The search for the ‘hurt’…..in the brain?

It was quite the line up at the recent IASP conference: Tracey, Apkarian, Flor, Crombez, Iannetti, Moseley …the groupies were gathering around a melting pot of pain-full ideas.

One such thought provoking notion was the search for “the ‘hurt’ in the brain”, in association with a staunch refuting of the use of the ‘pain signature’ label- a cardinal sin in the Pain Imaging Neuroscience Group, directed by Professor Irene Tracey at Oxford University.

grey The search for the ‘hurt’…..in the brain?Professor Tracey’s fascinating talk left me thinking how the use of language can be both powerful and limiting; we like to label ‘things’ but this becomes tricky when the ‘things’ that we are trying to label aren’t necessarily ‘things’ in the objective sense. The feelings we have, our perceptions, the qualia are open to a plethora of interpretations that can find themselves awkwardly grouped under broad umbrellas. Yet, without the structure of labels and language we would be lost.

Brain imaging has allowed us to take leaps and bounds in our understanding of the way our nervous system interacts, labelling specific regions in association with particular experiences that we have. As such, the ‘pain matrix’ (all the labels are coming out, the gloves are off) has evolved along with our understanding of what our brains might look like when we experience pain. A case in point for the Apkarian lab who has recently published a study, highlighting important connections in the brain associated with the development of chronic pain. The search is already underway- so where is this ‘hurt’ in the brain? And if found, are all our problems solved?

Hold fire….this may not be the only quest worth pursuing.

Experiences are unique to the individual and pain is one such experience.  The depth and breadth of our nervous system, immune system and endocrine system allow for innumerate communications and possibilities that could constitute someone being in pain. By labelling the ‘hurt’ in the brain we may run the risk of reducing our perceptions to a component part of the whole.

We rely on verbal communication and behaviour to convey our experiences, yet despite the sophistication of language it is still a crude representation of the multisystem communications behind it. Brain imaging offers a fantastic insight into these communications, but it too can be considered a crude tool in relation to understanding the person as a whole. It is thus with great caution that I believe we must proceed in our interpretation of the ‘hurt’ in the brain; the implications could be great, both to the person in pain and society at large.

The brain is edgy; it offers that final frontier, a place where information from the outside is interpreted into individual qualia. There is no denying that our brains set us apart from other species: we socialise, change beliefs, embrace culture in a uniquely human way, it is therefore paramount to explore the intricacies of the brain dynamics in order to understand our experiences. In the same breath, however, if we look at one component too closely, are we in danger of neglecting the whole?

Put simply, no matter how snazzy our scanners get, it is still the person that hurts not the brain.

Abby Tabor

grey The search for the ‘hurt’…..in the brain?Abby has a very posh English accent, and clearly doesn’t like granola bars.  What brought Abby out to Oz? Abby first got an inkling for what pain really was after listening to Mick Thacker during her undergraduate degree at King’s College London. It was his inspiration, along with a certain Moseley style Explain Pain experience that led her to the other side of the world to delve deeper into the world of pain.

She finally agreed to return to the UK, on one condition, that they would let her come back to the land down under to do part of her PhD. Still in the early days of research she is nurturing a nice little coffee habit and asking a lot about how philosophy can fit into our understanding of pain.  Here is Abby talking more about what she does.

Comments

  1. Hi Abby,
    Great post. Here are my thoughts in response to your thoughts:

    ‘The feelings we have, our perceptions, the qualia are open to a plethora of interpretations that can find themselves awkwardly grouped under broad umbrellas. Yet, without the structure of labels and language we would be lost.’

    A related concern is this: should we defer investigation of pain until we have first determined precisely the proper definition of ‘pain’? The answer is: no. The answer is negative because theories about pain and definitions about what counts as pain (the target phenomena) evolve together, in tandem. Many instances from the history of science shows that firm, explicit definitions emerge only fairly late in the game, as the science that embeds them firms up and matures (e.g., the definition of ‘fire’). This point is especially applicable to neuroscience, as it is a nascent field. Thus, theoretical innovation is needed in every subfield of pain neuroscience. Most theoretical ideas are bound to be losers (e.g., ‘pain signature’?), sure, but unless we can nurture lots of new ideas, the rightful winners will never see the light of day. This means it is too early in the game to discount the idea of a ‘pain signature’, and also technologies such as neuroimaging. Prudence suggests that we wait and see.

    ‘Put simply, no matter how snazzy our scanners get, it is still the person that hurts not the brain.’

    That is correct as it applies to pain treatment and management. Still, the point is that the weight of empirical evidence shows that differences in conscious experience (‘pain’ vs. ‘no pain’ vs. ‘pleasure’, and so on) do in fact involve differences in brain activity. The brain is a causal machine. There is no evidence that neuronal events happen without any cause. BUT – even though pain in the brain is caused, this does not imply that pains are predictable. Causality and unpredictability are entirely compatible. Causality concerns conditions that bring about an event, whereas predictability concerns what we know about such conditions. We need research on both fronts; but I think – to sum up! – given the data, the odds are against painfulness being uncaused.

    Many thanks!
    Simon

  2. Hi Abby,

    In my field of sensory re-education (the Alexander technique) the multi-various ways of representing sensory experience are a large part of the teaching/healing process. Language is very important not just as a representer of experience as in a ‘label’, but also, significantly, as a creator of experience… experience in these terms includes the neurophysiological patterns of coordination. The label that is used, and the individuals response to it are powerful tools in the search for improved functioning.

  3. Hi Abby,
    Great post. I noticed you have some interest in a philosophy of pain. I have a similar interest but quite frankly am a bit naive in digesting literature on philosophy. Thacker and Moseley wrote an interesting short report on first-person neurocience and experiential phenomenology borrowed from Price et al. 2002, but am looking for writings that are a bit more theoretical … One I’ve come across is by Lutz and Thompson titled: Neurophenomenology: Integrating Subjective Experience and
    Brain Dynamics in the Neuroscience of Consciousness seems to get at this marrying neurophysiological data with the ‘whole’ person but is not necessarily discussed in the context of pain. I’m wondering if you (or other readers of this blog) have come across any useful references looking at pain more philosophically?

    Many thanks,
    Geoff

  4. Hi Geoff,

    I am writing my PhD on pain and interoception from a neurophilosophical perspective. I believe I can help you: Go to philpapers.org and conduct a search ‘pain’. I suggest reading ‘BrainTrust’ by Pat Churchland. This is a neurophilosophical study on the nature of morality, in which pain plays a significant role. There is also material on my blog. Let me know if I can assist you further.

    Cheers, Simon

    Anonymous Reply:

    Awesome! Thanks Simon. I will also check out your blog.
    Geoff

  5. Abby Tabor says:

    Dear Simon,

    Many thanks for your comments. I definitely agree that techniques such as neuro-imaging used in the investigation of pain should not be discounted, they are extremely valuable, however we must be shrewd in our interpretation and extrapolation of these results.

    I am interested in your discussion around causality and how pain fits within this. Does this imply that pain is always an output caused by the brain? If so, I’m not sure I entirely agree. I am inclined to think that pain refers to a particular state, whether transient or persistent, that is a cyclical relationship that involves more than the brain.

    I would be very keen to hear your thoughts on this.

    Cheers

  6. Abby Tabor says:

    Dear Geoff,

    Thank you for your post. I am in the midst of getting around the philosophical side of pain, an interesting journey. I have found that philosophy, in the most part , has a relatively Cartesian view on pain, tissue based in the main part. However the application of philosophy in the form phenomenology is an interesting product. This area is still in its infancy, so some papers may not look specifically at pain but the parallels are clear.

    I would suggest this paper which looks specifically at chronic pain:

    Larkin and Osborn (2011) Interpretative phenomenological analysis and embodied, active, situated cognition.

    Secondly, this paper which is a little more broad:

    Overgaard M, Gallagher S, Ramsøy TZ (2008) An Integration of First-Person Methodologies in Cognitive Science.

    Maurice Merleau-Ponty, and Burt Dreyfus are two other philosophers I would recommend taking note of but it depends on how much time you have.

    If you have any other queries let me know.

    Cheers

    Anonymous Reply:

    Thank you very much Abby!
    Geoff

  7. Hi Abby,
    I would be very happy to have a discussion with you.
    As a neurophilosopher, my stance on the nature of pain is empirically informed. Thus, as a first pass response to your questions, does data have anything to say concerning pain having – as you put it – ‘a cyclical relationship that involves more than the brain’?
    There is no rush to respond; I’m not going anywhere ( = chained to desk writing PhD) – Cheers, Simon

  8. A book that may be of interest to those following this discussion is “Feeling Pain and Being in Pain”. From the description:
    “Nikola Grahek examines two of the most radical dissociation syndromes to be found in human pain experience: pain without painfulness and painfulness without pain. Grahek shows that these two syndromes—the complete dissociation of the sensory dimension of pain from its affective, cognitive, and behavioral components, and its opposite, the dissociation of pain’s affective components from its sensory-discriminative components (inconceivable to most of us but documented by ample clinical evidence)—have much to teach us about the true nature and structure of human pain experience.

    Grahek explains the crucial distinction between feeling pain and being in pain, defending it on both conceptual and empirical grounds. He argues that the two dissociative syndromes reveal the complexity of the human pain experience: its major components, the role they play in overall pain experience, the way they work together, and the basic neural structures and mechanisms that subserve them.”

  9. Hi Abby, Agreed. The whole person experiences the pain. And, as a bodyworker/massage therapist (and with personal experience of high sensativity) I know there is no seperation between brain and body, the nervous system extends to the surface of the skin (and the skin derived from the same embryonic tissue as is the nervous system). Seems to me our heirarchical view of the nervous system with the neocortex at the top, distorts our view of how the body/mind functions, what is in control. Our whole being, is part of a unified experience.