Talk:Pain/Archive 5

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Cancer pain

I've just posted Cancer pain. I'd appreciate it if anyone interested in the subject could take a look. It still needs to address physical, surgical and psychological interventions, which I'll get to over the next fortnight. It's based on two textbooks and several reviews. I'll compare it with another two textbooks in the near future, but thought it was complete enough now to be of some use. --Anthonyhcole (talk) 00:19, 22 August 2011 (UTC)

Every time I begin to read about psychological interventions in cancer pain management I find myself flinging the book at the wall in frustration, so someone else will have to write this. --Anthonyhcole (talk) 03:50, 9 September 2011 (UTC)

Expansion of the theory section

As my variable state of health permits, I'm reworking the theory section, trying to make it (as concisely as possible) more readable and comprehensive. Once it's done, judging by the way it's growing, I'll probably propose moving it to a new article Pain theory, History of pain theory or somesuch, leaving a summary here. Until then, I'd appreciate your patience with this ballooning and shrinking as I come to grips with the subject. I'm making a point of leaving it in a better state than I found it at the end of each editing session. Criticism and advice along the way would be very welcome. --Anthonyhcole (talk) 09:40, 31 July 2011 (UTC)

I think you should feel free to work in whatever way feels most convenient to you. That has always been my practice when expanding an article. Looie496 (talk) 15:51, 31 July 2011 (UTC)

Congrats for this initiative, Anthony. I suggest to include the "affective theory" (Marshall and others, end of 19th century). --Robert Daoust (talk) 15:49, 7 August 2011 (UTC)

Thanks both of you. I'll check out affective theory, Robert. The sources I'm using at the moment are a bit cursory on it. Can you recommend anything with comprehensive, or at least understandable coverage? I'm struggling to discern the difference between it and intensive theory. --Anthonyhcole (talk) 14:55, 12 August 2011 (UTC)

My first source was Melzack's "The Puzzle of pain". In his chapter on "The evolution of pain theories", there is a section "Affect theory of pain". The primary source is Marshall, H. R. (1894), Pain, pleasure, and Aesthetics: An Essay Concerning the Psychology of Pain and Pleasure, London and New York: Macmillan. --Robert Daoust (talk) 19:51, 12 August 2011 (UTC)

Thank you. I've found Puzzle at the local med library. I'll give it a read. That chapter looks great. --Anthonyhcole (talk) 09:50, 15 August 2011 (UTC)

Someone has borrowed "Puzzle". I'll get to it when it's returned. (I don't have borrowing rights.) --Anthonyhcole (talk) 08:00, 10 September 2011 (UTC)

Merged content from Breakthrough pain

Per this edit summary discussion. --Anthonyhcole (talk) 04:21, 28 September 2011 (UTC)

First sentence

The first time I read the IASP definition of pain:

Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

I thought "what?" It wasn't until I'd read into the history of the definition a bit that I really grasped its meaning and the reason behind this formulation - essentially, pain is the feeling caused by damage to the body or stimuli approaching damaging intensity, but also there may be no detectable damage or stimulus, but the subject uses the same descriptors to communicate the quality of the pain. I have seen the IASP definition called "tortuous" and "impenetrable", can't remember where. But I believe "difficult" wouldn't be inaccurate.

As it is the first sentence of this article, and may be putting people off reading further, I'd like to address this. I propose replacing the first paragraph of the lead:

Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." It is the feeling common to such experiences as stubbing a toe, burning a finger putting iodine on a cut, and bumping the "funny bone".

with

Pain is the unpleasant feeling associated with damage to the body. It is caused by activation of pain-signaling nerve fibers, such as by stubbing a toe, burning a finger and putting iodine on a cut, or by irritating or damaging sensory nerves, such as by bumping the "funny bone". Sometimes pain arises in the absence of any detectable stimulus, damage or disease.

and removing the last clause of the second paragraph: "... sometimes pain arises in the absence of any detectable stimulus, damage or disease."

"Feeling" covers both emotion and sensation. This formulation covers nociceptive, neuropathic and idiopathic pain simply and clearly, and I believe it would be less discouraging to the average reader. Your thoughts would be very welcome. --Anthonyhcole (talk) 04:21, 27 August 2011 (UTC)

The thing about pain is that virtually every reader will already have a good idea what it is. The surprise is that a word whose meaning is so obvious intuitively can be so difficult to define -- it might be useful to start the article by saying just that. Looie496 (talk) 16:03, 27 August 2011 (UTC)

Personally I would be inclined to give a simple definition first, and then add any complication that you wish : --Pain is an unpleasant sensation. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone".-- --Robert Daoust (talk) 17:19, 27 August 2011 (UTC)

Looie, I like your idea. The right language, and source, would probably come from philosophy, but I don't know where to look. Re Robert's suggestion, how about

Pain is an unpleasant sensation often associated with damage to the body. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone". It is caused by activation of pain-signaling nerve fibers or by irritating or damaging sensory nerves

--Anthonyhcole (talk) 13:31, 28 August 2011 (UTC)

Yes, it is better to say --Pain is an unpleasant sensation often associated with damage to the body. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone".-- But I would not venture on the causes of pain in the first paragraph! Does damaging sensory nerves per se, for instance the optic nerve or a Pacinian corpuscle, do cause pain? --Robert Daoust (talk) 15:47, 28 August 2011 (UTC)

"Somatosensory nervous system" is specified by the IASP 2008 definition. So I guess that makes "sensory" too inclusive. "Somatosensory" is pretty obscure jargon but, personally, I'd be comfortable with blue-linking it and including it in the definition.

Pain is an unpleasant sensation often associated with damage to the body. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone" and is caused by activation of specialized pain-signaling nerve fibers or by damage or disease affecting the somatosensory nervous system

Thoughts? --Anthonyhcole (talk) 00:37, 29 August 2011 (UTC)

I've made the change. [1] I'll be interested to see if this affects the readers' page rating for "Well written", which is presently at 3.5 out of 5. --Anthonyhcole (talk) 13:43, 5 September 2011 (UTC)

Readability is now 4.8 and it's never been above 3.5 before. Someone should tell the IASP. --Anthonyhcole (talk) 07:57, 10 September 2011 (UTC)

My thoughts, quickly -- Pain is caused by... by too many different things to be mentioned in the intro (although pain-signaling fibers merit to be mentioned somewhere in the intro)! And yes, somatosensory is too obscure. Besides, I think the IASP definition should also figure in the intro. Besides, also, the intro should be, after the first para, a kind of little summary of the article itself... --Robert Daoust (talk) 08:03, 10 September 2011 (UTC)

OK. Thinking. --Anthonyhcole (talk) 08:19, 10 September 2011 (UTC)

The IASP has pretty much broken pain into nociceptive and neuropathic, but they've lately reduced neuropathic to damage and disease affecting the somatosensory system. It used to include malfunction of the nervous system, which allowed for pain to be caused by psychological and social processes too. Is that the kind of cause you feel is missing? --Anthonyhcole (talk) 10:17, 1 October 2011 (UTC)

I've removed nociceptive/neuropathic from the lead. [2] --Anthonyhcole (talk) 22:56, 4 October 2011 (UTC)

this article is biased towards humans

When we discuss pain in sensory neuroscience classes, we don't have a "human pain" and a "pain in animals" section. Indeed, this sort of division violates WP:NPOV. We discuss pain reception through a whole host of model organisms as well as humans -- indeed, it is research through model organisms that gives us the most current and modern model of pain. Why should this article have such WP:UNDUE weight of being focused on humans? After all, the CNS is present in all vertebrates. The article should be changed to reflect the current distribution of sources. elle _{vécut heureuse} ^{à jamais} (be free) 19:35, 3 October 2011 (UTC)

It's hard to improve an article on the basis of generalities. Can you be more concrete about what information the article should have that it currently lacks, or what information is in it that ought to be removed? As a neuroscientist myself, I'm sympathetic to the idea that more information about the neural circuitry underlying pain should be included; but that's a matter of somebody actually writing it. Some relevant stuff might be in the nociception article, but that isn't a very good article. In any case, I don't think this issue has much to do with neutrality: the material in the article simply reflects the expertise of the editors who have contributed to it. Looie496 (talk) 20:16, 3 October 2011 (UTC)

I agree with Looie496 that the issue is not about neutrality. Do animals have a different opinion about pain than humans? I suppose that this article could be renamed to "pain in humans" (in analogy to pain in animals) and a separate general article about pain be started. But who is going to write such an article? Furthermore the lead should be directed at a wide audience who coincidentally are 100% human. Finally it is natural that an article about pain is centered on humans since the most direct information about pain used by reliable sources comes from the study of human pain. Boghog (talk) 20:48, 3 October 2011 (UTC)

The lead should say something about pain across species. --Anthonyhcole (talk) 22:45, 4 October 2011 (UTC)

Perhaps a note at the top saying "This article addresses pain in humans. For pain in other species see Pain in animals" would help. --Anthonyhcole (talk) 07:47, 5 October 2011 (UTC)

I don't think that is the right approach. There is a basic fact about pain that this article ought to convey: our methods for assessing pain were created with humans in mind and don't extend all that easily to other types of animals. I would be interested in knowing Elle's view of what a universal neuroscience view would be, at a concrete level. Looie496 (talk) 13:29, 5 October 2011 (UTC)

Pain from a biologist's point of view, perhaps? When you look at it from an evolutionary biology perspective it is very conceited to say "pain doesn't extend all that easily to other types of animals". At least in my classes we do not start with "pain in humans..."; in the very least we know it exists in our closest relatives and probably a good chunk of Chordata. elle _{vécut heureuse} ^{à jamais} (be free) 16:26, 5 October 2011 (UTC)

How do we know that? (I'm not trying to be obstreperous: this issue is a lot trickier than you think, but the only way I know to prove that is to make you try to explain it, so that you will see the difficulties you run into.) Looie496 (talk) 17:09, 5 October 2011 (UTC)

Also, please cite the textbook you're referring to, and relevant page numbers. --Anthonyhcole (talk) 19:23, 5 October 2011 (UTC)

Please, Elle, do introduce what you mean in the article, and it will be kept if it makes sense. I agree to a large extent with your view, but the problem is to get it done. --Robert Daoust (talk) 19:44, 5 October 2011 (UTC)

I'm wide open to pain in animals being addressed here with due weight. It appears in the last section of the article. But I believe it needs to be mentioned in the lead. And a more neutral (in the sense, due weight given to the topic's elements) essay construction may involve moving pain in animals to the top of the essay. I know a little about pain in humans, but almost nothing about pain in other animals and would welcome an effort to improve the balance of this article, and will contribute what I can.

I just saw Pain in invertebrates, recently contributed (largely) by DrChrissy (talk · contribs), and will point them to this discussion, and, though she's on a break at the moment, I'll leave a message forSlimVirgin (talk · contribs); she has experience editing animal welfare topics. --Anthonyhcole (talk) 07:01, 6 October 2011 (UTC)

Dear All, I've just made some changes to Pain in animals without realising this discussion was taking place. I'm rather new to this, so if I have breached protocol or offended/upset anyone by making these changes, I do apologise. My reason for making the changes is that we now know considerably more about invertebrates in relation to the possibility that they experience pain, rather than simple nociception. My own feeling is that there should be a seperate page for Pain In Humans - after all, we know considerably more about pain in this species than any other, and I doubt that ANYONE would deny the ability to feel pain in most other humans. We could then have a seperate page for Pain in animals. But this is where sub/sections get difficult. Pain is a private, emotional experience. As such, it can not be measured directly, either in vertebrates or invertebrates. There is a list of criteria which indicate the possibility of other species experiencing pain that appears to be well accepted by those working in animals welfare (please see Pain in invertebrates), but this list applies just as much to vertebrates as invertebrates. So, should we discuss these under different headings? I would be open to having two seperate pages, but the page on non-human vertebrates should perhaps address the same issues and concerns I have tried to address in Pain in invertebrates.DrChrissy (talk) 10:34, 6 October 2011 (UTC)

Welcome Chrissy. To be sure I understand, are you saying you favour two articles: Pain, addressing the topic in general but humans in detail, and Pain in animals, addressing what is known about pain in other species? Do you think Pain in invertebrates, Pain in fish and Pain in crustaceans should be subsumed under Pain in animals? --Anthonyhcole (talk) 11:33, 7 October 2011 (UTC)

I was thinking that perhaps the most logical way forward is to have three articles 'Pain (humans)', 'Pain (non-human vertebrates)' and 'Pain (invertebrates)'. The article on pain in fish could be incorporated into the second of these, and the article on pain in crustaceans into the third (this might result in a significant amount of repetition, although it could be tidied up). Potentially, it might be possible to have 'Pain (non-human vertebrates)' and 'Pain (invertebrates)' under one heading of Pain in animals, however I suspect this would be a rather lengthy article ...people with more experience of Wikipedia can provide a better opinion of this than me.DrChrissy (talk) 12:48, 7 October 2011 (UTC)

I'm OK with all of that. We could make Pain a disambiguation page like this, listing Pain (humans), Pain (invertebrates), etc. I'd prefer, though, that Pain were redirected to Pain (humans), with a hatnote there pointing to the other two articles, so that when people search Wikipedia for "pain" they get automatically directed to Pain (humans), because this article presently carries a lot of information relating to pain, not just pain in humans. But I can live with the disambiguation page option. --Anthonyhcole (talk) 15:51, 7 October 2011 (UTC)

That sounds like a perfectly sensible option to me.DrChrissy (talk) 16:17, 7 October 2011 (UTC)

I'm having second thoughts about renaming this article Pain (humans). I'll sleep on it. --Anthonyhcole (talk) 16:39, 7 October 2011 (UTC)

In case I wasn't clear earlier, count me as totally opposed to that. The article should discuss the fact that pain is subjective, and the difficulties of comparing subjective qualities across individuals, whether they be different people or different species -- but this article should attempt to be about pain in as universal a sense as possible. Looie496 (talk) 16:58, 7 October 2011 (UTC)

(ec): I don't agree Chrissy. I think the article on Pain should remain with the current title. It should be rejigged to include, early in the article, a better overview of the subjectivity of pain (a huge philosophical topic), and integrating that with a better overview on pain in animals in general. But the rest of the article should then discuss pain in humans in detail, as it already does, since that is what the large majority of readers who come to the article will be expecting. For example, last month Pain received 55,722 views while Pain in fish received only 1,783 views. It is important that, where it makes sense, users should generally get an easy ride and find what they expect to find, and not an unexpected and somewhat distracting disambiguation page. (I wrote Pain in fish–nowhere nearly as detailed as your Pain in invertebrates Chrissy–but I plead that if special interest biases me on this issue I would be biased in the opposite direction.) --Epipelagic (talk) 17:26, 7 October 2011 (UTC)

I also believe this article should not be renamed; any biases are only a reflection of interest and the weight of the sources that focus on pain in humans. Yobol (talk) 17:43, 7 October 2011 (UTC)

It seems several people are against re-naming the page. My reason for suggesting this was that without some division between humans and non-human animals, the article may become so large as to be unwieldy. I was simply thinking of trying to make the article easier for the reader. I defer to the opinions of those with more experience of Wikipedia.DrChrissy (talk) 11:05, 10 October 2011 (UTC)

As Looie says above, it's not simple. Pain, according to all the scientific and philosophical definitions I've read, involves suffering. Suffering engages the frontal lobes in humans. (Cutting the connection between the frontal lobes and the more primordial entorhinal cortex and hippocampus eliminates the suffering aspect of pain. Such patients report no change in the pain's intensity and still remove their hand from a hotplate, but say the pain doesn't bother them any more.)

All other animals have less developed frontal lobes than humans. Does this mean they have not developed a capacity for suffering? This is (in part) the neurological dilemma. On the present state of the science we cannot know the answer to this question. We cannot (yet) be sure, on the neurological evidence, that chimps and gorillas aren't responding like the above psychosurgery patients - feeling and responding to pain but not suffering. The evidence is building though, and most scientists and philosophers I've read concede it's quite possible or probable that at least our nearest relatives suffer.

Do we leave this article as it is, built around the only species we know for sure experiences pain, while explaining the dilemma of pain in other species? Or is there a better way of addressing this? I don't know. I'm still thinking about it. --Anthonyhcole (talk) 14:53, 10 October 2011 (UTC)

My take is that there are three important aspects that the article should clarify: (1) Pain as a subjective quality. (2) Pain as expressive/defensive behavior. If you step on a dog's paw and the dog howls and jerks away, we will infer that the dog felt pain; if the dog ignores it and wags its tail, we will say that the event was not painful to the dog. (3) Pain as nociception. Nociception is almost universal across animal species; expressive/defensive behaviors of the sort we recognize are universal in mammals but absent or very different in other species; and for the subjective quality we only have evidence from humans. Looie496 (talk) 15:10, 10 October 2011 (UTC)

I like that. Are you sure about using "pain" to denote expressive/defensive behaviour, though? The IASP insists pain is a subjective feeling involving suffering. Mammalian expressive/defensive behaviour tells us nothing certain about the animal's subjective experience. I know it looks like what we do when we're suffering from pain, but analogy is not certainty. The dog's response could well be a lobotomised one to nociception. --Anthonyhcole (talk) 15:23, 10 October 2011 (UTC)

This is a difficult issue. There is a school of philosophy, which I subscribe to, that says that whenever we attribute subjective experiences to a person or animal other than ourselves, we are really doing so on the basis of behavior -- because behavior is all we can see; we simply don't have any other useful source of information. See Consciousness#Why do people believe that other people are conscious? and Consciousness#How can we know whether non-human animals are conscious? for further discussion. (Both sections were written by me.) Looie496 (talk) 15:50, 10 October 2011 (UTC)

Thanks, those sections are very well written. I attribute the ability to feel and suffer to you because we are conspecifics. I know I feel, we're the same species, so it's highly likely we share the same faculty. I can't make the same analogy with anything like the same degree of confidence for a classmate. --Anthonyhcole (talk) 16:27, 10 October 2011 (UTC)

Do you feel like composing something along the lines of your three points, Looie? --Anthonyhcole (talk) 02:54, 13 October 2011 (UTC)

I think this complexity is the reason why I was suggesting 3 different pages for pain in humans, non-human vertebrates, and invertebrates. At present we can only use arguement by analogy for assessing pain in other organisms, so it really comes down to how much confidence we have in the 'evidence'. I would say that our confidence in the evidence for pain in other humans is great, just a little less for pain in other vertebrates, and less again for pain in invertebrates.

I would also make the point that it is rather dangerous to use the presence of specific areas of the human brain in the arguement about whether another species experiences pain: Many invertebrates lack a visual cortex, yet they clearly can see. DrChrissy (talk) 11:12, 12 October 2011 (UTC)

Looie seems to be saying behaviour in animals that is analogous to our suffering behaviour is an argument in favour of animal suffering, and Chrissy is saying that lack of analogous structure shouldn't be used as an argument against animal suffering. You're both right. Analogy shows us possibilites, but it doesn't take us anywhere near certainty. What we're waiting for is an understanding of the functional and structural neural correlates of suffering and I think we're about ten years away from that. Meanwhile, we have to present the present state of play in philosophy and neuroscience. I'm not up to it. But I'm reading in the area now. --Anthonyhcole (talk) 14:08, 12 October 2011 (UTC)

Can someone also distinguish between pain (seemingly physical in nature) and anguish (seemingly mental in nature)?--173.69.135.105 (talk) 02:57, 15 March 2012 (UTC)

Like the pain of empathy or a broken heart? This article is about physical pain (see the note at the top of the article). Suffering addresses all kinds of unpleasant feeling. Maybe we do need an article on non-physical pain. --Anthonyhcole (talk) 03:45, 15 March 2012 (UTC)

First sentence take 2

I was thinking of this, what do you guys think? Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen or chest or you may feel pain all over, such as when your muscles ache from the flu.

Pain can be helpful in diagnosing a problem. Without pain, you might seriously hurt yourself without knowing it, or you might not realize you have a medical problem that needs treatment. Once you take care of the problem, pain usually goes away. However, sometimes pain goes on for weeks, months or even years. This is called chronic pain. Sometimes chronic pain is due to an ongoing cause, such as cancer or arthritis. Sometimes the cause is unknown. — Preceding unsigned comment added by Bananas 77 (talk • contribs) 17:46, 4 October 2011 (UTC)

The material above is taken from MedlinePlus: health topics: pain . While this material does not appear to be copyrighted (see MedlinePlus copyright), there is another problem. Wikipedia purpose, like other encyclopedias, is to inform not instruct and to present facts, not to teach subject matter (see WP:NOTGUIDE). The MedlinePlus text reads too much like a guide and therefore in my opinion is not appropriate for Wikipedia. Boghog (talk) 20:51, 4 October 2011 (UTC)

We really can't just copy and paste stuff in any case. But regarding whether that's the right kind of thing, my feeling is that it's a good introduction for a person who is experiencing pain and looking for resources that might be helpful, but not such a good introduction for a reader who basically wants to know what pain is. Looie496 (talk) 21:42, 4 October 2011 (UTC)

Actually you can use material that is in the public domain as long as proper attribution is provided (see for example articles that transclude the {{NLM content}} or {{InterPro content}} templates). However I think in this particular case, it is very bad style to replace text that was agreed upon after extensive discussion and that is unique to Wikipedia with material that is copy and pasted from another web site. Boghog (talk) 06:26, 5 October 2011 (UTC)

The lead should define the topic and summarize the body of the article with appropriate weight. The IASP definition is difficult for most people to understand on first reading, so I changed it to simply "Unpleasant sensation often caused by body damage" - not exactly a precise definition but everyone should recognise it - followed by examples of the three "modes" of nociceptive pain (thermal, mechanical and chemical) and an example of neuropathic pain. What else to include in the lead? WP:LEAD says "The lead serves as an introduction to the article and a summary of its most important aspects."

Presently the lead mentions pain's usefulness (withdrawal, protection and avoidance), chronic vs. acute, idiopathic pain, a little epidemiology (most common reason for GP visit), impact on QOL and function, and its modulation by higher processes (cognitive and social) - some of which is covered in the Medline quote. What we don't cover and the Medline quote does is:

Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen or chest or you may feel pain all over, such as when your muscles ache from the flu.

I removed mention of the nervous system mechanism because it was thought to be too detailed for the lead, but we could mention that pain involves the nervous system. Temporal profile (recurring, constant), Quality (sharp, dull, burning, crushing, etc.) and localization add depth to the characterization of pain, and could follow the first sentence. This lead has mentioned quality before. --Anthonyhcole (talk) 22:16, 4 October 2011 (UTC)

Can we please have a universal neuroscience view and not a human-centric POV? elle _{vécut heureuse} ^{à jamais} (be free) 04:52, 5 October 2011 (UTC)

potential Scientific American MIND resource

http://www.scientificamerican.com/article.cfm?id=i-do-not-feel-your-pain 99.181.136.135 (talk) 16:27, 6 December 2011 (UTC)

"MIND on Pain: Why People Experience Pain Differently Researchers are unraveling why some people are more sensitive to pain than others. Their efforts could lead to more accurate diagnoses, better pain prevention, and safer, more powerful painkillers" by Ingrid Wickelgren Scientific American August 27, 2009

SciAm is not the best kind of secondary source. JFW | T@lk 12:02, 7 December 2011 (UTC)

Merging with pain history article

Hi everyone, I just came across a new article about pain perception in historical and modern contexts, and I think it could work as a daughter article of the "Theory" section of this article. I have moved the new page to the title History of pain theory and put a merge tag on the article to get the ball rolling. I was thinking that we could split some or all of the theory section and merge it with this new article; it looks like this would both stop this article from getting too long, and help the new article find a "niche" in our hierarchy of pain articles. Would other editors here agree with my assessment? — Mr. Stradivarius ^♫ 13:35, 13 December 2011 (UTC)

I second. --Robert Daoust (talk) 17:41, 13 December 2011 (UTC)

Third. I think the sections on the three dimensions of pain and theory today could stay, but the rest (including gate control theory, which is rarely referred to in anything but the history section of textbooks today) is more appropriate in the history article. --Anthonyhcole (talk) 18:20, 13 December 2011 (UTC)

I'm happy to leave this a few weeks before swamping the new editor's article. --Anthonyhcole (talk) 16:01, 18 December 2011 (UTC)

I can appreciate your concern, but I'm not sure if it's actually necessary. The author, User:Pete6187, hasn't made any other edits since their hour-long spurt when creating the article on the 13th, and there's no guarantee that they'll come back to it. I would say that enough time has passed already, but I suppose it can't hurt to wait a few more days before splitting/merging. — Mr. Stradivarius ^♫ 16:21, 18 December 2011 (UTC)

Ok, the merge is complete. I'd be grateful if people could check my work, as this field is not my speciality. Particularly, there may be glaring omissions in History of pain theory that have arisen from me not copying all the content from this article into that one. Also, I squashed together the existing claims about René Descartes in that article and the claim from this one that his work was done in 1644. I thought this was probably correct, but if not then please go ahead and fix it. If you spot anything else, of course, feel free to fix that too. Thanks — Mr. Stradivarius ^♫ 19:00, 3 January 2012 (UTC)

Thank you Mr. Stradivarius, that's a definite improvement. I'll have a careful read sometime over the next few weeks. --Anthonyhcole (talk) 04:07, 4 January 2012 (UTC)

Massage therapy

Someone sent me the following email, and all I can do is to forward it here: "I was surprised to see no mention of massage therapy in the article you've contributed to on wiki about pain. I'm hesitant to start learning how to edit. Just thought you might want to include something about it. eg: http://www.annals.org/content/138/11/898.short" --Robert Daoust (talk) 16:09, 3 January 2012 (UTC)

Neuroscience resource

I just stumbled across this from the University of Texas Medical School at Houston. Looks good. --Anthonyhcole (talk) 03:08, 21 June 2012 (UTC)

Drug seeking

Why is there nothing about drug-seeking behavior in this article? Addiction only seems to be mentioned in the positive context of 'nobody wants to get addicted'. On the other hand, the existence of people who lie about pain for the purpose of getting opiates is pretty well documented, and the "classic signs" are poor measures (PMID 23359650).

We need a proper article on it, to report things like screening measures (PMID 18786335) (both Drug-seeking behavior and Drug seeking behaviour are redirects—to different articles), but it should be mentioned here, because claiming to have pain is a major method. WhatamIdoing (talk) 19:33, 20 June 2013 (UTC)

Objective measurement

The interesting success described at http://www.nejm.org/doi/full/10.1056/NEJMoa1204471 probably deserves a passing mention, in a sentence about how objective measurement is being studied but it not yet available. WhatamIdoing (talk) 19:34, 20 June 2013 (UTC)

Malingering

I'd support a mention of feigned pain in malingering, too. But it does need to be done intelligently. This and drug-seeking only exist as problems because of the "objective measurement of pain" problem, mentioned by WAID immediately above. Both need to be handled by an informed editor with a good understanding of WP:NPOV, as there are strong views on all sides. So, possibly a section or subsection on objective measurement could briefly mention malingering and drug-seeking. But I stress again, there is much strongly-held yet uninformed opinion around these two controversial issues, and not just in the lay press, so only the very latest and best sources should be considered.

Portenoy, who almost single-handedly kicked off the recent popularity of opioids for chronic non-cancer pain, has been back-peddling recently I believe, so his pronouncements earlier than the last couple of years should be treated with that in mind. Thanks for bringing this up. I'll think about it (don't hold your breath), and would welcome anyone beating me to it. --Anthonyhcole (talk · contribs · email) 22:41, 3 August 2013 (UTC)

Soreness

Soreness is a redirect to this article, but this article even not names soreness. --109.53.222.210 (talk) 13:15, 30 June 2014 (UTC)

There are many synonyms for pain. We can't list them all - this is not a dictionary. JFW | T@lk 19:04, 30 June 2014 (UTC)

Questionable definition of Pain:

"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

I'm not sure that that all pain translates to "actual or potential tissue damage". There are many forms of excessive stimulus or distress or even extreme discomfort often termed Pain" that is not indicative of damage to tissue. --96.35.105.26 (talk) 02:38, 22 April 2014 (UTC)

That is your opinion, but not that of the IASP. JFW | T@lk 23:59, 22 April 2014 (UTC)

And is it the only opinion we have to comply with and state in the article? IASP may not be wrong, as there are kind of pain damage to tissue? --109.53.222.210 (talk) 13:20, 30 June 2014 (UTC)

Well, if you can find another authoritative opinion you are free to suggest it here. The IASP definition is not controversial but you might have misunderstood. Pain doesn't cause tissue damage, but it feels like it. JFW | T@lk 19:11, 30 June 2014 (UTC)

Furthermore, remember that pain is the brain's subjective interpretation of nervous impulses. Some people/brains may interpret the impulses as "pain" whereas others may not.__DrChrissy (talk) 09:03, 1 July 2014 (UTC)

Announcement

Jay Kirk (https://www.english.upenn.edu/People/JayKirk) would like to speak to editors of this article. You may contact him at jaykirk@comcast.net. --Robert Daoust (talk) 15:04, 19 February 2015 (UTC)

Robert Daoust Any particular reason why Mr Kirk would like to speak to us? The URL to his page is a dead link, incidentally? JFW | T@lk 23:18, 1 March 2015 (UTC)

Mr Kirk is a freelance writer. He wants to write on suffering and might appreciate our help. Sorry about the newly dead link, however you may access other links through Google. --Robert Daoust (talk) 19:00, 5 March 2015 (UTC)

I reached out. User:Anthonyhcole is probably best Doc James (talk · contribs · email) 20:01, 5 March 2015 (UTC)

Qualia

I have just blundered into the article Qualia. This article mentions pain at several places, so I was surprised that "qualia" does not appear in Pain. Is there a reason for its absence?__DrChrissy (talk) 11:32, 11 April 2015 (UTC)

Intense Pain

Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone."

Really? Was this written from the frame of reference of a ten year old? If these are intense or damaging stimuli, how do we classify cancer, or getting a limb shot off? Consider a rewrite please, these are extremely minor pain sensations, not "intense or damaging stimuli", especially since none of the above really causes much in the way of damage. A stubbed toe? THE HORROR... THE HORROR... — Preceding unsigned comment added by 24.57.246.210 (talk) 00:04, 28 December 2012 (UTC)

Thank you for telling this. Could you suggest a rewrite? I think it would be good to include the whole range of pain, from minor pain to intense pain. Lova Falk talk 09:01, 28 December 2012 (UTC)

I agree they are trivial examples. They represent neuropathic pain (the "tingling" pain from bumping the funny bone) and the three main classes of nociceptive pain (mechanical, thermal and chemical). "Intense" refers to the strength of stimulation required to initiate a pain signal - the threshold intensity - rather than the intensity of pain felt above that threshold. --Anthonyhcole (talk · contribs · email) 23:23, 3 August 2013 (UTC)

I have edited this section and eliminated the trivial examples. Pattkait (talk) 13:11, 13 August 2015 (UTC)

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Remove primary research?

I just updated the text to reflect a 2016 version of the cochrane review, and I noticed this primary research.

Pasted from wiki article:

"Sugar did not significantly affect pain-related electrical activity in the brains of newborns one second after the heel lance procedure.[95] "

Do you think it should be removed?

Thanks. JenOttawa (talk) 14:41, 4 December 2016 (UTC)

I'm a little confused because you've pasted the text from Pain in babies #Oral sugar which is referenced to Slater 2010 and Lasky's commentary on it.

This article contains a similar sentence at Pain #Medication, but only referenced to Lasky's letter.

A citation to a primary source is not sufficient to support a biomedical claim of effectiveness or otherwise in either article.

However, there is a 2016 Cochrane review that would support some text on the issue:

Stevens, B; Yamada, J; Ohlsson, A; Haliburton, S; Shorkey, A (2016). "Sucrose for analgesia in newborn infants undergoing painful procedures". The Cochrane Database of Systematic Reviews. 7: CD001069. doi:10.1002/14651858.CD001069.pub5. PMID 27420164. Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants.

I suggest you use that to replace the current text and cites. --RexxS (talk) 15:56, 5 December 2016 (UTC)

Thanks @RexxS:. Yes, I made a mistake and did not read the more specific Pain in babies #Oral sugar page with the primary reference. I had just added in the 2016 Cochrane review to the general Pain page (paragraph right before).

If this information is already in its own Pain in babies #Oral sugar page, should I remove the specifics re electrical activity from the general Pain #Medication page? Thanks again! JenOttawa (talk) 16:11, 5 December 2016 (UTC)

In an online encyclopedia, it doesn't matter if small amounts of information are duplicated between a general article and a more specific one. Somebody searching for an answer might well look at the Pain article without knowing that the Pain in babies exists. We're not running short of electrons. --RexxS (talk) 16:29, 5 December 2016 (UTC)

agree--Ozzie10aaaa (talk) 20:57, 5 December 2016 (UTC)

Sounds good. Thanks again for your feedback! JenOttawa (talk) 16:39, 5 December 2016 (UTC)

Dubious Statement -- The philosophy of Friedrich Nietzsche: Masked-man's fallacy located in the first section.

"One judgment on the value of pain is given by German philosopher, Friedrich Nietzsche, who wrote: "Only great pain is the ultimate liberator of the spirit….I doubt that such pain makes us ‘better’; but I know that it makes us more profound”.[12] Nietzsche and philosophers influenced by him thus oppose the entirely negative valuation of pain, instead holding that 'What does not destroy me, makes me stronger."[12][13]"

In defining the beliefs of both Nietzsche and any philosophers influenced by him in terms of propositional logic, asserting that 'pain' will make us 'stronger' creates a masked-man's fallacy. The word "stronger" should not be used, as it may connote an increase in one's health. An increase in one's health in response to great pain was specifically doubted by Nietzsche, as we can clearly see in his quote.

Defined propositional terms:

a.) is pain and "what does not destroy me"

b.) is 'better', in terms of 'what' are somewhat unclear. However, I'd imagine that one's health is a given.

c.) is an increase in a human being's capacity for profound thought == The liberation of the human spirit == an increase in a human's strength or perhaps metaphorical strength, or both.

There is also a grammatical error where a single quote is used to begin a quote, and is consequently then closed with a double quote: 'What does not destroy me, makes me stronger."

Apologies if I did anything wrong, this is the first time I've attempted to report a dubious statement via the talk section on Wiki! — Preceding unsigned comment added by 173.67.31.198 (talk) 07:28, 19 March 2017 (UTC)

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Potential source

This source might be useful. (Redacted) https://doi.org/10.1179/108331907X223010 --Karinpower (talk) 00:36, 17 January 2018 (UTC)

Emotional pain under mechanisms section?

Why is emotional pain not under mechanisms of pain? social-emotional perception can trigger the same areas of the brain that physical pain would activate (I don't have the source with me, but I remember reading it somewhere :?). But also, emotional pain is realized in the nervous system, the same place where physical pain is realized, so I don't understand why they would be differentiated. Also, it's interesting to think about how emotional pain and physical pain may share similar properties (and ways to heal). Mr Robot 2020 (talk) 01:39, 23 December 2020 (UTC)