The Biology and Phenomenology of Pain

Introduction

Introduction

When asked, “what is pain?” many respond: “the response to something painful.” That answer is tautological. To escape tautology, we need to understand pain independent of any stimulus; we need to understand pain subjectively.

A subjective focus, however, causes problems. The need for subjectivity might deny pain to the unborn and to animals, and seemingly leads to the conclusion that we can “think” ourselves into, and out of, pain. Consequently, many argue that pain should be understood objectively as the expression of biological changes (hormonal increases, brain activity) that are mobilised by noxious events and defend or warn the organism against injury.

An objective focus, however, also causes problems. Viewing pain as objective means either locating subjectivity in material objects or turning subjectivity into a determined object. Both positions lead towards a great deal of lunacy, such as believing that thermostats might be a little bit aware or that perception is an illusion.

The escape from unpalatable conclusions based in subjective and objective views of pain relies on an understanding of subjectivity as emerging not from the physicality of the brain, which is determined, but from the varied and complex social interactions of human beings, which are negotiable. This enables escape from the necessity to force physics to have subjective properties and escape from the necessity to force subjectivity to be determined.

Learning outcomes

Learning outcomes

By the end of this module you should have a basic understanding of how nerve fibres respond to noxious stimuli and the pathways from the periphery to the brain; the brain areas involved in pain experience; the official definition of pain and the objectivist rebuttal; the nature of acute, chronic, and functional pain; cultural and historical change, especially the key moments of the Enlightenment and the key events of the 20th century. You should also be able to think and write critically about the emergence of subjectivity historically and individually; the “hard problem” of relating brain activity to subjective experience; the social construction of persons and the difficulty of private pain experience.

Teaching modes

Teaching modes

Blended, including lecture-style elements with seminar style discussions, online activities and group work. There will also be a field trip to the Battle Box or Kranji Memorial, TBD. This is a new course and changes are likely as we progress.

Limited to 30 students
2 h/week of “lectures”
2 h/week of “tutorials”

Syllabus

Syllabus

Neuroscience
Specificity theory
Anatomy and function of nociceptors
Projections into the brain via the spinal cord
Gross anatomy of the major brain terminations
Biochemistry and essential function
Similarities and differences compared with other sensory systems
Gate control theory (and the unravelling of specificity)
The pain “neuromatrix” (and its current unravelling)

Psychology
Massive variability in pain experience
The definition of pain and the subjective focus
Implications of the subjective focus:
-We can think ourselves into pain (social pain, hypnotic pain, empathic pain…)
-The “wrong” thoughts can cause chronic pain, which CBT can be used to cure
-Only subjective creatures (generally, human infants older than around 12 months) can feel pain
Arguments against a subjective definition and a return to neuroscience
fMRI as a “lie detector” for pain
Feigning pain and functional pain

History and Philosophy

The beginnings of thought
- Upright stance, the hand, the brain
- Tool use, the first signs

The rise of Enlightenment man
-       Descartes, the empiricists and Kant
-       1776, 1789 and all that
-       The Romantic response

The fall of Enlightenment man
-       Nietzsche
-       The First World War
-       The failed Russian Revolution
-       1989 and all that

Risk obsession, therapy culture and the emergence of the diminished subject as a potential explanation for functional pain

Assessment

Assessment

Online participation: 10%

Online quizzes: 10%

Lecture and tutorial participation: 10%

Presentation: 20%

Short essay (500 words): 20%

Long essay (2000 words): 30%