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Paul Grobstein's picture

pain: nociception or something more?

As per our discussion, pain brings neuroscience importantly into the realm of a number of number of social/political controversies. It is indeed interesting, for example, that both doctors and scientists take pain in and of itself more seriously now than twent years ago. Once taken primarily as a signal of something else wrong and otherwise largely ignored as basically "subjective", pain is increasingly regarded (in the west at least) having "health" or other important significance in its own right. 

In this context, though, its interesting that most textbooks and other "scientific" sources (see Society for Neuroscience Brain Briefings) still tend to talk about pain in terms of nociceptors and specific brain pathways for pain. While significant work has certainly emerged from this emphasis, it retains the perspective that the origin of pain is in well-defined peripheral disturbances. A number of phenomena, including peristent pain, phantom limb pain, referred pain, neuropathic pain, and psychogenic pain, are not well accouted for from this perspective, suggesting that there is significant work yet to be done starting with the principle that "all symptoms are psychosomatic". New understandings from research with this starting point (cf "abnormal painful sensations might be related to the incongruence of motor intention and senory feedback") might not only yield improved therapies in many cases but also new understandings that could be significant in regard to social and political controversies. Among other things, it might encourage a useful blurring of the dichotomy between "physical" and "mental" and so encourage greater investment in both research and therpeutic approaches to what is actually going on inside the brain.

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