Table Of ContentSimon van Rysewyk Editor
Meanings
of Pain
Meanings of Pain
Simon van Rysewyk
Editor
Meanings of Pain
123
Editor
Simon vanRysewyk
Department ofPhilosophy andGender
Studies
Schoolof Humanities
University of Tasmania
Hobart, TAS
Australia
ISBN978-3-319-49021-2 ISBN978-3-319-49022-9 (eBook)
DOI 10.1007/978-3-319-49022-9
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For Elina, and all people who struggle
with pain
Contents
1 A Call for Study on the Meanings of Pain ... .... .... ..... .... 1
Simon van Rysewyk
2 Pain and the Dangers of Objectivity .... .... .... .... ..... .... 23
Stuart W.G. Derbyshire
3 Neural Plasticity and the Malleability of Pain. .... .... ..... .... 37
Grant Gillett
4 The Emotional Perception of Phantom Limb Pain. .... ..... .... 55
Magali Fernández-Salazar
5 Is Pain Unreal?.... .... ..... .... .... .... .... .... ..... .... 71
Simon van Rysewyk
6 The Contribution of New Technological Breakthroughs
to the Neuroscientific Research of Pain Communication ..... .... 87
Aurore Meugnot and Philip L. Jackson
7 A Scientific and Philosophical Analysis of Meanings
of Pain in Studies of Pain and Suffering . .... .... .... ..... .... 107
Bustan Smadar
8 An Interpretative Phenomenological Analysis of Non-Malignant
Chronic Low Back Pain . ..... .... .... .... .... .... ..... .... 129
Sherrill Snelgrove
9 Phenomenology of Chronic Pain: De-Personalization
and Re-Personalization.. ..... .... .... .... .... .... ..... .... 147
Saulius Geniusas
10 Pain Experience and Structures of Attention:
A Phenomenological Approach. .... .... .... .... .... ..... .... 165
Agustín Serrano de Haro
vii
viii Contents
11 Should Investigators Introspect on Their Own Pain
Experiences as Study Co-Participants? .. .... .... .... ..... .... 181
Simon van Rysewyk and Carl L. von Baeyer
12 The Moral Experience of the Person with Chronic Pain ..... .... 195
Ian Edwards
13 Chronic Pain and Meaning in Life: Challenge and Change... .... 211
Jessie Dezutter, Laura Dewitte and Siebrecht Vanhooren
14 The Lived Experience of Pain-Related Fear in People
with Chronic Low Back Pain.. .... .... .... .... .... ..... .... 227
Samantha Bunzli, Anne Smith, Rob Schütze and Peter O’Sullivan
15 Conceptualising Secondary Pain Affect: The More Personal
and Elaborate Feelings .. ..... .... .... .... .... .... ..... .... 251
Drew Carter
16 Mental Imagery in Chronic Pain: An Access to Meaning
Beyond Words. .... .... ..... .... .... .... .... .... ..... .... 267
Chantal Berna
17 The Challenge of Validating the Experience of Chronic Pain:
The Importance of Intersubjectivity and Reframing ... ..... .... 281
John Quintner and Milton Cohen
18 Meanings of Chronic Pain in Patient Interactions
with Health Services .... ..... .... .... .... .... .... ..... .... 295
Karin Säll Hansson, Carina Elmqvist, Gunilla Lindqvist
and Kent Stening
19 Making Sense: Regaining Self-Coherence .... .... .... ..... .... 309
Bronwyn Lennox Thompson
20 Seeking Order Amidst the Chaos: The Role of Metaphor
Within Pain Reconceptualisation ... .... .... .... .... ..... .... 325
Mike Stewart
21 The Social Side of Pain: What Does it Mean to Feel
Another’s Pain?.... .... ..... .... .... .... .... .... ..... .... 355
Melita J. Giummarra, Lincoln M. Tracy, Kurtis A. Young
and Bernadette M. Fitzgibbon
22 Tests and Models to Study Pain in Animal-Based
Translational Research.. ..... .... .... .... .... .... ..... .... 375
Michel Barrot, Eric Salvat and Ipek Yalcin
23 Animal Pain: The Limits of Meaning ... .... .... .... ..... .... 389
David B. Morris
Chapter 1
A Call for Study on the Meanings of Pain
Simon van Rysewyk
Shetoldmethatthehighpointofherlifewasplayingtheorganforherchurchchoir.She
lived for the twice-a-week practices and Sunday performances. Now, with pain immobi-
lizingherelbow,shecouldnolongermanagethekeyboard.Herdaysheldnothingthatshe
lookedforwardto.Theconstantachinghadrobbedheroranyhope.Lifeseemedemptyof
everythingexceptpain.WhenIaskedherifshehadexplainedthistothestaffoftheclinic,
sherepliedthattheyhadnotasked.Hermedicalhistory,asonemightexpect,readexactly
likethehistoryofanelbow(Morris1991,p.275).
Pain is a complex personal experience, with the widely accepted definition of
painadvocatedbytheInternationalAssociationfortheStudyofPaindefiningitas
an“unpleasantsensoryandemotionalexperienceassociatedwithactualorpotential
tissuedamage,ordescribedintermsofsuchdamage”(InternationalAssociationfor
the Study of Pain 2005). This definition rejects the traditional view that pain is
causedbytissuedamagealone(Sternback1968;Mountcastle1974),andreplacesit
with the claim that pain is associated with perceived bodily damage, thus sup-
portingmultiplecausesandmediators.Nociceptionreferstotheunconsciousneural
process of encoding noxious stimuli. In contrast, pain is a conscious personal
experience that varies with the organism. In normal adult humans, pain links with
meaning, appraisal, learning, emotional and cognitive experiences and responses
(MelzackandCasey1968;HaleandHadjistavropoulos1997;Arntz andClaassens
2004;Avila2013;Gatcheletal.2007;PriceandBarrell2012;vanRysewyk2014).
Several pain interventions are based on psychological mechanisms, with evidence
supporting their beneficial role in pain management (e.g. Nicholas et al. 1992;
Morleyetal.1999;Jensenetal.2001;ButlerandMoseley2003;Louwetal.2011).
S.vanRysewyk(&)
SchoolofHumanities,DepartmentofPhilosophyandGenderStudies,
UniversityofTasmania,PrivateBag41Hobart,Tasmania7001,Australia
e-mail:[email protected]
©SpringerInternationalPublishingAG2016 1
S.vanRysewyk(ed.),MeaningsofPain,
DOI10.1007/978-3-319-49022-9_1
2 S.vanRysewyk
Althoughsignificantimprovementsinourunderstandingofpainhavebeenmade
through preclinical and clinical scientific research, pain is often poorly recognized
and poorly treated in the clinic (Craig 2009). Advancements in pain neurobiology
are necessaryto attaina more complete view of thenature of pain and tooptimize
its treatment (e.g. Tracey and Mantyh 2007; Wager et al. 2013; Nijs et al. 2014).
However, such developments are insufficient without dedicated study of the psy-
chosocial factors that determine qualities of pain experience and pain-related out-
comes (e.g. Walsh et al. 2004; Kirwan et al. 2007; O’Brien et al. 2010;
Hadjistavropoulos et al. 2011; Avila 2013; van Rysewyk 2014; Edwards et al.
2016).AsDavidMorrisrecognizesinChap.22,“Anunderstandingofpain,evenin
its most basic logico-scientific dimensions, cannot entirely float free from human
motivations, human satisfactions, and human twists.”
This book acknowledges calls in the literature for research scientists and clini-
cians to recognize biopsychosocial approaches to pain (Hadjistavropoulos et al.
2011). These calls parallel the growth of patient-centered organizations and
advocacy groups that seek to integrate patients into the process of prioritizing
research needs and creating alliances wherein patients and researchers partner
together to accomplish research goals. Although biopsychosocial and
patient-centered approaches to pain are well-supported by evidence (e.g. Gatchel
et al. 2007; O’Brien et al. 2010; Hadjistavropoulos et al. 2011), preference for
neurobiology continues to overshadow research and clinical attention to psy-
chosocial factors of pain such as meaning (e.g. Morris 1991, 2001, 2010, 2013;
PriceandAydede2006;PriceandBarrell2012;ThackerandMoseley2012;Avila
2013; van Rysewyk 2014).
This interdisciplinary book is the first to report in-depth scientific research
dedicated to the meanings of pain. Situated within the wider context of a biopsy-
chosocialframework,thisbookaimstoimproveunderstandingofthelinkbetween
perceived meaning and pain, and to stimulate further research in this area. The
intended audience of the book is research scientists, clinicians, patients with pain,
and caregivers. To improve understanding of the meanings of pain in the target
audience, this book studies several aspects within this area. These aspects include,
commonmeaningsofpain acrosstypesofpain,extendedpain-relatedfeelingsand
their meanings, meanings of pain associated with patient-clinician interactions,
interactionsbetweenbrainactivityandmeaningsofpain,qualitativemethodssuited
to studying meanings of pain, and meanings of pain in rodents and non-human
animals. These aspects,together with relevantchapters inthe book, are introduced
below.
To my knowledge, no book in the pain literature presents research solely on
meanings of pain together with a research call to study such meanings. Bustan (in
press)focuses onthecomplexityofhumansufferingandpain,withattentioninthe
book partly devoted to analysis of the meanings of suffering and pain. In the
scientific literature on consciousness, Price and Barrell (2012) develop a research
program with a focus on conscious experience and experiential meaning, but only
onechapterofthatbookappliesthisintegrativeapproachtopainexperienceandits
common meanings. The call in this book is methodologically compatible with
1 ACallforStudyontheMeaningsofPain 3
“Neurophenomenology,” a research program developed in the 1990s to study the
neuroscienceofconsciousness(Varela1996).However,veryfewempiricalstudies
ofpainhavebeenconductedbasedwithinthisprogram(e.g.Grace2003;Rainville
and Price 2004; Kerr et al. 2011; Valenzuela-Moguillansky 2013) and few theo-
retical pain publications have used it to develop theories and qualitative models
aboutthemeaningsoflivedpainexperience(e.g.Giordano2010;Fink2011).Also,
the focus of this book is on meaning, not consciousness (for the latter, see
Garcia-Larrea and Jackson 2016). Thus, this book offers the first comprehensive
treatment of the topic in the pain field. As such, it stands to make unique contri-
butions towards study of the meanings of pain, and particularly towards under-
standing relationships between such meanings, the brain, and clinical practice.
Readers can take this introduction in parallel with, or independently of, reading
the book. Chapters are mutually reinforcing, and interwoven with the same con-
cerns. Despite the overlapping structure of the book, chapters are topically arran-
ged. Chapters 1–5 focus on relationships between pain experience, meanings of
pain, and the brain; Chaps. 6–11 present several qualitative methods suitable for
studying meanings of pain; Chaps. 12–15 address extended pain-related feelings
and their meanings. Relationships between meanings of pain and clinical practice
featureinChaps.16–20.Chapters21and22areaboutstudyingandunderstanding
meanings of pain in rodents and non-human animals. The 36 international book
contributors approach meanings of pain from diverse research perspectives,
including health psychology, psychophysics, philosophy, phenomenology, psy-
chiatry, humanities, and cognitive and behavioural neurobiology. Many chapters
are interdisciplinary, combining multiple perspectives.
1 Pain Experience and the Primary Meaning of Pain
Psychophysical studies offirst (“protopathic”) and second (“epicritic”) pain using
investigator-participantsandstudiesofpatientswithpainrevealcommonmeanings
within the experiences of different types of pain. William Landau and George H.
Bishopconductedself-experimentstostudythequalitativedifferencesbetweenfirst
andsecondpain,andfoundthatfirstpainwassharporstinging,well-localized,and
brief, whereas second pain was dull, aching, throbbing, or burning, poorly local-
ized, and longer lasting (Landau and Bishop 1953). In his own self-experiments,
Head (1920) found that first pain was associated with temporal summation, spatial
spread, and an increase in arousal. It was later discovered that the qualities offirst
pain, including the increase in “arousal,” is the result of C-nociceptor activation,
whereas A-nociceptor activation leads to second pain.
These findings were confirmed in studies combining psychophysical and phe-
nomenologicaldesignsusinginvestigator-andnaïveparticipants.Theunpleasantness
of first and second pain was found to be associated with a common meaning of
immediate intrusion or attack upon the body, despite the observed qualitative dif-
ferencesbetweenthesetypesofpain(Price1972;Priceetal.1977;Staudetal.2001).
