beyond Chomskian philosophy).

The article is also short on biomechanical information that could better explain why people suffering pain do not become addicted to opiods. The basic difference between opiod response among those suffering physical pain and all others is that those in physical pain almost always present increased adrenal and cortisol levels, which generally act against the opiods sedating effects, and which dulls the addictive quality of sustained opiod use. SoCal 16:43, 19 Feb 2004 (UTC)

Also, I am removing the last line that says an ethics of pain will have to recognize something, for several reasons. One is that Wikipedia is not an authority that declares who will have to do what based on any logical construct, no matter how solid. Another is that the language personifies ethic and as written avoids accurately saying homoids who strive to develop an ethic of pain are confronted by various rhetorical and philosophical conflicts and limitations.

In defense of biomedical physiological language, an accurate understanding of the compassionate capacity built into a brain that allows it to conjecture on the pain of others might provide as much a useful nudge toward understanding the complexities of soldiers perception of others pain as would the firm rhetorical push from a paragraph more about language and philosophy than about the physiology of pain, and the physiological perception of pain. (See Imagery in Healing, Shamanism in Modern Medicine, Shambhala, Boston, 1985) SoCal

These comments make no sense in the context of the page as it now stands. The section on pain and philosophy is now at Pain (philosophy)SoCal 04:49, 20 Feb 2004 (UTC)

This page still needs to be cleaned up but I helped create a clear definition for it so people who are doing research can get some immediate knowledge from it. I also removed the word "modern" as a description of the Gate control theory of pain because this constituted a POV. Also the biological definition has allot of evidence in its favor. Overall its better than nothing. It is also hard to beleive there is no entry for spinal column. hmmmm. GrazingshipIV 03:44, Mar 11, 2004 (UTC)

"However, there is much evidence that pain can retard healing in the hominoid"

How? What evidence?

"Recently, scientific findings show the first evidence that sunlight can affect the perception of pain."

How? What findings?

200.149.25.2 02:19, 4 Apr 2004 (UTC)

This article discusses pain, but doesn't address the root question: what IS pain? In philosophical terms - in fundamental terms - pain ISN'T nerve activity, or sensation, or neural-chemical stimulation. Pain, both psychological and physical, is the fundamental feeling of AVERSION. The essence of pain isn't the sensation. It's the feeling of aversion, dread, dislike, discomfort-- the "not liking the sensation."

What is this quintessential quality of pain-- this "not liking the sensation"? How does it come to be? How CAN it be? What conceivable mechanism could be behind this "not liking the sensation"?

That's the root issue, if you're going to define "what pain is."

    ****That would be covered by the Pain (philosophy) article. Wrongfooting 08:57, 12 April 2007 (UTC)

Physiology

There's some incredible work going on now in pain modulation at Stanford, using real-time fMRI technology to enable patients to control their rostral anterior cingulate cortex. Worth exploring to expand and connect the cognitive/biomedical and subjective/mind-body topics in the article.

See http://paincenter.stanford.edu/research/rtfmristudy.html --Ryan Blum 23:28, 24 February 2007 (UTC)

Pain in Children

I have found this site, and external links discussing the physiological response to pain. I was wondering if anyone had information about the prevelace of acute pain in pediatric patients (particularly in hospital settings). I am running into blocks in my searching. I have found much information about the behavioral perspective, and experential perspecive. Not as much for the pathophysiological perspecive to pain. However since finiding this site I have found a plethora of psyiologial persective to pain. Megankboyce (talk · contribs)

Those prevalence figures should be available somewhere. It is determined by many variables, but I suspect pain management in children is not as good as it could be. JFW | T@lk 01:20, 30 October 2005 (UTC)

You're right on. I am a medical student who has worked with pedatric pain patients and there are lots of complicating factors. Two big ones being the variable response to analgesic medications (especially among the very young), drugs which are designed and tested almost exclusively on adults; and the subjective nature of reporting pain. Kids can close up, or they can report pain that *seems* unjustified. It's always hard to tell, especially in patients with severe chronic pain. --Ryan Blum 23:17, 24 February 2007 (UTC)

:: I am the author of the pain management series for children called The Painelius Series. This is of course based on my vivid memory of chronic pain as a child. It was perceived that there was nothing medically wrong with me as a child. I had unexplained pain. Unfortunately, due to the undetermined origin of my pain I was left to suffer. Recently, I was diagnosed with Ehlers-Danlos Syndrome types 2 & 4 and Stickler's Syndrome. Both are connective tissue disorders. Throughout the years I have had two retinal surgeries for detachments, two anterior cervical fusions, tumor removal, talus surgery, lumbar laminectomy and discectomy and am currently looking at a rod in my lower back. I believe all too often due to a lack of initial diagnosis, practitioners quickly dismiss children as attention seeking rather than earnestly investigating complaints of pain. I really appreciate the above writer utilizing the * in the quote "*seems* unjustified" and hope that the medical profession continues to take recognition of this (sadly) new paradigm called pain management and awareness, not only in pediatric patients but adult & geriatric patients as well.

To answer the initial question, in my research in testing the market for need and also investigating pain management practices in children I was shocked and markedly upset by what I had uncovered. [2] At one point it was believed that the infant nervous system was not fully developed thus no anesthesia was used during surgery. One would believe this occurred 50/100 years ago; however, we are talking a mere 20 years ago.

"...The case of Jeffrey Lawson changed all that," Dr. Lee said. "He was a 1 pound, 11 ounce neonate who received a patent ductus arteriosus ligation with no anesthesia, only pancuronium, a muscle relaxer. The thinking was that drugs can't be used safely in babies."
Jeffrey died a month later. On reviewing his medical records, his mother discovered he had not received anesthesia for his surgery, contrary to the neonatologist's assurance that he would.
His mother wrote about the surgery and how Jeffrey was conscious throughout it, paralyzed by a curare-type drug. Public outcry came after her account was published in The Washington Post in 1987. This prompted other parents to speak out about their experiences. The practice of administering little or no anesthesia for surgery in premature and critically ill infants became a public issue."

(Cited: [3])

"Chronic pain in children is an under recognized and under treated health problem worldwide, according to an Oct. 17, 2005, news release from the American Pain Society (APS). In the United States, chronic pain affects approximately 15% of children.

(Cited: AORN Journal Feb.2006 Chronic pain in children is an under treated problem.)

In short, you are going to be hard pressed to find not only statistical information on the prevalence of acute pain in pediatric patients (with a concentration on hospital setting) but also chronic pain. One might consider that acute pain is many times the initial flag that alerts us to a problem within the body. This of course is not the only time we are able to determine that anything is wrong. For example, with pediatric diabetes one will find the child will have an insatiable thirst (one I like to refer to as 'the thirst of the confederate dead'), frequent urination and weight loss. Many times pain is absent, but with these symptoms one is hopefully alarmed enough to seek medical attention for the child. On the other hand for a majority of ER visits I think most pediatric patients are dealing with some sort of acute pain. Pain essentially has three points of origin: dysfunction, poison or trauma. We would classify genetic abnormalities, diabetes, cancer, heart disease, sickle cell anemia...etc as dysfunction. Poison would be airborne, blood born or food born - essentially infectious disease or food poisoning. And I think of trauma having a physical origin - anything from stitches on the chin to an amputation or full body cast. Armed with this knowledge you may be able to deduce the prevalence of pediatric acute pain. I seriously doubt that there is enough tracking of pediatric pain in place to gather the data you are seeking. However, there may be the dysfunction, poison and trauma. From there you could establish an initial system for tracking acute pain in pediatrics through deduction. I am referring to logical inference: IF a child breaks his/her leg THEN the child suffers acute pain. 20 children broke their leg THEREFORE 20 children suffered acute pain
This idea may be filled with logical holes but I believe as a general rule one would assume that if you broke your leg you would suffer acute pain. Absent a head injury – if the child suffered a broken leg and is unconscious due to a head injury then the question is – is the child still feeling pain? Of course I’m going to be on the side of YES.
Good luck in your search. Julie Nanos Painelius 20:16, 27 May 2007 (UTC)

The conception of pain and also the flora and pain

Last things first. :) Can the flora fell pain (or nociception)? Is there some why it could feel discomfort because of it? It seems to me that it's impossible but we had some discussion recently so it's still a thing to ask.

Next thing - pain is understood by the mind, huh? I mean - if the mind is turned off there would be no pain? But how can then nerves put the pain into thoughts so that even the mind could understand it? Like, I can understand actions and ideas, but how pain? Or more importantly, how does it make the mind feel uncomfortable? The same question would be about the touch, but it does not hurt for the mind - it just gets the information so that it could process it. But how pain?

I hope you understood my points. :)

Philosophy of pain.

I think there should be at least a short blurb about the philosophy of pain. I'm adding one; however, feel free to remove it if you feel fit. --ILikeThings 11:35, 29 May 2006 (UTC)

the problem is that pain these days signifies any damn emotion or bodily function that causes an undesired "feeling", either physcial or emotional. the article on pain should really only be on physical pain and perhaps pain from "phantom limbs", mental pain, if it indeed can be called that, should be considered a different thing.

Fingernails and Toenails, teeth, and survival pain

It seems apparent to me that fingernails and toenails being prone to extreme pain have an obvious (vestigial) survival benefit.

We evolved from animals that defended themselves and hunted primarily with their claws, assumedly, if you go back far enough. Damage to a claw could mean death! Being unable to defend yourself or hunt, sure sounds like bad for survival.

The same is true of teeth. This part of the article seems to assume we always could go down to the grocery store and buy some mushy processed food.

I have no citations, so I'm not changing it, but it seems logical to me. Gigs 03:08, 1 July 2006 (UTC)

Location of pain

I removed this text (quoted verbatim) from the article, but it seems like a good question...

While pain signals are processed in Brain, what makes you feel that the pain is occuring in a perticular organ or point ? AndrewWTaylor 12:33, 18 July 2006 (UTC)

Dead link

During several automated bot runs the following external link was found to be unavailable. Please check if the link is in fact down and fix or remove it in that case!

http://www.pain.remedica.com
- In Palliative care on Sun Jul 16 21:24:00 2006, Socket Error: (-2, 'Name or service not known')
- In Pain on Mon Jul 17 15:19:09 2006, Socket Error: (-2, 'Name or service not known')
- In Palliative care on Mon Jul 17 17:19:26 2006, Socket Error: (-2, 'Name or service not known')
- In Pain on Thu Jul 27 00:46:01 2006, Socket Error: (-2, 'Name or service not known')

maru (talk) contribs 04:46, 27 July 2006 (UTC)

Thanks Maru ~ apparently this link should've been http://pain.remedica.com/. However, I took the liberty and removed the link anyway. All I found on the site was publication titles, not even short summaries or reviews or any educational material; the site requires everyone to register ("Subscriptions are free for healthcare professionals. Non-healthcare professionals can subscribe at the rates detailed below." / the rates not shown.) Am I missing the obvious? will be glad to be mistaken, but from what I see, I'm taking the link out as it doesn't seem of any particular use. - Introvert • ~ 07:57, 27 July 2006 (UTC)

Lead para

"Pain is a severely unpleasant feeling" - severely doent always apply. Pain is often slight or mild. "Sensation" is better than "feeling" because pain is ?always felt as a bodily sensation or feeling not purely an emotional feeling. What do you think? SmithBlue 04:46, 30 November 2006 (UTC) I think this article should explain how pain gets to the brain. through sigbals? Which part of the brain are the signals or impulses the pain sensors sent going to? Could Wikipedia have more information on how exactly the brain relates to the pain? Please give me information about that relationship. User:75.40.0.246 1 December 2006

This info is in the sections starting with "Physiology of nociception" - its called nociception cause the signals might not be felt as pain. Pain is something that happens in consciousness. Nociception is not in consciousness. Have added some info on Wikipedia on your talk page. SmithBlue 03:48, 1 December 2006 (UTC)

Bold textLook at entry from The Institute for the Study and Treatment on Pain - iSTOP in www.istop.org. User:154.20.73.202 1 December 2006. Appears to say there are 3 situations of nociception. ? SmithBlue 23:50, 1 December 2006 (UTC)

Definitions, common usage; pain & nociception

My position is: the paragraph I deleted belongs on the talk page, not in the article itself. Material stating that another part of the article needs to be improved belongs on the talk page. If some words in the article need to be changed from "pain" to "nociception" they can be changed. Some people may not agree with such changes. The word "pain" may be better in some contexts: understood by more people and therefore clearer to most readers. The distinction between "nociception" and "pain" does not have to be brought up every time pain is mentioned. --Coppertwig 23:52, 1 December 2006 (UTC)

At present, in the article, definitions of pain and nociception are given (or referenced) and then the word "pain" is used in ways contrary to the definitions. The deleted para is not about improvements needed in the article. Its about acknowledging and warning the reader of the contradictions and confusions within the article and subject. I'd like the distinction between "pain" and "nociception" brought up every time the word "pain" is used contrary to its offered definition. Or could add a section on the historical use of the word "pain" within physiological research and explain the confusion and misnaming? Others views? SmithBlue 00:25, 2 December 2006 (UTC)

Alternatives: Change the definition of "pain" given in the introduction, or give more than one alternative definition, so that the way it's used later in the article is not contradictory. I believe this is similar to what you're suggesting. Or, edit the article so there are no contradictory uses of the term. Or, mention here on the talk page which uses you believe are contradictory and why and maybe we can find a solution. We don't have to limit the use of the word "pain" to a specific, restricted definition if it is not the way the word is usually used. There may be other acceptable alternatives I haven't thought of. --Coppertwig 01:07, 2 December 2006 (UTC)

Its "obvious" to a naive human that pain is happening, say, down there at their toe. Initially medicine/science used this assumption as the basis for naming the structures involved in the detection, transmission, types and causes of "pain" ; e.g. pain receptors, pain fibres, cutaneous pain, visceral pain, neck pain, back pain and physical pain. But recently it has become clear that pain, as we experience it, is something totally distinct from most of the preceeding examples. The International Association for the Study of Pain (145,000 google hits), founded by J Bonica (101,000 google hits: pain Bonica) whose scientific staff officer was Patrick Wall of Gate Control Theory of Pain fame, on their [Pain Terminology] page say "Avoid use of terms like pain receptor, pain pathway, etc." Obviousy we are not bound by this. But we need to find a way to be consistent in this article. (Kinda muttering to myself here. No disagreement with ::Alternatives) SmithBlue 02:09, 2 December 2006 (UTC)

I disagree with the advice "Avoid use of terms like pain receptor, pain pathway, etc." and agree that we are not bound by it. It may be useful under some circumstances to follow that advice. It may be useful under other circumstances not to. --Coppertwig 03:40, 2 December 2006 (UTC)

"Pain, as mentioned above, is usually experienced as having a location within the body. This experience gives rise to terms such as "physical pain" and "back pain". Medical researchers into pain continued with this way of naming dicoveries related to pain and so used terms such as "pain receptor" and "pain fibre". Although now named "nociception", this meaning of the word "pain" is in common usage and is used frequently in this article." Hows this look? At present article is internally inconsistent/misleading. Will be posting above unless another way for consistency is achieved - even if only temporarily. SmithBlue 08:11, 4 December 2006 (UTC)

I don't understand what you mean by "will be posting above". Please explain. "unless another way for consistency is achieved" -- that sounds as if you are not satisfied with any of the several alternatives I suggested. Please explain reasons for not being satisfied with each one, or mention another alternative, if you're thinking of editing the article in a way different from the ways I suggested, with regard to the definition of "pain". --Coppertwig 14:21, 4 December 2006 (UTC)

Does {"Pain, as stated above, is usually experienced as having a location within the body. This experience gave rise to terms such as "physical pain" and "back pain". Medical researchers into pain continued naming their discoveries as if pain was located in the body and so used terms such as "pain receptor" and "pain fibre". This usage of the word "pain" is common and occurs frequently in this article."} meet your standards for an additional definition of pain? If you have something better please put it in. SmithBlue 15:42, 4 December 2006 (UTC)

How about this shorter, less POV definition: "In this article, the word 'pain' can refer to what is subjectively experienced, as in 'there is a pain in my foot', or to the action of experiencing it, which occurs only in the brain." (I find the "as if" in yours to be too POV.) --Coppertwig 03:20, 5 December 2006 (UTC)

Brevity! Good. - 1. is subjectively experiencing something either an action or act? 2. how to fit this definition to usage such as "pain receptor" and "pain fibre" - which are not subjective experience but anatomical entities? 3. "occurs only in consciouness"?("brain" seems antimind POV and vague) 4. Also "subjective experience" is the existing definition of pain(vs nociception). To use the same terms for a contrary definition is difficult reading. 5. ""pain" is used as an adjective/noun for ?"much" to do with the location, physiology and treatment of disease/injury resulting in pain." ie p managemnet, p fibres, p pathway, p specialist, p in foot, neck p. This might be another place to work from. Wanna define much? SmithBlue 07:06, 5 December 2006 (UTC)

1. The meaning of "action" may be being stretched a bit here, but I think people will understand it. "Event" may be more correct but to me less clear. Or "the action of experiencing it" can be replaced by "the experience itself". Other suggestions? 2. Easy. "pain receptor" means "a receptor which has something to do with pain", etc., according to the standard method in English of using any noun as an adjective. 3. "consciousness" is OK but to me makes the entire pair of definitions harder to understand -- I think more people will end up thinking "what is this trying to say? both these definitions seem to be the same thing." 4. I think what you mean is that "subjective experience" is the definition of nociception, and that using the words "subjective experience" when defining something located in the foot is confusing. I agree it's a little confusing; can you improve it? However, I don't think it's very confusing, because I'm making the distinction between the subjective experience itself, and the thing that is subjectively experienced. The mention of concrete body parts (foot and brain) in the defniitions makes this pretty clear, in my opinion. 5. "pain" is used as an adjective for anything having to do with pain. Thanks for working on improving a Wikipedia article. It's interactions like these that result in good, polished articles. --Coppertwig 14:32, 5 December 2006 (UTC)

4. No: pain is defined at beginning of article as "a subjective experience" (and so not open to direct measurement or comparison.) Nociception is a measurable physiological event. So using "what is subjectively experienced" is confusing. Writing about consciousness is just plain dificult I see now. 5. This looks like it may be an easier beginning for a second definition - no need to write deeply about consciouness or subjective experience. Have asked some experts to help on this but no sign of anyone yet.SmithBlue 15:38, 5 December 2006 (UTC)

Now you have me confused. What is nociception? --Coppertwig 05:05, 6 December 2006 (UTC)

Nociception is that subsection of the nervous system (and central nervous system) that carries information concerning insult to tissue. It includes receptors, nerve fibres and pathways in the spinal cord and (I think)areas within the brain. The information it delivers is used by the nervous system in many ways: often below the level of conscious awareness - reflex movements away from the point of activation of nociceptor, adjustment of sensitivity of nociception system,... (I dont know what else). And Sometimes the information is passed to the thalamus ( an area in the brain) at which point we first become consciously aware of an nonlocalised Pain. If it then goes to the ?somotosensory cortex the pain becomes localised in our awareness. If this is news to you then I'm fasinated by your ability to recognise the trashiness of my definitions of "pain". Assuming I've got nociception right how do we need to rewrite this article so that an intelligent motivated reader such as yourself can understand what its trying to convey? SmithBlue 16:58, 6 December 2006 (UTC)

Thank you so much for inviting me back to help edit. Re lack of previous familiarity with the term "nociception": a good person to test a definition is one who has no previous familiarity because such are the target audience. I think I got the two terms "pain" and "nociception" reversed at some point in this discussion. I hope I have them straight now.

The opening section still requires editing. I will make an attempt below. Please comment. Goals: internally consistent; smooth and flowing, pleasant to read; logically organized; spelling and grammar, as well as accuracy. Problems: awkward to read. First paragraph is great, but some of the rest gets bogged down. Link to "nociception" goes to a page listing a bunch of terms but "nociception" is not on the list. Confusing. Does not give the reader a clear idea of what "nociception" is or how it relates to pain.

Question: Can we say that nociception usually or normally results in pain? If not, can we say that nociception, when sufficiently intense or above a certain threshold, usually or normally results in pain? If not, could you explain again what nociception is?

You might want to consider creating a Wiktionary entry for nociception and linking to that, or finding some other, more informative link than the one you gave. (I only saw a list of other words, no info on nociception; did not read the whole page; if the info is there tell me where and I'll read it.)

I'm still not quite happy with the 3rd paragraph below, but here's my version -- what do you think? I have not changed the first paragraph, nor the last two paragraphs.

Pain is an unpleasant sensation, ranging in intensity from slight through severe to indescribable. Pain is experieced as having qualities such as sharp, throbbing, dull, nauseating, burning and shooting.

Pain is a subjective experience -- it occurs only in consciousness, in the mind. The severity and quality of pain is only describable by the person experiencing it. Pain usually results from nociception, (stimulation of specialized nerve receptors and transmitters in the body), when it is sufficiently intense to become consciously noticeable. Pain can also be experienced in response to both external percieved events, e.g. seeing something, or internal cognitive events, e.g. felt tightness in an amputated limb.

Pain often has both a emotional quality and a sensed bodily location. In plain words; you feel bad, and your body hurts somewhere, when you experience pain. This subjective reality of the localisation of pain to an area of the body is the basis for terms and phrases such as neck pain, cutaneous pain, and "pain in my back". Scientifically, nociception is the system which carries information about inflammation, damage or near-damage in tissue to the spinal cord and brain, while the term "pain" is reserved for the subjective experience, something which happens only in consciousness, not in the part of the body where the pain is felt.

Nociception frequently occurs below the level of consciouness without pain being felt. Despite it triggering pain and suffering, nociception is a critical component of the body's defense system. It is part of a rapid warning relay instructing the central nervous system to initiate motor neurons in order to minimize detected physical harm.

Lack of the ability to experience pain, as in the rare condition Congenital insensitivity to pain or Congenital Analgesia, can cause various health problems. The two most common forms of pain reported in the U.S. are headache and back pain. Pain is also a term specifically used to denote a painful uterine contraction occurring in childbirth.

The word "pain" comes from the Latin: poena meaning punishment, a fine, a penalty.

--Coppertwig 14:04, 8 December 2006 (UTC)

Glad to see you here Coppertwig. The temptation is to try and describe what the intro is meant to mean to you. But that, like you say, will not be taking advantage of the present situation. Cn we walk through the current entry (9-12)? If so (and looking at your combining paragraph above - "describable by the person experiencing it. Pain usually results from nociception,") Yes and no - if you are a stuntman then yes pain would ussually arise from nocoception - if you are a teenage drama queen pain would ussually arise from emotional sources. Here I want to check - do you get the vast difference between a physiological event and subjective experince? Physics and chemistry will describe one but the other is totally incomparable, in a very different dimension, it exists verifiably only for the person experincing it and is communicatable only by us assuming that something very similar is happening in the other persons head as well. Is this distinction familar to you? Cause thats a lot of the difference between nociception and pain. When you go to the doctor and say "since that fall I've been in a lot of pain" there is no way the doctor can verify the truthfulness of your claim. She can find out if you have nociception increased from your ?hip. But the pain is wholly in your consciousness and is unverifiable. If you havent "got" this from reading the first two paragraphs then what do we need to do there? (before we move to the next ones) SmithBlue 01:49, 9 December 2006 (UTC)

Hi. Hmm. "pain usually results from nociception" can mean two things. It can mean that when nociception occurs, pain usually follows. Would you say that is false? It can also mean that when pain occurs, it was usually a result of nociception. I think you're saying that one is false. That may be. Perhaps what I meant to say is more like this: the word "pain" describes something best exemplified by a result of nociception. I'm thinking in terms of radial categories as described by George Lakoff in his book "Women, Fire and Dangerous Things: What Categories Reveal About the Mind." In other words: emotional pain can well be called pain, but when someone is asked to come up with a good example of pain, they'll tend to see pain from nociception as a good example. Emotional pain is not a good example. Calling emotional pain "pain" is almost metaphorical. It's like if you're asked to give an example of a bird and you give a dead bird, or a baby bird, or an egg not yet hatched, or a bird such as an ostrich that can't fly. Well, they are birds. But they're not good examples of birds. A bird is a thing that flies (at least usually). Pain is something you feel when you're physically hurt (at least usually).

OK, here's another try for the 3rd paragraph (after "...only decribable by the person experiencing it.")

" Pain can result from nociception, (stimulation of specialized nerve receptors and transmitters in the body), when it is sufficiently intense to become consciously noticeable. Pain can also be experienced in response to both external perceived events, e.g. seeing something, or internal cognitive events, e.g. feeling tightness in an amputated limb."

You ask: "Here I want to check - do you get the vast difference between a physiological event and subjective experince? " Yes. And I think the phrase "physiological event" is clear. But "subjective experience" has three possible meanings. If I say "I have a pain in my (amputated) foot", we could say the subjective experience happens in the (amputated) foot. (Well, that's at least where it subjectively seems to be happening.) Or we could say it happens in the brain. I don't understand why you don't like to say that; maybe because parts of the spinal cord, nerves in the heart etc. are also involved in doing the sorts of things the brain does? Or we could say it happens in "consciousness" -- that seems to be just possibly getting out of the realm of the scientific. At least three meanings associated with these three locations, I think. So it's a little vague or ambiguous. That may or may not be a problem when trying to figure out what words need to be in the article.

I'm not sure that consciousness is in another dimension or is verifiable only by the person experiencing it. I think maybe when we find better tools for looking at the brain maybe we can see consciousness happening. For example, there was an experiment that looked at the time it takes people to compare two objects and decide whether they're the same or not, and the results seemed to suggest that people rotate a model of the object in their brain at a measurable speed. That could be called a study of consciousness or of an aspect of consciousness. As we advance in artificial intelligence these sorts of things may come under greater scrutiny. Again, this may or may not be a problem when choosing what words to include in the article.

Just because pain is only in our consciousness doesn't necessarily mean it's unverifiable. We could measure results of the pain: insomnia, heightened anxiety evidenced by quicker breathing, and other things could be evidence that the person was experiencing pain.

I think I "got" the distinction between consciousness and a physical event fine from the first two paragraphs, and that one of the problems is that the other paragraphs are boring because they're repeating some of the same information that has already been said. It needs to be snappier to keep the reader's attention. If anything needs to be discussed in detail it can be moved into one of the other sections where the reader is presumably already interested and paying full attention (though that would be happening in consciousness and unverifiable :-) --Coppertwig

Howdy - At present the best scientists and insurance companies can do is find neural events correlating with reported consciousness. Its these scientists who define Pain as a mind event. Health nsurance companies would love (big money) to be able to show whether someone is in pain or not. They cant. So at present, the quality of consciousness is only verififiable by the person experiencing it. Yes a lot of pain follows nociception. But it is in no way a consequence. Emotional pain is pain - ask someone who has just been betrayed by their best friend, lost their spouse in a car crash, Or ask someone who is about to commit suicide - "Why?". Already, like you say, the common thinking of the main cause of pain would be "Physical pain" (a slightly older physiological term for nociception). But this unfortunately just strengthens their thinking that pain is a consequence of nociception and some sort of neural event. (You yourself keep wanting it to be like this and you've read the introduction many times.) But science says no, so far it cant even come up with a widely accepted model of consciouness. Found an article on the hard problem of consciousness [4]

I like your idea of keeping it snappy - I've made a sandbox AlternativeUniverse2 linking from my talk page and will experiment there with more like the first two paragraphs. Will attempt to flow on through without laboring point on consciousness and let it have a section later in article. I suspect this is wrong but I dont know enough - "when it is sufficiently intense to become consciously noticeable." SmithBlue 08:46, 9 December 2006 (UTC)

You seem to be implying that pain is not a consequence of nociception. I don't follow at all. I thought you were defining nociception as the signals going from damaged body parts (for example) towards the brain and (sometimes) resulting in pain. If that's not it, then tell me again what nociception is. You're really getting me confused. —The preceding unsigned comment was added by Coppertwig (talk • contribs) 03:18, 10 December 2006 (UTC).

Hi Coppertwig - sorry if I'm getting you confused. In terms of cause and consequence , pain is a possible consequence of nociception (I acknowlege this contradicts what I wrote above - apologies) I think "when it is sufficiently intense to become consciously noticeable." is wrong because it may not be the intensity of the nociception that determines whether pain is experienced but rather how consciouness in functioning at the time. But then again consciousness may be able to desensitise nociception so that little nociception is occuring in the brain. In which case you'd be right. Or we could both be right ... Writing this its obvious to me that I dont know enough to edit this article at the moment. I've put together my understanding of a ?easily understandable, internally consistent, Possibly verifiable intro in my sandbox [[5]] but until I've got sources for stated facts I'm not going to develop Pain. Thanks for your edits and contributions over the past weeks - I've learn a lot and will at least have good questions for future editors here. SmithBlue 10:05, 10 December 2006 (UTC)

Thanks for your collaborative style. My main objection in the beginning was that one part of the article was saying that another part of the article was wrong. When I said something about the nociception being intense enough to be noticed in consciousness, I realized that the threshold would vary based on things like how busy the person was; but I figured that (at least almost always) given the state of the mind there would be a threshold above which the nociception would result in pain. I didn't mention that, in order to keep things simple. By the way, I don't know whether you count headache as emotional pain. I count it as physical pain. I find "pain in my foot" to be a better example than "pain in my back" because the back contains the spinal cord, part of the central nervous system, leading to possible confusion about where the pain is located (i.e. in the body part or in the central nervous system or in consciousness); the foot is the most distant part, maximally reducing this confusion (as well as being a part that occasionally gets stepped on or stubbed. That reminds me of an Ambroise Bierce definition: "Shin: a device for finding furniture in the dark" :-) --Coppertwig 02:38, 12 December 2006 (UTC)

Hi Coppertwig - you are right about "pain in my foot" being less confusing. Changed that. I too think that headaches arise from nociception (physiological pain) and are sensed as "physical pain". (Sorry trying to be overly pedantic and funny - didnt quite work.) I come from a science background and like my definitions to be all encompassing. Even absolute. Which works great for science but not well for other areas. So when I think of a soldier shot in the leg (heaps of nociception happening) who doesnt notice it at all until dismounting and finding an ankle one third missing, I say "no I dont thinks its an amount of nociception" It may well be some sort of threshold of consciousness. But I diont know." However at the moment as long as no-one is claiming that pain is the neural correlate of gravity or caused by Neptune I dont mind. Are you OK with the renaming of the topic to "Pain and nociception" ? - with the conflicting uses it seems impossible to explain pain without teasing out nociception. SmithBlue 03:11, 12 December 2006 (UTC)

Pain is a subjective experience....

172.200.74.209; (depending on interpretation this statement is either too obvious to be worth mentioning, or probably wrong) "Pain is a subjective experience: it occurs only in consciousness, in the mind. The severity and quality of pain is only describable by the person experiencing it." What interpretations do you have and which is wrong and which trivial? SmithBlue 15:20, 11 December 2006 (UTC)

This statement is confusing. However, the subjective nature of pain is paramount to understanding it, and we should build on this topic in the article. I'm drawing on my experience as a medical student in pain clinics, especially with children. --Ryan Blum 23:24, 24 February 2007 (UTC)

nociception (syn. nociperception)

nociception (syn. nociperception, physiological pain) Google; 578,000 for nociception, 6,600 for nociperception, 10,700 for "physiological pain". SmithBlue 23:58, 11 December 2006 (UTC)

== "can sometimes follow from nociception" ==

I object to the phrase "can sometimes follow from nociception" in the introduction. This statement is highly confusing. It gives the impression that nociception is some rare phenomenon, like the pain felt in amputated limbs. Many readers will not be familiar with the term "nociception". My understanding is that "nociception" is actually the usual mechanism causing ordinary pain (as opposed to emotional pain). The phrase "can sometimes follow from nociception" is a massive understatement (unless nociception actually is some rare phenomenon. I'd like to see a definition of nociception.)

Please do not edit the opening section of this article in ways that go against what any editor is expressing here while discussion is in progress.

Does anyone particularly like the "can sometimes follow from nociception" bit? If so, we can look for wording that satisfies both. Please state clearly that you like that phrase and why. If no one speaks up I'll edit it out. --Coppertwig 14:11, 12 December 2006 (UTC)

Actually, unless someone can supply a reference to a definition of "nociception" in an authoritative source, I would like to edit that word out of the article completely. --Coppertwig 14:13, 12 December 2006 (UTC)

from http://sulcus.berkeley.edu/mcb/165_001/papers/manuscripts/_804.html "Nociception, itself, is comprised of four basic processes .... The first process is known as transduction and involves the translation of noxious stimuli into electrical activity at sensory endings of nerves. ... The second and third processes are known as transmission and modulation and can be considered simultaneously. Transmission involves activation of peripheral receptors with subsequent depolarization of their axons. It is these axons that relay information to their cell bodies in the dorsal root ganglion .... Modulation involves the modification of nociceptive transmission at the level of the spinal cord. Nociceptive fibers enter the spinal cord through Lissauer's tract,..... The dorsal horn, itself, is a processing center for information and is made up of many distinct layers of neurons with varying morphology and function. The dorsal horn basically serves as a "complex neuronal switching station" that filters, attenuates, and amplifies sensory input before relaying this information to other spinal segments ...."

Section B 2. from NP(Nurse Practioner)Central http://www.npcentral.net/ce/pain/section1.shtml states "Nociception refers to the process by which information about tissue damage is conveyed to the central nervous system (CNS)." SmithBlue 16:13, 12 December 2006 (UTC)

Hi Coppertwig - thought this Pain definition seemed very concise "International Association for the Study of Pain is as follows: "An unpleasant sensory and emotional experience normally associated with tissue damage or described in terms of such damage." and then "Pain is whatever the experiencing person says it is, and exists whenever he says it does."(via - http://www.sign.ac.uk/guidelines/fulltext/44/references.html#3 - McCaffery M. Nursing management of the patient in pain. Philadelphia, Pa: JB Lippincott 1972.) SmithBlue 07:11, 13 December 2006 (UTC)SmithBlue 07:24, 13 December 2006 (UTC)

Hi. OK, well, we sort-of have a definition of nociception but not really. That web page you gave says "Term Paper". That gives the impression that it's an essay someone did for their homework. We need an authoritative definition. What about that International Association for the Study of Pain? They define "nociceptor" but not "nociception" as far as I can see. It would be good to provide a link, in the article, to an authoritative definition of nociception. (I tried a dictionary and again got a related term but not that particular term.) However, I won't insist on deleting the word from the article.

Aha! "normally associated with tissue damage" -- that's what I was trying to get at. The phrase "pain usually follows from nociception" is ambiguous. It could mean "whenever pain happens, there was usually nociception involved". That's what I meant. But you interpreted it as "whenever nociception happens, there's usually pain involved." which is quite different and not what I was trying to claim. We just have to find the right wording.

I would also like to delete this sentence: "This usage of "pain" is often inconsistent with pain being a subjective experience and occurs frequently in much communication on this subject and contrasts to the definition given below." This seems to be claiming that it's wrong to say "foot pain". But you've provided a quote saying "Pain is whatever the experiencing person says it is", and anyway, people aren't going to stop saying "foot pain". I don't consider it wrong. I disagree with the assertion "This usage of "pain" is often inconsistent with pain being a subjective experience." I don't think that's true. A person can be well aware of pain being a subjective experience and still say "foot pain" or "pain receptor". --Coppertwig 02:25, 15 December 2006 (UTC)

Hi Coppertwig - didnt see "term paper". What did you think of the Nurse Practitioner Central definition of nociception? Section B 2. http://www.npcentral.net/ce/pain/section1.shtml Yes the way the IASP puts it is very inclusive of all pain. It makes my atttempts about" inconsistent etc" irrelevant for the intro. Delete them please. The IASP had a panel of experts working for some time to come up with their definition. At least we have the good sense to recognise its value.By including ""Pain is whatever the experiencing person says it is, and exists whenever he says it does." McCafferey"" we'd have the subjective experience POV confirmed with a cited source. SmithBlue 03:32, 15 December 2006 (UTC)

I think the IASP definition is ideal for intro. Read no further if intro is your focus. Found info on research into nociception - "Feinstein and colleagues injected lateral interspinous process tissues with hypertonic saline and mapped out local and referred pain patterns." BUT "Certain subjects who were injected with hypertonic saline complained little of pain, and instead,... "were overwhelmed by a distressing complex of symptoms." These patients suffered with pallor, sweating, bradycardia, a drop in blood pressure, subjective "faintness," nausea and syncope. ... these visceral manifestations "were not proportional to the severity of or to the extent of pain radiation; on the contrary, they seemed to dominate the experience of subjects who complained of little pain." ..."this is an example of the ability of deep noxious stimulation to activate generalized autonomie responses independently of the relay of pain to conscious levels." ...In short, we need to appreciate that we are not all wired in the same neurological pattern. One thing is for sure: It is an extraordinary mistake to equate nociception with pain. Nociception is not pain. Nociception is the reception of a noxious stimulus, and this can lead to the experience of local pain, referred pain, or visceral symptoms." citation seen at http://findarticles.com/p/articles/mi_qa3987/is_200603/ai_n16117205/pg_2 SmithBlue 10:49, 20 December 2006 (UTC)

"Nociception is the term introduced almost 100 years ago by the great physiologist Sherrington (1906) to make clear the distinction between detection of a noxious event or a potentially harmful event and the psychological and other responses to it."

"Assessing Pain and Distress: A Veterinary Behaviorist's Perspective by Kathryn Bayne" in "Definition of Pain and Distress and Reporting Requirements for Laboratory Animals: Proceedings of the Workshop Held June 22, 2000 (2000)" pg 23 (http://fermat.nap.edu/books/0309072913/html/23.html) SmithBlue 11:09, 20 December 2006 (UTC)

I'm happy with the intro as it reads now. Thanks everyone for collaborating. --Coppertwig 14:22, 6 January 2007 (UTC)

Disambiguation

Now that the article is Pain and nociception rather than just pain, I've noticed that it doesn't seem possible to get to the Pain disambiguation page, but am not sure of what would be the best way to go about fixing this, thanks, Shad3z 11:01, 19 December 2006 (UTC)

OK, someone has fixed this with an otheruses template at the top of the article with a link to the disambiguation page. --Coppertwig 17:51, 6 January 2007 (UTC)

Pain as a weapon/punishment

Though this article covers a wide range of material, I still feel this area should be included as well. Use of pain as some sort of a threat or punishment as in severe cases such as torture, beatings etc, or less severe cases, such as smacking, should be covered. I also would like to see some small mention of sadism/masochism, though it doesn't exactly fit in well with these other ideas, so may require a small section of its own. Richard001 04:13, 15 January 2007 (UTC)

Quick review of article

Since I've just read the article and given it a quality rating, I thought I'd post some comments on what I feel it needs to become A-class.

Though the POV is pretty minimal in the article, some areas (mainly at the beginning) have a few comments that seem more like the opinion of the editor than a neutral discussion of the topic. If opinions are to be inserted in the article it would be a lot better to have a citation with them.
Missing or improperly formatted citations (this is quite a problem at the present time).
One of my main concerns was the article's appearance - quite easy to fix, but it looks rather messy at the moment. This includes spelling mistakes, many red links, poorly structured paragraphs, overuse of boldface etc.
A few minor areas not covered or not in enough detail. Some areas to add or expand include
- Use of pain as a tool (e.g. torture)
- Communication of pain (e.g. in animal language)
- Perhaps a little more on the philosophy of pain (e.g. multiple realizability)
- More on the evolution of pain (tying in with survival and pain in other species)
- More on pain in non-human animals (e.g. a survey of the history of human attitudes toward animal feelings (e.g. Descartes theory) and a mention of animal rights and related laws today).

Finally (though fairly trivially) a few images would be nice :)

Overall it's a good article which still needs a bit more work. Given the scope of the subject and length of the article its clear a lot of work has been put into it by its editors. It would be great to see the remaining problems ironed out and have this important topic reach GA or even FA-class. Richard001 05:17, 15 January 2007 (UTC)

Pain and alternative medicine

In the 'Pain and alternative medicine' Section it is claimed that in the traditonal Chinese medicine pain is viewed 'as "stagnation of blood" - theorized as dehydration inhibiting metabolism.' Could a citation for the second part of this claim be provided?

I don't think it accurate or acceptable to cite a book that states "scientist say" as valid support for a statement. Without a citation to a scientific study (one from a peer-reviewed) journal, the statement should not be considered supported. One could easily opine that placebo effect (the unconcious desire to have something happen manifested as a report that something did happen) is just as valid an argument. I would love to see the citation for the study that gave a bunch of people opiod blockers or placebos (it would need to be double-blind for validity) and then performed accupuncture.

Assistance needed

I have run across the article dolorimeter, about devices for measuring pain. Does anyone want to help? It is in sort of sad shape. And I need good reference materials/reviews to work from.--Filll 16:26, 24 January 2007 (UTC)

Heartache

Is it pain too? And what makes heartache inside a human unit? That s what I m missing a little bit outside there in the article. ff JaHn 20:53, 1 February 2007 (UTC)

See Broken heart, Psychological pain, and Suffering. I am trying, within this encyclopedia, to straighten out the ambiguous or conflated or entangled meanings of the words pain and suffering. That is a long-term task that I am just beginning, taking as a basis the definition of suffering that is used in the article Suffering and that of pain in Pain. From there, corrections would have to be made in broken heart, psychological pain, and a host of other articles. Robert Daoust 23:34, 1 February 2007 (UTC)

Robert Daoust, I am glad someone else will try. I came and found many islands of articles on pain, but very few connections between them. I tried to establish a few crosslinks, but I am pretty sure I did not do a very good job and I did not do a complete job either. I am not a specialist in pain or medicine. If you have any background in pain and medicine, I would love your assistance at dol and dolorimeter and pain scales. I think there is a lot more that can be done.--Filll 00:29, 2 February 2007 (UTC)

Your contributions about pain in Wikipedia look great to me, Fill. I would be happy to collaborate with you. Pain however is not my specialty, pain measurement even less. My specialty is the topic of suffering. Since pain is a major kind of suffering though, I have spent much time studying it : hopefully, I'll be useful... Robert Daoust 16:52, 3 February 2007 (UTC)

Shaking due to pain

Nice edit Wastelander, but could you bring a reference? The shaking you describe seems due to shock rather than pain. Robert Daoust 01:42, 1 September 2007 (UTC)

I'm moving it to the talk page until it can be sourced. It's below. It needs a reliable source and a re-write for tone if it's actually true. WLU 00:33, 4 September 2007 (UTC)

One of the effects of being in pain is shaking. When a person experiences an extreme, or continuous pain, they start to shake. This is an effect of the nervous system's responce to pain. Putting nerves in absolute, constant feelings of pain, it causes the person to shake, which usually causes the person to feel cold, or have very long, painful periods where the person blacks out in the mind, and starts to fall asleep. Note that having these shaking effects cannot be caused by headaches, but can be caused by serious cut wounds, high fevers, or developing infections. Common household medicines don't have a quick or effective reaction to the shaking. Usually, the best thing to do is sleep off the the shaking, so that when you wake up, your nervous system will have had time to repair the wound, or to calm itself down.

"Disputed" tag - first sentence

The lead sentence is very misleading.

"Pain is a sensation transmitted from sensory nerves through the spinal cord and to the sensory area of the cerebrum, where the sensation is perceived."

What is being transmitted by the sensory nerves is nociception. Pain MAY happen if nociception triggers conscious sensation.

As well as being misled into thinking that "nervous activity from nociceptors = pain", most readers will not understand that the "sensation" in the phrase "Pain is a sensation transmitted from sensory nerves..." is nonconscious, non-percieved, not felt, that "sensation" is being used in the non-common usage of psychological science. So most reader will not understand that what is being transmitted by the nerves may or may not result in pain being percieved/felt

If the article is to include the term "nociception" then it needs to keep differentiating between pain and nociception where practicable.

Other than this first sentence the rest of the present section is very well done - congratulations editors. SmithBlue 03:04, 24 October 2007 (UTC)

Thank you for your comment! Could you please rephrase this first sentence. Lova Falk 09:23, 24 October 2007 (UTC)

The easiest way seems to be to delete it - the lead section is then internally congruent and congruent with article title "Pain and nociception" - by going into anatomical and physiological psychology detail in the first sentence we bang into ways in which "pain" has been used (and is used still) in place of nociception. Its a very interesting insight into language evolving. But totally out of place in an introduction. I think the lead section (minus 1st sentence) does a good job of being clear and accurate and presenting all the basic information. Anatomy and psychology can be better explained in their own section later in the article.

I wont be able to edit for the next 9 days or so - feel free to remove the disputed tag if it is annoying anyone - not that I accept the 1st sentence - just that I wont be here to discuss. SmithBlue 04:41, 26 October 2007 (UTC)

November edits

My addition on the importance of multifocus treatment for chronic pain is undisputed largely, for a citation just ask your doctor or search google for `imporance of combined treatment for chronic pain` please.

I have also added a brief reference for pulsed radiofrequency for chronic pain. One of the reasons popular knowledge of this treatment modality is not spreading as fast as it should, given its results is that nobody has a patent on it, and therefore drug companies do not shovel money at making people, including general practitioners, aware about its very existence. In addition the anesthetic of choice during the procedure, Ketamine HCL, is over forty years old and likewise there is no patent, and no great potential for the large drug companies to absorb money.

I have, also on humanitarian grounds, added a small tidbit of advice for chronic pain patients about what they should expect and request from their doctor in terms of co-ordination of their treatment. While such information perhaps does not belong in an encyclopedia, i feel that it is done in the spirit of the green tree you have at the top of all pages and statements about making the world better, (certainly from those who suffer from chronic pain.) These people are often in a desperate state!!! Neutral tidbits of advice may be helpful as they often fall victim to charlatans. Recently, there was an article on how chronic pain patients receive atrocious treatment worldwide, compared with what could be done for a few dollars to alleviate their pain, in the New York Timees

Feel free to move my text about as you see fit.

I will attempt several posts about, particularly severe pain, but also pain in general based on my medical training, research, and experiences; where such posts are appropriate. I do have an agenda and that is better treatment of pain worldwide, the US is actually ahead here. I will dedicate my writings to the large number of chronic pain suffererers who each year committ suicide for no other reason, no psyc Hx, or other problems. The pain simply becomes so severe, akin to torture so they could not bear it. A large number of Physicians fail to approptiately treat, because the patient is not coming in with a tree branch stuck through their arm, or a gunshot wound to their thigh- (Which may actually not nearly be as bad as a pain spike for a patient with chronic pain.) Less blood- less interesting... There also exists a chasm between the treatment offered to chronic cancer sufferers and chronic pain from other causes. Yet, the brain cannot tell the difference between for instance a vertebral disc pressing on a nerve, or a tumor doing the very same thing.

Please dispute my assertions if you would like to do so; However, fellow wikipedians I promise to publish articles only with a solid scientific, or othrt source foundation. I will do all i can to keep any posts on articles opinion free unless one would be appropriate, I will try to keep opinions here in the discussion area. At least now you know what my agenda is. K. Larsgard

84.208.103.93 (talk) 12:36, 21 November 2007 (UTC) 84.208.103.93 (talk) 12:36, 21 November 2007 (UTC)

I have removed a newly added section from chronic pain as it needs discussing, rephrasing and work to follow policy and guidelines of teh encyclopaedia:

An important medical treatment which is currently gaining popularity is pulsed radiofrequency or also known as pulsed radiofrequency denervation (the latter somewhat of a misnomer as no nerves are removed or destroyed.) Its rise in popularity is mainly due to increased awareness among physicians.

Pulsed radiofrequency is an interventional procedure worthy of consideration in all chronic pain patients, along, naturally, with a comprehensive pain treatment program. It is of immense importance that chronic pain patients receive coordinated multiple interventions. By this I mean pharmacologial treatment, counseling, psychological consultation, support groups, physical therapy, occupational therapy, and others. Many Pain Clinics offer such services, or the the patient`s general practitioner (Family Doctor) can arrange for it. The general practitioner, in my opinion, since he knows the patient, is the best person to coordinate and follow up chronic pain patients.

A word to chronic pain patients: make sure your Doctor understands that he is the main pracritioner whose responsibility it is to act on specialist conclusions, coordinate your treatment, follow up on your various treatment modalities, and act such that your quality of life is as good as it may be.

A discussion on treatment needs follow after discusion on the nature of a condition. Also common or initial approaches need be covered before a developing new therapy.
Wikipedia does not give advice nor instruction to readers/patients. So "I have, also on humanitarian grounds, added a small tidbit of advice for chronic pain patients about what they should expect and request from their doctor in terms of co-ordination of their treatment." is against policy
I do not dispute that multidisciplinary approach to Chronic Pain is required, nor that a selection of treatment modalities, and as a GP I would totally agree about role of GP to act as a focus to help co-ordinate provision of care. However material added to encyclopaedia must be supported, hence need WP:Cite from WP:Reliable sources in order to WP:Verify - and responsibility for this is with the editor who adds (but of course one hopes everyone else tries to help out)
The above therefore needs be rephrase, removing the personal opinions (the "I...") as we allow No original research. Instead it needs make reference to a suitable national guideline, journal paper or suitable textbook on the topic. David Ruben ^Talk 14:29, 21 November 2007 (UTC)

Dead link

Hi

I just noticed this reference is a dead link

Pain Map PDF from Nature.com

Cheers —Preceding unsigned comment added by Anthonyhcole (talk • contribs) 06:29, 8 December 2007 (UTC)

Thank you! I removed the link. Next time, may be you would like to be bold and remove it yourself... :) Lova Falk (talk) 09:13, 8 December 2007 (UTC)

Focusing on humans

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)

I agree that for nociception the article would be better if it focussed on animals. But for pain we have a problem - pain is defined as an experience and by long convention humans attribute experiences to each other - we act as if we knew what was happening experientailly for another human. With animals doing this is considered "non-scientific" and "anthropomorphising". Science in general takes the view that we can only infer the experience of pain in non-human animals. (That we can cognitively only infer the experience of other human is perhaps not promoted widely by scientists as doing so would be politically destructive of a career and seen as Nazi/inhumane/immoral/unethical.) Which means that most of the avaiable info on pain is on human pain. If you have the time and inclination to find well sourced material on animal pain then please bring it here so we can find a way to include it in Wikipedia. SmithBlue (talk) 00:29, 20 March 2008 (UTC)

Pain pathways vs. acupuncture meridians?

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[6], 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)

"PQRST"

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)

"Disease of pain"?

Never heard of it. Fibromyalgia, maybe? Zickx009 (talk) 02:22, 26 February 2008 (UTC)

"...relief of chronic conditions such as migraine and backache. Chronic pain, unlike the acute pain associated with trauma, has no apparent physiological benefit, often being referred to as the 'disease of pain'." [[7]] SmithBlue (talk) 00:10, 20 March 2008 (UTC)

While it's obviously not a technical term and that article isn't a primary source, at least now I believe that there are people who actually call chronic pain "the disease of pain." I certainly wouldn't mention that if I were writing a paper on pain because I don't think it's particularly useful or interesting, but I'm open to leaving it in.Zickx009 (talk) 19:14, 21 March 2008 (UTC)

Definitions of Pain

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)

The McCaffrey quote: This definition recognises that "pain", in part, is a "construct of language" formed by individuals. As a working definition that is in use by nurses and stated in a nursing textbook it is a valuable definition to have in this article.

"Melzack and Wall" - I agree it is not a complete definition. However it is not merely about complex/simple - Melzak and Wall are explicitly categorizing pain as an experience. Melzak and Wall were the pain experts of the 20th centuary. I think including this material in the article would be advantageous - most readers erroneously think that pain is a physiological event - not an experience. I agree that the present header/layout could be improved upon.

I am interested in working to improve this article and would appreciate your further input. 23:35, 19 March 2008 (UTC)

The "McCaffery M., Nursing management of the patient in pain." definition is the one that they teach to new british nurses (don't know about doctors) while they are being trained. ^{(Hypnosadist)} 06:42, 20 March 2008 (UTC)

My point is that these are not definitions of pain. If someone asked you what pain was, saying "it's whatever we say it is," or "it's a set of complex experiences" would not be sufficient and would leave your questioner confused. These quotes describe properties of pain but they are not definitions. I do agree that the ideas that pain is a "construct of language" and that it is an experience rather than a physiological event are both very important and should be addressed in the article. Perhaps a new section could be devoted to the subjective nature of pain? That would provide a good place to insert these quotes as well.Zickx009 (talk) 19:26, 21 March 2008 (UTC)

I disagree, these are both experiential definitions, what we need is more definitions based on biology. ^{(Hypnosadist)} 14:13, 23 March 2008 (UTC)

Given that pain is by definition subjective/experiential I am curious as to what sort of biological definition you are referring to. Please explain. SmithBlue (talk) 07:34, 24 March 2008 (UTC)

I don't believe that Zickx009 is saying that pain is (just) non-physiological. I believe he said only that these two ideas ("contruct of language" and "experience") need to be included in the article. WhatamIdoing (talk) 15:52, 23 March 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)

SmithBlue, I think you're missing the critical issue here. You cannot use a definition to prove itself right. This is a disputed definition. You need to find something more than an assertion of this definition to prove it "right." So far all you've done is prove that "some people define pain this way" -- which is true enough, but some people define pain in other ways, too. WhatamIdoing (talk) 19:57, 24 March 2008 (UTC)

I am not using a defintion to prove that definition right. I am not saying that McCaffrey's def should be the basis or the only definition of pain offered in this article. I am saying that McCaffrey's definition is a important, currently used, notable, unique addtion to the material in this article coming from a WP:VER and WP:RS tertiary (textbook) source. I am not seeking to prove this definition "right" - just showing that it meets and exceeds the standards for inclusion into this article. I do not understand why you think I am trying to prove this definition right. Please explain. SmithBlue (talk) 07:25, 26 March 2008 (UTC)

I understand your statement, "Given that pain is by definition subjective/experiential..." to mean that you do not believe even in the possibility of any non-experiential definition. The mere fact that someone has defined pain as subjective has excluded for you any objective definitions. I would certainly include subjective definitions, but I am opposed to presenting them as True™ or as the only options. WhatamIdoing (talk) 18:47, 26 March 2008 (UTC)

alternate approaches to pain

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)

The studies you present above are into physiological or behavioral correlates of pain. All indicators mentioned can be present in exactly the same way as present when pain is present without pain being experienced. I agree that the indicators cited may well show that if the person is normally conscious with a normal nervous system then its likely they are experiencing pain. neurotransmitter levels - "Many pain researchers are sceptical about whether such a test is possible.", changes in oxygen saturation - "The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2", skin conductance - "objective method for measuring the stress response to painful stimuli in premature infants". I will stop going thru the research you cite here and say that it appears very unlikely that a definitive behavioral or physiological analog of pain has been found. Maybe this work will bear fruit but at present the first 3 studies given do not show an functioning definition of pain as other than as an experience. I very much doubt that the others do otherwise. If so pls show me. I support the inclusion in the article of physical and behavioral correlates of pain but see no evidence for pain being other than essentially experiential and subjective.

My understanding of vetinary work comes from the citation in the article - something like "we act as if the animal is experiencing pain if this seems reasonable." I have no doubt that snakes experience pain - but I can find no scientific studies showing that conclusively. If you can find them pls bring them to the article. (Have made this a new section cause I think its very interesting.) Seriously, maybe we need to find sources for the way pain is ascribed to fellow humans and many animals without anything more than self-reports by humans and each individuals own experience of pain to go on? SmithBlue (talk) 07:25, 26 March 2008 (UTC)

You have misrepresented the second study entirely: the "expert raters" were people looking at babies and guessing whether this one or that one appeared to be in pain. That they didn't always agree with each other ("agreement between expert raters") is hardly surprising, and has nothing to do with whether the babies were in pain or even on what the objective measures turned up.

But what I want from you is this: If you take a machete and whack a snake in half, or if you step on a cockroach, or if you pull the wings off of a housefly, what counts as pain for that animal according to you? These animals do not "experience" anything like we do. They do not have emotions. You seem to believe that pain is solely a subjective experience, which has more to do with how we psychologically respond to a situation than with, say, nerve signals. These animals have no emotions. These insects barely even have what we'd call memory. Would you describe these events as pain-free for the animal, since they have no capacity to understand, symbolically organize, or remember them? WhatamIdoing (talk) 19:05, 26 March 2008 (UTC)

I disagree that I misrepresented the changes in oxygen saturation study - "Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI" indicated to me that the study is about pain indicators, not a non-experential, non-subjective definition of pain. Objective measures are behavioral or physiological events - if there is a scientifically accepted objective definitin of pain in terms of physiological or behavioral events please bring it here.

Nociception - this, I understand, is scientifically accepted as the usual response of all? animal's nervous systems to injury. In our culture it is common to ascibe pain for an injured fly - so no I wouldn't describe the injured animals as "pain-free" but nor can I find scientific work that says that they definately experience pain. What is the relevance of your question to this article? SmithBlue (talk) 21:23, 26 March 2008 (UTC)

Because I think that this question illustrates the problem with the article. We are representing pain in this article in a way that requires a psychological component -- the one, True™, scientific definition of a "subjective conscious experience." We are therefore representing pain in this article as something that never happens to simpler animals. We are also, BTW, defining pain as something that never affects people who are in comas, or people with sufficient brain damage, or even babies that were born a few hours ago. I think this is misleading, at best, and absolutely horrifying in some contexts.

So: You would probably say that the snake finds being cut in half painful. You would likely support anesthesia for people with severe dementia, if (for example) they needed surgery. You would likely oppose doing surgery on a newborn without proper painkillers (despite some surgeons saying that it's not worth the risk because "babies aren't developed enough to really experience pain"). You would likely do this because you think it's not nice to needlessly inflict pain on people or animals.

Now: where in this article do we have a definition that supports this basic, common, everyday understanding of pain? I'm not finding it. And I think it should be present. WhatamIdoing (talk) 21:56, 26 March 2008 (UTC)

Yes On what you have written about including the basic, common, everyday understanding of pain we agree furiously! Do you have suggestions on what material from what sources we need to bring to this article? SmithBlue (talk) 22:28, 26 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."[8] 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:

History of pain definitions

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.

Pain as nociception without emotions

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?)

Psychological response without any sort of nociception

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)

Some possible causes of pain by region

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 too would like to know the rationale of the contributing editor. Maybe there is a good arguement to be made for its inclusion that I cant think of at the moment. I'll look in history section and see who I can find. Material doesnt seem to require immediate removal. SmithBlue (talk) 03:56, 21 March 2008 (UTC)

I've assumed that its purpose was primarily for the convenience of readers who want to know what might be causing a specific pain. So you go to Pain and it helps you find Shoulder pain, or something like that. WhatamIdoing (talk) 04:43, 21 March 2008 (UTC)

I has been quite a while since I made changes to the article. So, I'm not sure what I was thinking at the time. I think the section has some use. Pain has a biologic function and its location is often key to identifying its cause. Other factors are the onset of the pain, its character, intensity, provoking factors, alleviating factor, quality and change with time. It could be split-out into a separate article and made a lot longer. If you want more opinions from people that edit medicine-related articles, you can solicit more opinions at WP:MED. Nephron T|C 05:36, 21 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)

Suggestions for med collaboration of the week

My suggestions are pretty basic, but here they are:

Pubmed and scholarly book citations to justify information on the page
Expansion of sections with referenced information, in particular, sections lacking main articles
Addition of treatment information - opiate and non-opiate drugs (possibly just expand management section)
Expand mechanism by which drugs reduce pain
Expand to comprehensive, or delete section on Pain and nociception#Causes of pain by region based on editorial and professional judgement.

WLU (talk) 21:41, 29 March 2008 (UTC)

This is an archive of past discussions about Pain. 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.

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^ McCaffery M., Nursing management of the patient in pain. Philadelphia, Pa: Lippincott 1972.
^ Melzack R, Wall PD. The Challenge of Pain. Penguin: Harmondsworth, 1982

[1] McCaffery M., Nursing management of the patient in pain. Philadelphia, Pa: Lippincott 1972.

[2] Melzack R, Wall PD. The Challenge of Pain. Penguin: Harmondsworth, 1982

[1]

[2]