Pain is defined scientifically as, ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ (IASP, 1979). Health professionals typically view pain within the bottom-up sensory-appraisal paradigm as predominately sensation arising from nociceptive input; they are unsure about how to handle the emotional side of pain. Such a shortfall arguably addresses only part of the person’s pain. The consequences of focussing on sensation alone are most evident in regard to procedural pain in children where the dominant emotion is fear and despite best intentions, the experience culminates in distress and harm to the child. While emotions are an important aspect of pain, construing ‘pain’ as a sensory and emotional experience is somewhat limiting. A shift to the cognitive however, opens the full range of top-down (Mesulam, 1998; Pally, 1997) mental processing that seems relevant to pain and includes: memory, emotion, attention, language, thought and consciousness (Crick & Koch, 2000; Mesulam, 1998; Roth, 2000). All of these brain functions are integral to one’s subjective ‘experience of pain’. Each affords an avenue for intervention and modulation of the pain experience and can be accessed and developed through relaxation, distraction and guided imagery techniques. An important factor however in terms of change in pain management is the issue of how pain is seen by health professionals and institutions alike. The attitude of the primacy of treatment – ‘At least we got the blood’ over impact on the individual sits poorly with ‘patient-centred care’ and can only change when the ethics and balance of pain and treatment are escalated and addressed by health professionals. Crick, F., & Koch, C. (2000). The unconscious homunculus. In T. Metzinger (Ed.), Neural correlates of consciousness: Empirical and conceptual questions (pp. 103-110). Massachusetts: MIT Press. International Association for the Study of Pain Subcommittee on Taxonomy. (1979). Pain terms: A list with definitions and notes on usage. International Association for the Study of Pain Subcommittee on Taxonomy 6 (3), 249-252. Mesulam, M. (1998). From sensation to cognition. Brain, 121, 1013-1052. Pally, R. (1997). Developments in neuroscience: II. How the brain actively constructs perceptions. International Journal of Psycho-Analysis, 78(5), 1021-1030. Roth, G. (2000). The evolution and ontogeny of consciousness. In T. Metzinger (Ed.), Neural correlates of consciousness: Empirical and conceptual questions (pp. 77-97). Massachusetts: MIT Press.

Pain is defined scientifically as, ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’ (IASP, 1979).

Health professionals typically view pain within the bottom-up sensory-appraisal paradigm as predominately sensation arising from nociceptive input; they are unsure about how to handle the emotional side of pain. Such a shortfall arguably addresses only part of the person’s pain. The consequences of focussing on sensation alone are most evident in regard to procedural pain in children where the dominant emotion is fear and despite best intentions, the experience culminates in distress and harm to the child.

While emotions are an important aspect of pain, construing ‘pain’ as a sensory and emotional experience is somewhat limiting. A shift to the cognitive however, opens the full range of top-down (Mesulam, 1998; Pally, 1997) mental processing that seems relevant to pain and includes: memory, emotion, attention, language, thought and consciousness (Crick & Koch, 2000; Mesulam, 1998; Roth, 2000). All of these brain functions are integral to one’s subjective ‘experience of pain’. Each affords an avenue for intervention and modulation of the pain experience and can be accessed and developed through relaxation, distraction and guided imagery techniques.

An important factor however in terms of change in pain management is the issue of how pain is seen by health professionals and institutions alike. The attitude of the primacy of treatment – ‘At least we got the blood’ over impact on the individual sits poorly with ‘patient-centred care’ and can only change when the ethics and balance of pain and treatment are escalated and addressed by health professionals.

Crick, F., & Koch, C. (2000). The unconscious homunculus. In T. Metzinger (Ed.), Neural correlates of consciousness: Empirical and conceptual questions (pp. 103-110). Massachusetts: MIT Press.

International Association for the Study of Pain Subcommittee on Taxonomy. (1979). Pain terms: A list with definitions and notes on usage. International Association for the Study of Pain Subcommittee on Taxonomy 6 (3), 249-252.

Mesulam, M. (1998). From sensation to cognition. Brain, 121, 1013-1052.

Pally, R. (1997). Developments in neuroscience: II. How the brain actively constructs perceptions. International Journal of Psycho-Analysis, 78(5), 1021-1030.

Roth, G. (2000). The evolution and ontogeny of consciousness. In T. Metzinger (Ed.), Neural correlates of consciousness: Empirical and conceptual questions (pp. 77-97). Massachusetts: MIT Press.

Pain = Sensation + Cognition

Pain and Cognition

Pain is much more than nociception. At the very least: