It is not just the brain that changes itself – time to embrace bioplasticity?

My mate Dr Mick Thacker, has long been teasing me for being neurocentric. In fact – for being A neurocentric. That is, he attaches this neurocentricity to me not just as a characteristic, but as an identity. Moving on from positions of prejudice first requires understanding and I have slowly come to understand that pain is not an emergent property of the nervous system, but of the human. Mick and I have actually said as much here.[1]  It is worth iterating that, clearly, all we know about pain and protective responses is not really confined to our neurones. Indeed, not even the brain itself is confined to neurones – there are more immune cells in the brain than there are neurones. The interconnection between neurones and glia is so tight that they literally rely on each other to work (see my posts on this here: Neuroimmunology for Dummies Part 1, Part 2 and Part 3).  But the integration doesn’t stop there – the fact is, all the systems are so integrated and interdependent that we have little choice but to hold our hands up and say ‘Jeepers! Double Jeepers!  We really are fearfully and wonderfully complex’. But that is not my point, actually.

My point is that, although the nervous system is the one I have been most enthusiastic about in my time as an Enquirer-Explorer, it is not the only Magnificent System. Similarly, neuroplasticity – such a fashionable term nowadays – really is amazing, but the nervous system is not the only system that has a remarkable capacity to change in response to demand. Not at all – the other systems are also highly adaptable. They all respond to demand – in obvious ways such as growing muscle cells when we lift weights – myoplasticity; sweating more when we acclimatise – endoplasticity; learning to recognise a pathogen and eliminating it on next contact – immunoplasticity;  increasing our heartrate earlier on a hill after running up it a few times – cardioplasticity; adjusting the aperture of our pupil to improve our underwater vision – obiculoplasticity; the toughening of skin on well trodden heels – dermoplasticity. You probably don’t recognise these terms, but they are all, in my view, just as legitimate as neuroplasticity. OK, I made those terms up – but they would be legitimate if we chose to use them as a method of capturing this fundamental property of biological systems – adaptation. I suggest, in order to avoid this type of extravagant neologismics, we start to use an umbrella term for this property. It is a property that exists across our biological systems. It shall be called….bioplasticity.  Bioplasticity is, from herein, the new black. I repent my neurocentric ways and hold aloft the banner of biocentricity. It seems to me to be a fairer reflection of what we know about ourselves and it is a sensible umbrella term for the changes that occur across multiple systems when, for example, pain persists, or when, for example, we try to change pain. In fact, these tasks that we call neuroplasticity training, do not only induce changes in the nervous system, so perhaps they should be called bioplasticity training. Just a thought. And immune activation. And endocrine response. And motor output. And heart rate fluctuation….

About Lorimer Moseley

Lorimer is NHMRC Senior Research Fellow with twenty years clinical experience working with people in pain. After spending some time as a Nuffield Medical Research Fellow at Oxford University he returned to Australia in 2009 to take up an NHMRC Senior Research Fellowship at Neuroscience Research Australia (NeuRA). In 2011, he was appointed Professor of Clinical Neurosciences & the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide. He runs the Body in Mind research groups. He is the only Clinical Scientist to have knocked over a water tank tower in Outback Australia.

Link to Lorimer’s published research hereDownloadable PDFs here.


[1] Thacker MA, & Moseley GL (2012). First-person neuroscience and the understanding of pain. The Medical Journal of Australia, 196 (6), 410-1 PMID: 22471546


  1. …..and gene expression and gut behavious(enteric nervous system) and emotional and mental bioplasticity to hating bananas, heights and spiders to name but a few…. it is endless. So exciting and all possible by embracing the possibility that change can occur at any level and forgetting old dogmas that limit and control our expansiveness.Who put these limiting ideas here anyway?!

  2. Connie Posigian says:

    Bioplasticity–I love it!

  3. John Quintner says:

    @ Lorimer. With respect, there already exists a term for the biological property you are describing – autopoiesis (self-creation). Welcome aboard.

  4. Hi Lorimer,
    The concept of Bioplasticity dovetails nicely with the primary observation of F.M. Alexander over 100 years ago… Alexander said “Use Affects Function” and this was the missing link in medical diagnosis. Alexander’s concept of “Use” is deliberately wholistic… he used the term “psycho-physical unity” to express the interconnected of things you refer to above. Jeepers! but we are complex arn’t we 🙂

  5. Does bioplasticity ignore the chemical changes that are seen in the body? I propose the term biochemoplasticity!

  6. Neil Pearson says:

    Well stated Lorimer. Its interesting though. I guess I misunderstood you before, since I never heard you say anything about nerves being the only things that could change chemistry or function. Bioplasticity for sure. But my guess is that if you had started with this word, you would not have changed so many people. With your work, many are ready to stop blaming everything on what we traditionally considered to be MSK cells, and if not that on psychology. It’s not all your fault, but thanks to people like you and David and Mick we find it easier to move away from dualism and peripheralism. Thanks.

  7. Ruth White says:

    Thanks John Q, good to know the correct clinical terminology- ‘autopoiesis’, though from a patient-centred language perspective “let’s get to work on ‘bioplasticity training’ ” is a winner, total awesomeness!

  8. “pain is an emergent property of the human.”
    Where does the origin of consciousness fall in this complex system emergence? Is it the organizing substrate, or the result of…?
    John, not sure I understand or agree (will have to think it through further) that the defined meaning of autopoiesis is equal to what Lorimer is trying to say, but I suspect my reason for suggesting this is a likely fundamental difference on the answer to the above question?

  9. @John & @Lorimer, what about simply adaptation. The term plasticity whatever its iteration seems to imply a physical change to the system. Yet at many levels of biology the change is not morphological (i.e. like the stretching of plastic) but is organizational (the re-arrangement of parts without modification of the constituents). For example, inter-neurons may change their organization in the lamina of the spinal cord due to a barrage of noxious input but that change may be organizational i.e. inter-neuron and not intra-neuron. Adaptation seems to convey at least some aspect of functional purpose that may be a combination of organizational and morphological changes to the structure. Yet, adaptation also keeps in mind one key ingredient: purpose. Keeping both purpose and change in mind, one must ask what is the point? Why do we have systems that are adaptive/plastic especially as it pertains to pain? As we march up the hierarchy animals we see progressively increasing variability of behavior to stimulus. Responses that are more or less stereotypical in our less cognitive brethren become increasingly modifiable in our unique genus of homo. The fact that our CNS is primed for such modulation of expression seems to point to a double edged sword. On one hand we have chronic pain, and on the other hand we have….what? Medicine seems preoccupied with the former, I don’t think science has clearly articulated the latter. Can either of you opine as to what you think of the latter?

  10. John Quintner says:

    @ Eric. Your comments are in line with autopoietic theory, as originally proposed by Maturana and Varela, two Chilean biologists. Rather than “adaptation” the term of choice should be “adaptability”.
    As we are trying to understand the behavior of complex dynamic living systems, it is incumbent upon us to learn a new language – that of systems biology. With the assistance of Pamela Lyon, Milton Cohen and I have tried to come to grips with the language and associated concepts, and to suggest how they might help us to better explain some of the clinical phenomena that we encounter in our practice. If it gains currency, I hope that “bioplasticity” will lead us in this direction.

  11. Paul, ‘Biochemoplasticity’ limits the changes to chemical ones where here we are talking about much more. As far as I see it chemical changes occur after there has been a more profound shift in gearing and ‘Bioplasticity’ incorporates many more facets.

  12. Thanks for this inspiring commentary Lorimer.

    Here’s some other food for thought that has been partly published in the Cell Journal “Do our Bones Influence Our Minds?”, which suggests that exercice may have unexpected consequences…

  13. Well – what a barrage of excellent comments! I am currently in Nashville where it is snowing. My family is sweltering in 40C+ back home. Something about that seems to fit with a discussion of bioplasticity but i am not sure how. Thanks for your wonderful encouragement Neil – and Ruth seems to share my suspicion John, that autopoiesis might not get traction out there! I reckon that the bio covers the chemical and other changes that have been suggested. The issue of plasticity implying physical change is an interesting one – it has, like you Eric, spurred me to suggest that we should really be talking about neuroELASTICITY, or perhaps bioelasticity. However, as has been pointed out to me, there is some conjecture as to whether things do actually change back to how they were – a requirement of elasticity – or are in a perpetual state of transformation. I think whether or not it is morphological depends on how small you want to go – I agree that dorsal horn interneurons for example might be reorganised but not grow new sprouts etc. However, the mechanisms of their reorganisation, ultimately involves alterations in biological substrate.
    So, finally, should we just use adaptation, or adaptability? I prefer bioplasticity because it dips the lid to biology and I reckon we can still benefit from conjuring the marvel of biology; i prefer it because it is already ‘out there’ (I saw a TV ad at 2 O’clock this morning selling a product that ‘captures the latest science on neuroplasticity’ and the ‘plasticity’ part was done with a particularly white and beaming smile).
    keep it up groovers! nice conversations!

  14. Bioplasticity? Aren’t you talking about what we already refer to as homeostasis??!

  15. John Quintner says:

    Alison, do we have any idea as to the mechanism(s) responsible for “a more profound shift in gearing”?

    Bioplasticity is being proposed by Lorimer to describe a fundamental property of living tissues (i.e. biological systems).

    Before we all enthusiastically embrace Lorimer’s suggestion to move into “bioplasticity training,” it would be a good idea to first consider how our living tissues have evolved to be able to train themselves.

  16. Phil Earnhardt says:

    I’ve been playing around with rope rolling for the past 6 weeks. It’s very clear there is neuroplasticity training in learning the sideways roll. I’m simultaneously clear there is fascial plasticity in smoothly directing the rope behind my body. Both are working in tandem, and both are required to roll the rope well.

    One note: I fear that neuroplasticity enthusiasts may feel threatened by the use of so many other plastic-words. Do you agree? Do you have any suggestions about how to deal with the neurocentric enthusiasts in an inclusive fashion?

  17. John Quintner says:

    Lorimer, I must tell you that autopoiesis is already “out there” in biological circles. It did not receive the attention it deserved because of the fascination of biologists with the work of mapping the human genome.

    Yes indeed, we are in “a perpetual state of transformation” (a principle central to autopoietic theory). When the opposite is the case, we cease to exist.

    I have suggested this before on Body in Mind – that the experience which we call “pain” can be seen as but one response of an organism (i.e. in this context, human beings) to perceived existential threat.

    That, in a nutshell, is our hypothesis, as published in 2011.

  18. @Duncan Homeostasis generally describes the maintenance around a fixed state i.e. negative feedback system. Adaptive changes, or plastic if you prefer, describes changes that are state changes in the system that were not previously present.

    @John autopoietic theory is the grandfather of the embodied movement in cognitive science, is it not? This movement seems to be gaining traction especially among the philosophers like Andy Clark.

    @Lorimer every level of organic life demonstrates some level of adaptability. But not every level of organic life displays chronic pain. It seems more than a coincidence that chronic pain, or even pain itself should exist only in the species that possess consciousness. So a follow up question to a neurocentric such as yourself is, does bioplasticity have anything to do with pain? To be in awe of a universal principal that applies to organic life is one thing, to correlate it to a painful experience is another. There must be plastic capacities of a system that bear no affect on pain and others that are highly relevant (as evident by the non-universality of pain in the animal kingdom). To the extent that pain exists within the confines of a conscious experience must constrain which plastic systems we evaluate, right…?

  19. John Quintner says:

    Eric, as far as I know, the answer is yes. But there have been many other luminaries who have figured in the development of Systems Biology, including the European proponents of General Systems Theory, Paul Weiss and Ludwig van Bertalanffy.

    A word of caution – exploring the realms of consciousness is a job for highly experienced neuro-philosophers. For us lesser mortals, it can be a “swamp” from which few of us will emerge any the wiser.

  20. John Quintner says:

    Great comment and link, Marco. This research may lead the discussion into the emerging discipline of Biosemiotics. Could we be participating in a paradigm shift? If so, all to the good.

  21. Hello John, You asked about processes that change the gearing. As you say Biosemotics is the interpretation and communication by signs and recent work by the Russian Pjotr Garjajev and others points to the 95% of DNA which repsonds to changes in frequency. This can include light, sound,electric and magnetic vibration and emotions. This is bioplasticity is independant of whether we have pain or not. What significance we put on the signs (emotional ones) will also determine their integration. Cells responds to specific frequencies as research at Uni of Bologna on stem cells shows. We all know how we might react differently to the frequency of the feeling of anger versus love ! What chemical cascade follows?

  22. Marco Gabutti says:

    @Lorimer, @John, there is a concept that has been specially created to give account of phenomena that are only partially reversible, this term is HYSTERESIS.

    Hysteresis was first used in electricity and material mechanics but has been further extended to other fields, biology included.

    So, if one wants to describe things that undergo some reversibility but don’t retrieve exactly the initial state, the term HYSTERESIS may be the right one.

    The idea is simple but its application may prove to be rapidly complex, anyway it is an avenue of research that is worth exploration.

  23. John Quintner says:

    Alison, I think we are discussing different topics. In the words of Don Favareau:

    Biosemiotics is about “chemotaxic sign-relations by which single cell animals negotiate the world of alien “externality;” the intercellular sign exchanges upon which the human body’s internal networks operate and self-regulate; the chemical and electrical events that constitute the “signals and messages” of the brain and central nervous system; and the nucleotide sequences that, when read by cellular mechanisms, give rise to life from the genetic code … examples of true sign processes – i.e., substitution relations whereby something is “re-presented” to an organism by something other than itself – and yet each of these instantiations differ from each other in a number of fundamentally important ways … non-linguistic, non-brain-based setting up of successful sign relations is both ubiquitous throughout the biological world, and the basis upon which our later linguistic sign relations are made possible.

    Favareau D. Fundaments of animal knowing: establishing relations between sensations, actions and the world. In: Witzany G, ed. Biosemiotics in Transdisciplinary Contexts. Helsinki: Umweb Press, 2007: 61-69.

  24. Julia hush says:

    Good call Lorimer. Clearly multiple body systems are involved in pain and our responses to it. This term nicely captures that.

  25. Alison,

    Thanks for your response. My intended meaning was “biological and chemical plasticity”, and not “biochemical plasticity”.


  26. Great word Lorimer… although I’m amazed it’s a term that hasn’t been coined before!

    Definitely agree that we need to move away from purely neurocentric thinking. As you say, other bodily systems are all likely to interact and influence nociceptive processing. The term bioplasticity got me thinking about literature on fibromyalgia that has theorised how early life trauma could “prime” the HPA axis to increase susceptibility to developing FM in later life – a possible example of bioplasticity?

    Also agree that the term “brain / cortical training” implies there are exclusive effects on neural processes alone…. when (as your work has shown) it also seems to change autonomic & immune processes within chronic pain conditions too. These systems all entwined together & work in synchrony within our body & so are surely likely to change together too.

    “Bioplasticity” certainly adds another layer of complexity when delivering pain education to patients!! However, I think it is a concept that needs to be embraced by all “neurocentrics” when explaining pain. As Mick states in the article referenced, saying that pain is an “output of the brain” is not an entirely accurate explanation. Furthermore, this same article highlights interesting philosophical questions pertaining to pain…. Is the emergent conscious experience of pain the result of these multi-biological systems? Can a person in pain really be assimilated into multi-system molecular processes alone? I’m still yet to explore the world of neurophilosophy & pain (and am now fearful of not emerging from the “swamp” if i do!) but after reading your article I can imagine neuro-philosophers arguing we are all too “biocentric”!!!

  27. stuart miller says:

    Hi, thanks for the excellent post! Having come late to a basic understanding of persistent pain, I find it fascinating the levels of complexity. Thanks to Lorimer and Body in Mind for trying to make it understandable. It’s great to be able to be at home when it’s – 30 degrees outside and connect with the world.
    John, in terms of autopoiesis, would you agree that when we are looking at humans, the organism in question is really an ecosystem ? Just read an interesting book, The Invisible Kingdom by I Ben-Barak, that explores the role of microbes in us and our world . If we’re literally talking plastics (and by-products of the petrochemical industry) those are products that microbes still have a hard time with – adaptability in bioremediation might help – also might connect Lorimer’s musings on extremes of weather. I was blown away when I read the info on modic changes with chronic LBP and use of antibiotics. Adaptability and host response.
    Eric – Jared Diamond might have something to say about the exclusivity of the genus homo and hierarchies. In terms of consciousness, Jaak Panksepp’s The Archaeology of Mind has been illuminating (still stuck in the swamp). I realize that research on the social influences on pain is still young (Hadjistavropoulos et al has a nice review article) but I think there might be something there in terms of understanding how pain becomes persistent. Keep up the great work !

  28. John Quintner says:

    Stuart, I agree that we are part of an ecosystem.

  29. John Quintner says:

    Lorimer, a brief search on Google turned up the fact that “bioplasticity” has been used by microbiologists and “” is a registered domain name. Bioplastics deals with biodegradability of plastic materials.

    The other issue that has not yet been discussed (or I have missed it) is that of possible biological mechanisms. Simply giving a property a name is not the same as defining it in terms of underlying (theoretical) mechanisms.

    Let us be very cautious lest we run into the same sort of difficulties that we did when it seemed that everyone In the pain world was getting excited about “central sensitisation”. Some even accorded disease status to this neurophysiological process!

  30. A. Gallaher says:

    As a non-scientist I can say without hesitation that the Lorimer Moseley piece on bioplasticity and the follow-up comments constitute one of the most intelligent dialogs I have come across on the internet. Really astonishing!

  31. @Alison – by pre-determining that emotion is a frequency are you not creating yet another duality whereas, to my knowledge to date, what an emotion ‘is’ and how it relates to the human experience is still to be fully elucidated? I’d agree that emotion is an embedded/embodied aspect of the human experience/state of being but to equate it with properties of nonconscious physics then begets the as yet unanswered question of how does physical properties and conscious experience co-relate.

  32. John, thank you for stating clearly the definition of biosemiotics . Mark H, I do not believe that I have stated what an emotion is, just that we experience them as suggested and how we relate to each is certainly very individual. Picking them from the external environment helps us to navigate and set our internal environment. This would then ‘tune us in’ to those presettings and perhaps bias the range of options we detect. Could it follow that we are then unable to feel/express them at a cellular level too ?

  33. John Quintner says:

    Alison, three years ago I commenced work on an ambitiously titled article – “A biosemiotic approach to understanding pain.” It was a valuable learning exercise for me but, in the end, the sheer complexity of the subject overwhelmed me. I do hope you have better luck with it.

  34. @John, that is an interesting idea for a paper. Sort of like biology meets the Da Vinci Code 😉 But on a serious note, I do think humans exist in a semiosphere but I don’t necessarily think biology below the level of human culture contains semantics in the same way we appreciate it. As humans we can attribute meaning to things, but I find it hard to believe that inanimate or non-conscious life can have that same capacity. To believe that it does seems like just another form of anthropomorphizing…opinion?

  35. John Quintner says:

    Eric, might I suggest that you read Pamela Lyon’s seminal paper – “Biogenic approach to cognition”? If you cannot access it, please contact me and I will forward you a copy.

  36. Michael Ward says:

    Eric, I agree there is an intrinsic difficulty with the inanimate :), but is the counter risk to anthropomorhizing becoming “homo-centric”.

    Lorimer, John Q, Stuart M + others great comments. When we look across all the physiological parameters and gene expression and suppression, epigenetic changes we have to become less neuro centric or is it less cortico-centric

  37. John Quintner says:

    Michael, how about we become a little less anthropocentric? There is a lot we can learn from evolutionary biology and related disciplines. I find the phenomenon known as quorum sensing in bacterial colonies to be quite fascinating.

  38. Marco Gabutti says:

    @John. I’m a newbie here but it’s been a very pleasant surprise to see you use the word ‘Biosemiotics’. My current research lead me to Gregory Bateson and his very original contributions (see for example ‘The role of somatic change in evolution’, Evolution, Vol 17, N°4, 1963), which led to Hoffmeyer and his collective book ‘A legacy for living systems: Gregory Bateson as precursor to biosemiotics’ (2008).

    Biosemiotics bears all the advantages and disadvantages of the new fields of research: a potential source of major insights and contributions that may lead to some paradigm shift, but at the same time with plenty of chaotic movements of new concept of ideas through which it’s hard to find its way.

    By the way, a great source of thought provoking ideas.

  39. Marco Gabutti says:

    A good example of how evolutionary biology may be helpful to better understand health issue, I would suggest Kuzawa’s article in the International Journal of Epidemiology (2012) :

    “Why evolution needs development, and medicine needs evolution”

    (pdf available at

  40. Jan Dommerholt says:

    The notion that “pain is not an emergent property of the nervous system, but of the human” seems to support that the notion of “pain is in the brain” is indeed a fallacy. While the brain is required for processing and experiencing pain (no brain, no pain), I have never understood why one organ (the brain) would be more important than the entire human being. Pain is experienced by the human being with all its components (multiple organs and systems, cultural background, past experiences, etc) and holding one component responsible for pain above the whole poses significant limitations on our conceptualization of pain. Bioplasticity is a good start away from single component thinking. It is time to start looking at all components and the first person phenomenological perspective.

  41. mick thacker says:

    Hi All
    Amazing what a little bit of friendly jibing of one of your mates produces!!!
    I have been following this discussion since Lozzi blogged. I am fascinated by the responses. (I want to meet you John, chat – share ideas and a beer or two!) I have spent the last couple of years attempting to develop a unifying hypothesis based on an enactive, embodied- extended cognitive approach to the understanding of pain, I am surprised that no one has mentioned Prof Evan Thompson’s seminal work – Mind in Life – which effectively develops an enactive approach based on autopoiesis (he worked and published directly with Varela). Whilst there is only the briefest discussions on pain it effectively takes the ideas presented by John on this discussion, and expands them out into an incredible yet scientifically credible hypothesis on cognition and perception. I believe that these approaches, which proposes interactions between the organism (person) and their environment constitute perceptions including pain and offer the potential to unify what at first appear disparate hypothesis from biology and cognitive science/philosophy. I have recently approached both Profs Andy Clark and Kevin O’Regan, experts on neuroscience and philosophy of perception respectively and hope to form a collaboration that aims to develop a proper testable model/s of pain based on these theories. This is a key point, we can throw theories at this discussion but how do they fit with what we see in the clinic?; more importantly how are they testable so that they will withstand scientific scrutiny? This is my current focus – combining neurophilosophy with cognitive neuroscience and “bioplasticity” (pinched from Lozzi’s blog above, even though I am not sure i like it :), jibe, jibe ) to produce testable hypotheses about pain and perception. Thus far I am struggling but am excited about the journey ahead – i am sure about one thing however – that purely neurocentric views offer little if anything to answering the real questions that pain and associated perceptions pose!

  42. John Quintner says:

    Mick, I am aware of the theory of enactive embodied cognition as developed by Varela, Thompson and others. Francisco Varela departed from this world at a relatively young age. He had so much more to offer in his many areas of interest! I am delighted to find that many of his ideas are filtering through into the pain world, as well as into that of consciousness research. Yes, we must meet.

  43. Mick if you need someone with chronic pain for any research, don’t hesitate to ask. I loved this part of your comment (openly admitting some of the rest goes over my patient-limited-knowledge’s head): ‘ we can throw theories at this discussion but how do they fit with what we see in the clinic’.
    I just presented my art/pain story at AIM Pain in Sydney and to think the message there of ‘Listen to the patient more’ was a new concept, was quite surprising.

  44. Michael Ward says:

    John – “Michael, how about we become a little less anthropocentric? ”

    No argument with me here! The more we elevate our “specialness” the more likely we are to lessen our “humanity”.

  45. @JohnQ I have not read that article, I have now downloaded it. Briefly skimming it, I can see I am familiar with some of the concepts: dynamic systems, anti-representation, anti-computation. I need to review it more in-depth so that I can understand their 10 characteristics of biogenic (which is new to me). Are you familiar with the book by Shapiro titled Embodied Cognition? It is an excellent summary of different conceptualizations and lines of research that are being tackled in this emerging field.
    @All I think critical to this discussion is the idea that pain is anything more (or less) than an expressed social-cultural behavior. Pain is a label that a community of minds converges upon to classify a category of experiences that face the individual and the group. Any discussion of pain requires some sort of implicit agreement about the ontological characteristics that define this category. My own experience with pain and that of my patients oftentimes defy such categorization. Where in my phenomenological experience of threat is this thing we label pain? I only bump up against “pain” when I seek to describe these sensations to another.
    So while I disagree with those who want to look at the body for pain, I disagree with most people who want to pry open the brain and go looking for a socio-cultural behavior that is pain. Researchers create labels that operationally define what pain should be, we correlate those with states of the body and the brain, yet there is always an outlier, always a phenomenon that defies attempts to apply ontological categorization of one level of analysis to another i.e. attributing pain to brains, peripheral stimuli, genes etc.
    If we all readily accept that nociception does not equal pain, that nerves of any kind don’t send pain messages, then where does pain begin? It is certainly not in the body, and it is exclusively not within nervous system. Bodies are necessary and sufficient for nervous systems, and nervous systems for minds, and a community of minds for “pain”. Can we and should we be retroactively trying to correlate every bottom-up phenomenon with pain? Is this even a valid pursuit?
    The plasticity/flexibility/variability/adaptabilit of interactions expressed at one domain of analysis may be important but I think we should proceed with extreme caution when extrapolating directions of causality or rules of categorization. I think central to the issues that surround the phenomological aspects and sociocultural correlates of pain is the lack of clear consensus of what domain (and its accompanying methodological analysis) pain belongs to.

  46. John Quintner says:

    Eric, you are way ahead of me in your reading.

    Are you (and we) encountering an aporia (a metaphorical brick wall) when we try to answer the very important questions you are asking?

  47. @John perhaps, I am sure you have read a great deal more than I. I have read your paper describing aproria. Clinically, your concept of aporia has been liberating and enlightening to me and I have been influenced by it. I think it has allowed me to focus and refine the most parsimonious aspects of my practice. But…this concept of aproria, the imprecision of the clinical encounter, should not deter us from expanding our metaphors, and refining the precision of our language right? Every clinical encounter feels like being immersed in a gordian knot, but if we take a far enough step back and apply the appropriate lens (level of analysis) will a pattern emerge? I guess what I am asking is the metaphorical brick wall we experience as clinicians one and the same that we experience as researchers? Do we accept a certain Heisenberg uncertainty at the level of social interaction and pain? Does that uncertainty yield at the right level of analysis? More questions than answers as per the usual. Thanks for the engaging discussion.

  48. Adam Bjerre says:

    Thank you all for this amazing discussion. It’s the beauty of Turings insight that made this possible – technically. 🙂
    You have presented new words, terms and concepts that gives the rest of us some exciting new areas to explore.
    Can any of you help me explain biologically what happens when we learn a new word? What changes “in” us in respect to before we learned a new word?
    The computation side of the neurophilosophers (I think) would say that the change is not found on the hardware level, but on the software/information level. I wonder what the anti-computation side would say?
    Thank you all for an amazing contribution in sharing your thoughts.

  49. John Quintner says:

    Yes, more questions than answers as per the usual. But I find the energetic discussion to be most envigorating. We have lingered far too long in an philosophical desert. There is no comparable forum where these matters can be raised, let alone discussed and debated. Well done, Lorimer!

  50. Eric great insights with this discussion. As you say people are ‘paining’ but where did the notion of a the noun ‘pain’ come from, is there such a thing? Being a clinician I try and find emerging patterns and often a level of threat, either metaphorically or in real terms, socially or in internal beliefs about an encounter, instigate a change in gearing in the body. This can be learnt or come through a one off experience. What tools we have to deal with this determines the outcome. HAving just spent time with a 70 year old Buddist nun who spent 12 years in a cave to study her mind anything seems possible……..

  51. Adam Bjerre says:

    @Jan Before we dismiss the brain entirely in the equation I would like to know what role you assign the brain/higher order processing regarding experience/perception/emotion (of what we humans socially has categorized as “pain” for example)? What does the brain *do* in your view?

    There are thrown a lot of fallacies around in the comments (what things just aren’t) and I guess that’s one of the tools of getting clear about what things actually *are*.
    What would be your explanation of the different kinds of perceptual illusions then, for example?

  52. Mick Thacker says:

    Hi Eric
    Fantastic post – the Shapiro book is essential reading in the embodied cognition world and should be for those in other fields too!

    Together with Kate Jolly – an extremely bright PhD student with me at King’s, we have proposed that :

    “pain is an embodied element of suffering encapsulated by an experience of the person within the society and culture in which they live”

    I would welcome your thoughts.

    Your and our ideas have obvious similarities to Wittgenstein’s view that pain is not pain until it is communicated to others (although his proposal fails to consider that we communicate with ourselves metacognitively – therefore we do not have need for others to be in pain).

    Whilst I would agree with almost all of your post, I would question your suggestion that nervous systems are necessary and sufficient for minds – I think that whilst necessary they remain insufficient for minds – to accept your statement suggests that minds somehow emerge from the nervous system. This leads ultimately to an infinite regress I.e. how does neural processing produces a mind when they have different “ontological substrates”. What element of the nervous system produces the mind? What mechanisms within neurons produce the mind etc?.

    I think a better explanation is that minds emerge from a dynamic interaction between the person/animal and their environment (which includes their society and culture).

    You are correct about researchers and their approaches – but here we are beginning to see the emergence of a new field that is happy to include a wide range of perspectives and hypotheses. Lorimer and I suggest one approach in the paper he cited in his original post. First person neuroscience overcomes some of your worries about outliers from the clinic – there are no outliers when we employ an approach that includes the individual’s narrative and experience into the data for analysis. The hope is that we are finally working towards the development of a unique domain that will finally advance our understanding of pain.

  53. Adam Bjerre says:

    @Mick It sounds like that we at present just don’t have a language that can link the personal level (which I take Wittgenstein would claim cannot be broken down into parts/a subpersonal level with the same kind of language) with a subpersonal level and therefore we are entitled to postpone the question and concentrate on mainly the holistic aspect – the organism and the environment. I think quite a few scientists and engineers would view that as mistake. The two levels is exactly what the computational view has tried to sow together because of Descartes seductive division. The architecture on the subpersonal level might still be fearfully complex.

    The extended mind hypothesis is all the rage these days but how is our abilities and talents (of which not all are exactly alike other animals) accomplished from nothing more than subpersonal parts? That’s why scientists and engineers will keep exploring this question through examining our human abilities and try to replicate this artifically to improve the understanding.

    The more radical proponents of the embodied movement have serious doubts about this view and think it’s a waste of time as I understand it. Am I right? I might be wrong in that simplistic interpretation.

    I wouldn’t be so dismissive of the computational view – yet (as is expressed in the comments in my interpretation at least). It depends on what we call computation.

  54. John Quintner says:

    Mick, please explain what you and Kate mean by “suffering”. Another of life’s aporias?

    Adam, you rightly pose the question “what does the brain do”? Could we say agree and say that it creates our world from moment to moment. How it achieves such a Herculean task remains a source of wonderment.

  55. Kris Porter says:

    I tell my patients daily, “you have heard of the Newtonian laws of physics? Good. Well, let me tell you about Wolffs law of adaptation.”

  56. Michael Ward says:

    Mick wrt to your definition, why not open it to simply “pain is an embodied element of suffering encapsulated by an experience”?
    Why constrain the experience of pain by the expansion supplied?

  57. Yes agree Michael about the definition, it does not allow for inherited or other means by which people believe they are suffering. However, as John says what is suffering, another mankind comparison. Do we say then that those who do not have pain do not suffer? By empathising and associating with their belief of suffering does this actually help?

  58. @ John, yes I think clinicians in physical medicine are positioned like no other profession to gain key insights at the junctions between body, mind and society. I think learning to spread philosophic wings will allow us to shape the paradigms that we operate under instead of being subservient to them.

    @Mick that is an interesting proposal by your PhD student I probably would take it a step further in saying pain is the embodied social construction of threat or something of that nature. I would be interested to know how the three definitions of embodied, encapsulated, suffering and pain are defined in relation to each other.

    Yes, Wittgenstein presents some challenging ideas. In response to your challenge of “self talk” (i.e. metacognitive talk), the only individuals whom can engage in “self talk” have learned to verbalize with others. Take for example tragic examples of those who developed in non-verbal environments as an extreme example of those denied communication. Do these people feel pain, do they know what occupationally induced low back pain as described through mechanistic reasoning is (e.g.. “I blew out my disc while picking up a crate at work”). I would suspect not. On the flip side take vision as an example, those that can see or have seen can imagine objects without their presence in the visual modality; those that have never seen have no such capacity. This is same phenomenon is present in those that have congenital insensitivity to pain; no pain at birth means no stereotypical ability to feel or even the imagine bodily threat.

    You’re right a nervous system is only necessary but probably not sufficient for mind and pain, as is demonstrated by those in comas, or being anesthetized. I should have given the trite phrase “sufficient and necessary” a bit more consideration. I agree with you about trying to avoid infinite regress of the definition of mind and or pain within the nervous system.

    With regards to neuroscience education, how do you advocate for pain education with those whose metaphorical repertoire is limited in scope, or in other words their health literacy is limited? I work with a lot of non-native (English) speakers and low socio-economic status patients with complex health and painful issues, and this is a challenge I face on a daily basis. I have shifted throughout the years to a metaphorically informed neuroscience education but even the mention of a nerve may be sufficiently above the head of my patients. Lakoff and Johnson and the constructed embodied movement (as defined in Sharpiros work) has been particularly informative on this front for me.

    @AdamB I believe the subpersonal and personal is Daniel Dennet’s terms. I find these convenient and very informative when attempting to understand a brain, mind, society and their respective constituents. I am curious if we should consider society as the suprapersonal? I think we could agree that phenomenological aspects that we correlate with the verbal expression of “pain” exist probably at the junction between subperosnal and personal. However, the expression of “pain” exists at the level between the personal and suprapersonal.

  59. I think I should clarify, the examples cited regarding congenital insensitivity, blindness and people raised without exposure to language is to demonstrate that a modality and its conscious correlate depend both on the neural substrate but also the exposure to the modality. In terms of language i.e. the expression of pain, it is dependent upon enculturation provided the neurophysiology has already been supplied.

  60. John Quintner says:

    Eric, in his article “Autopoiesis, Culture and Society,” Humberto Mariotti reaches some sobering conclusions that might be obliquely relevant to your work with socio-economically disadvantaged people.

    I have read that Maturana was not in favour of extending his biological concepts to the behaviour of human societies, but others seem to have found them useful in this context.

  61. “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Quote from Buckminster Fuller and a clinician of great age and patience !

  62. Michael Ward says:

    Alison, I agree. I am reminded of a comment by a pain patient – “Pain is what I say it is, I have it when I say I have it and it is as bad as I say it is” -paraphrased and unfortunately I am unable to correctly attribute it. (john, you may be familiar with it from chronic pain Australia)

    Each time we caress, nudge, mold, convolute, redefine “pain” a word of general usage – I cant help fearing we are disenfranchising those very patients of their most important asset – a voice. It is the flip side of the neuroscientists losing the terms of neuroplasticity or motor control to clinicians who in turn resent the popularization of it. Maybe we should have our very own science term for the thing which we call pain – maybe distress, maybe suffering, maybe dolor or maybe nociception :0)

  63. Mick Thacker says:


    John – agree but a working definition is “the ongoing experience of negative hedonic valance that the individual wishes to cease immediately”.

    Adam – I agree – I do not think that we shouldn’t attempt to understand/describe the subpersonal level, as a neuroscientist/clinician this is what fascinates me most; neither do i think that the extended mind protagonists are ignoring/against this. Theories such as Walter Freeman’s neurodynamic models offer some headway here too. The extended mind people come in all colours and across a massive spectrum – I think they would argue that we need to combine several models and approaches but the exact models, is how they differ – my preference would be towards Andy Clark’s perspective that marries neoconstructivism together with embodied cognition in a Bayesian framework! Yes some of the radical enactivists such as Dan Hutto do reject attempts at understanding the subpersonal mechanisms using current strategies but I do not think they are opposed to the scientific endeavour just the methodologies employed.
    I agree it depends on what computation means to you, so for the discussion could you tell us what your meaning is?

    John – I don’t think brains create anything – they may construct or constitute i.e. they need exposure to the correct elements and a reason to do so e.g. Physiological and environmental exposure?

    Michael and Alison – the last part of our definition is important as we feel it is essential to see the embodied suffering in the context of ones life world e.g. Not just internal but external influences and experiences – it is the opposite of a constraint – it allows a greater perspective.
    Negative hedonic valance – is not limited to pain, so suffering is not unique to pain. I would like you to explain your “…..does not allow……” comment Alison – I think it does?

    Eric – I think that our definition of pain acknowledges the person as influenced by their own physiology and environment (embodied component) in the widest perspective and that they ultimately are the one that experiences the impact of these factors. These experiences occur within their life world, which they shape in part and which is shaped also by the geo/eco political landscape they live in (encapsulated) . Suffering occurs because of the interaction between the experience of the embodied components and the encapsulation of the individual in their life world. The geo/eco political landscape either creates a system where there is an expectation of adequate pain relief or one where this is not possible! I would argue that this effects the dispossesed of many in all so called industrialised countries – but especially USA where many cannot afford adequate healthcare cover and have no realistic expectation of pain relief even though it is widely available within their society . Those in third world countries may not have any expectation at all! Which is the worst depends on the degree of expectation-reality mismatch for the individual.

    In terms of your examples, I think that all these specific groups have a capacity for conveying the information of pain,vision etc e.g. blind sight is possible and reported by those that were born without vision, also those congenitally insensitive to pain report experiences they readily report and often say “it would be painful if I could feel pain”.
    Language itself my be unique – it depends on your acceptance of Chomsky’s theories.

    Educating these patients is difficult but our Aussie mates can help us out with the unique work done with indigenous Australian peoples – where unique metaphor and conceptual frameworks have been developed to provide essential healthcare education. Ian Edwards may be able to help here?

  64. Mick Thacker says:

    Sorry my last post should have read Indigenous Australian peoples.

  65. Hi Mick, I agree that both the internal and external influences are important but you are implying that the external influences are a cause of the suffering. This disempowers both the patient and clinician. The choice is there for the choosing. I see this as a constraint still.
    Pain and suffering… do we also assume then that those who have pain always suffer? This ma not always be the case.
    Def: Pain is an embodied element of attachment as viewed by the individual from their experiences.

  66. John Quintner says:

    Mick, I think you are splitting hairs. Both “create” and “construct” can mean “bringing something into existence”. Of more importance is that we acknowledge our very limited understanding of how our brains are able to perform this vital task.
    When you say “correct elements” and “a reason to do so,” are you not attempting to impose your own conditions upon the brain’s ability to create/construct our world?

    By the way, Walter Freeman is also one of my heroes.

  67. Jan Dommerholt says:

    @Adam, I have been traveling a lot recently and was not able to reply any sooner. I am not suggesting to write of the brain, but tried to suggest that the notion that pain in the brain is just too simplistic certainly in light of this very energizing discussion. The brain is necessary for processing but I doubt that it has a mind of its own. Regarding perceptual illusions, could these be sensory distortions? I am not sure.

  68. Jan Dommerholt says:

    I would suggest to consider thoughts from the field of Phenomenological Psychology (The Dutch School), which offers several interesting concepts. F.J.J. Buytendijk, a Dutch philosopher, moved from doing animal research to human research and identified significant differences. According to Buytendijk human consciousness is intentionally directed and has meaning. Experiences, such as feelings and thinking are seen in the context of the relations of a human being and his world. Buytendijk talks about an “existing human being.” An experience of pain is being projected and projects the world the individual relates to. Human movement is always intentional in Buytendijk’s view. A person experiencing pain moves in a different way than a person who does not experience pain. Because movement is intentional, a person experiencing pain has a different intention and therefore a different relation with the world and perhaps with himself. Pain and antalgic movements reflect an attitude to the interactive process with the surroundings. Buytendijk wrote that “feeling is a mode of replying to a situation and transforming it as a projected new world, in which unknown qualities are categorically experienced.” “The situation is created by the mode in which I have accepted it, by my chosen projection. Of course, this projection is not the result of reasoning and my choice is not arbitrary.” Buytendijk does not consider pain to be a feeling, but “an emotional sensation only possible in the intentional experience of existence” and “there is no pain without a preceding, original attitude toward our existence as a physical-being-in-the-world.”

  69. Jan Dommerholt says:

    Forgot to mention one source: Buytendijk FJJ: The Phenomenological Approach to the Problem of Feelings and Emotions. In: Kockelmans JJ: Phenomenological Psychology – The Dutch School. Hingham,Kluwer Academic Publishers, 1987: 119-148

  70. Mick Thacker says:

    Hi John – really I am not splitting hairs here- one of these words, creates, leads to a mereological fallacy (a la Bennett and Hacker) the other constructs does not – the whole of this discussion focuses on the idea that brains are not by themselves sufficient to create pain, experience, minds etc does it not? This is why sementically there is a huge difference between the two. I used the terms concstruct or constitute intentionally as I believe that if we accept an extended perspective (which I do) we avoid the fallacious thinking that suggests brains are sufficient to “create” experience, pain, minds etc. Construction or constitution requires both a reason for (governing rules) and elements (such as stimuli) on which to act – I am not imposing the exact nature of either!

  71. Adam Bjerre says:

    Thank you very much for your responses.

    @John (and Mick) As I understand the ongoing discussions of the brains role, the enactivist view has reservations about “the brain” doing anything in particular as that would imply some kind of internalism, “erecting a veil between mind and world which theoretically puts the world off-limits” (Froese and Ikegami, 2013). As such it doesn’t “create” anything but can still be regarded as a “computer” that in Dennett’s words “takes information in and yield control out – just like a computer, but not the kind of computer that critics are imagining, e.g. a laptop”. In Andy Clarks words: “brains like ours are sensitive statistical sponges open to deep restructuring by the barrage of inputs coming from the world.”

    @Eric The personal and subpersonal level is Dennett’s terms as we have discussed over on SomaSimple. Just like you I find the theoretical distinction very helpful in understanding these complex topics. According to Dennett, Ryle and Wittgenstein were the preeminent philosophers of the personal level.

    Viewing society as the suprapersonal level is an interesting explanatory perspective but I’m not sure that dividing the expression of pain up into verbal and “expression” (non-verbal?) and assigning them to junctions between (now) three different levels is helpful. I don’t know. You have looked more into social psychology so it might be useful.

    @Mick I applaud your preference of Andy Clarks perspective! 🙂 Judging from the massive references and responses in the BBS-paper from last year I got the impression (through the cognitively exhausting terminology) that this so far is quite a trustworthy perspective. This is new territory for us all and I have to say I’m struggling. On the other hand it seems to give us a better handle on the fuzzy bit in the middle of Melzack’s Neuromatrix – in other words how perceptual systems might work.

    Since I’m not a scholar of the Copenhagen-Tartu school of biosemiotics I rely my understanding of computation on Daniel Dennett who suggests this version of “maximally bland computationalism”: “a computational system consisting of trillions of “registers” in a massively parallel array. A register is something that has got a little plasticity – it can take a value, it can be more or less. There are many physical ways of realizing a register, a place where plasticity can be exploited. The content of each register is some magnitude that can change as some (simple, computable) function of the contents of other registers. This can include glial cells, sub-cellular activity, neuromodulator activity and field effects.” (from Harvard Distinguished Lecture Series 2009).

    @Jan I agree with you that pain in the brain is too simplistic and also reject that the brain per se has a mind of its own. Who has expressed these views? That would constitute a classical homuncular fallacy where the homunculus has the same competence as the larger system.

    Regarding perceptual illusions Clark and Jakob Hohwy among others has proposed a hierarchical model where perceptual inference (top-down effects) trumps the bottom-up input. Parade cases here are the rubber hand illusion, the hollow face illusion (try google the “Gathering For Gardner” dragon) and several other optical illusions. To reject that higher level processing doesn’t play a vital role here (not singlehandedly responsible, of course) might be a mistake. There might be an important clue about nociceptive prediction gone awry here and expectation mismatch creating uncertainty or – even worse – the self-fulfilling prophecy of a broken-part model presented by a doctor or therapist as an explanatory model for the experience of pain. That’s highly speculative from my side of course.

  72. John Quintner says:

    Mick, I can go along with you, but have you factored in the possibility that brains might be self-referential systems, nested within other self-referential systems? The implications of brains possessing this property would appear to be profound.

  73. @Mick Thanks for the tip on Ian Edwards, I will look him up for sure. That sounds like very interesting work.

    As I understand, blind sight is due to lesions of V1 in the occipital lobe but preservation of connections to the superior colliculus. Yet, if someone were to be denied any input (lesion at the retina, optic nerve, or thalamus) they would not be able to have blind sight or regular vision. Thus they would not be able to dream in images as those with sight can. These blind people obviously have a verbal system connected to tactile-spatial representations of space and objects but lack a visual correlation. As opposed to people who lose their vision later in life, they can still form these simulated visual images in their mind despite the absence of input – just as I can dream images without meaningful visual input.

    @ Adam A reason of the import of the suprapersonal goes as follows: In terms of self-talk we must have talked with someone to form our own ability to talk. Is the general point I am trying to make. Because talking consists of linguistic acts (semantics), speech acts (overall classification of the meaning of the act), and conversational acts (the desire to produce certain effects). Learning what pain is from a social perspective is more than just a feeling but it is learning what that expression means in terms of future predictions of health and the affect that the expression has on other people’s behavior. When an infant first cries on in pain, or when a child breaks their first bone, they do not consult a dictionary to look up the definition of pain to measure its accuracy to their experience. They rely on a lifetime of other previous experiences and vicarious observation of others. This for me is the crux, why the word “pain” or the suprapersonal experience of the word is important.

    As clinicians as researchers we attempt to tidy up this word to fit our models and our paradigms. We attempt to depersonalize it all together by embedding it in a nervous system or our genes. We all have unique phenomenological experiences some intense and pressing, but the act of converging this experience into a word involves applying the layer of “what does this mean in relation to the minds and behaviors around me?” By this reasoning a researched “pain” is never a phenomenological experience of pain — unless you are studying the pain in the arse of PhD students who sit all day reading and writing.

    @Jan I am skeptical of those who claim that all pain demonstrates movement related changes. I am not sure to what extent you are advocating for this position. To the extent that pain correlates with some changes in movement and thus behavior seems quite variable. Just as nociception does not equal pain, movement related changes that occur due to nociceptive input may not equal pain despite their sometimes ostensible correlation with a conscious correlate of pain. As physical therapists I think we could improve our care of patients if we understood more clearly how coupled or decoupled these relationships actually are. My suspicion is there are times when movement expressions correlate nicely with verbal expressions and other times not. I feel like I am surprised on a daily basis by the quality that a movement looks and its association with how it feels. Trying to understand the utterly paradoxical behavior of “cutting” seems to prove just how uncoupled such relationships can become in the human organism.

    Mick your idea if I take it correctly means is that there may be a mismatch between expectation and care in the domain of public health i.e. health care systems. In my experience, it’s not that patients don’t expect relief; it’s that they fluctuate between unrealistic expectation of relief based on an external locus and abject hopelessness. They visit a provider and the expectation is high, much higher than is realistic, then becoming disappointed return to their prior state of hopelessness. I need to think about this more but I really like where you are going with this.

    This thread is making me accumulate books and journal articles–just what I need 😉 That being said, I ask has anyone read Wolfgang Prinz’s book Open Minds? He attempts to solve the intractability of cognitive science and social construction and essentially argues that agency and intention are constructed socially — provided the human nervous system in a social environment is fecund for both. Or stated another way, we first infer agency and intentionality in others and then we apply it to ourselves. His treatise is still very tentative, but if such a grand synthesis is possible in the manner that he describes then something like pain stands a chance of being much more modulated and constructed than we realize.

  74. mick thacker says:

    Hi Alison – we are not implying that the external influences are the cause of suffering alone. I would be against anything that disempowers anyone!
    Pain and suffering are not one and the same, there are many reasons for suffering however the negative hedonic valance associated with pain is suffering, especially when it is not relieved.
    I am worried by the word attachment in your definition, this is usually used by clinicians as a prejudicial statement about patients who they feel have some maladaptive psychological relationship with their pain, i accept that is not your intention.

  75. Michael Ward says:

    Mick – re definition: love the poetic rhythm and alliteration but the reasons for questioning the extension “of the person within the society and culture in which they live” is for a couple or more reasons.
    1. person – well that leaves out way too much sentience from the outset.
    2. society and culture:
    a. Implies a predictable impact or a constant – what of the immigrant with a change of a s&c; a “stranger in a strange land” (Heinlein or Russell) or the rebel. Could it mean that as a Caucasian I feel more or less pain than an Asian or Koori.
    b. The effect of S&C is not external but an internalized version hence it is always internal
    c. For the individual, s&c is constantly variable from day to day
    d. By including s&c, you exclude other factors by omission, unless you also go onto say shaped by genetic expression, bodily health etc etc Therefore the specification of S&C constrains your definition IMHO

  76. Michael Ward says:

    PS Where does the description “thats a good pain” fit.

    John – I first read your comment as Walt Whitman – but then reading back saw it was Walt Freeman? I miss the reference.

  77. John Quintner says:

    Michael, Walter Freeman’s many papers are freely available on the web. His original work on olfaction in rabbits was ground-breaking. But he has since ventured into other areas of neuroscience and philosophy, all being of great interest to me.

  78. Michael Ward says:

    Oops I googled Freeman and came up Freeman II the lobotomy fellow and I was surprised.

    (rather than Freeman III)

  79. Jan, love your post, it fits in so well clincially. The phrase “An experience of pain is being projected and projects the world the individual relates to ” is so pertinent to relieve of the sensation. Change the reality, change the feeling, it is a choice. However clinicians can only help to show them the way as long as they do not come from the same reality of expression/belief/experience.

    Mick, I can see where you are coming from with understanding of my use of the word attachment and it could be taken as if it was something that the client wants and has decided to own but it has not been ‘owned ‘ by logical reasoning. (otherwise logic would make it better) In the majority of cases when their “projected world’ (Jan’s post) is changed the sensation changes. Using the word attachment removes the suffering element.

    I take much interest in the Cerne project and the possibility that a Higgs boson particle has the potential to be in 3000 places at the same time. This gives us all more room to manoeuvre.

  80. @Michael I’m a person in pain, and I used my voice when PainAustralia put me forward to present at AIM Pain 2014 last weekend in Sydney. I spoke and presented my art/pain story to 180 pain interested practitioners, I spoke to them all weekend, it was amazing… Everyone can view it here:

  81. Michael Ward says:

    Thanks Soula, I read through your presentation and wish you well on your journey as well as the contributions that you can make to understanding pain.

  82. Salli Wood says:

    Just for kicks, I googled the term biological plasticity. One of the first results was from Researchitaly. It stated:

    Plasticity of biological systems refers to the ability of living organisms to change their ‘state’ in response to any stimuli and applying the most appropriate, adaptive response. This occurs at any level of complexity: molecular, cellular, systemic and behavioural. The response to a given event, may also be traced and memorized so that the original state may not be restored. This is what happens, for example, in the immune response and learning.

    Stazione Zoologica Anton Dohrn (SZN)

    I think this is a useful definition (and it avoids the overlap with bioplasticity as microbes digesting petroleum products).

  83. John Quintner says:

    Salli, this useful explanation (definition) of biological plasticity raises the next question – how are living organisms able to perform these remarkable feats? And some further questions – what happens to the organism when things go wrong and how does it know that urgent action is required?

  84. Wow! I hope you aren’t really expecting an answer to those questions. That would be a dissertation and more.
    In my introductory biology courses, the first day often included a discussion of the characteristics of all living organisms. One of these was that all living things adapt to their environments. Why? Because they evolved to do so- almost a circular argument. How? That’s beyond me.
    As I try to learn more about chronic pain, I am led further and further afield by terms like biobehavioralism, biopsychosocialism, neuroendocrineimmunology, psychoneuroimmunology, and a favorite: neuropsych immunoendocrinology (none of these terms are recognized by my spell checking program). Hopefully this interdisciplinary complexity will eventually lead to a simplified, or simpler, answer to your questions.

  85. John Quintner says:

    No, Salli, I was not expecting these questions to be answered but I think they are questions that are most pertinent to this discussion. It so happens that in the context of trying to make sense of the pain experience, a number of different disciplines intersect. We are only at the stage of trying to establish a new language to help us communicate about the complex phenomena that are daily before us in our clinical practice.

  86. Well if your interested in going down the rabbit hole of interdisciplinary thinking there is no better guide than Robert Sapolsky. He has written several books but he has an entire course from Stanford for free on youtube. He attempts to bring behavior, evolution, neuroscience, endocrinology etc all under one big roof. I am currently going through the lectures and find them awe inspiring. Warning: it is dense but is very approachable if you have a basic biology background. See this link:

  87. John Quintner says:

    I concur – there is none better! By the way, thanks to Lorimer, we are all now obliged to go down this particular “rabbit hole”. Let us hope that the paradigm shift in pain theory sweeps all else before it.

  88. Evanthis Raftopoulos says:

    Lorimer, John, Mick , and others interested in systems biology and relational biology (as coined by Nicolas Rashevsky) or “relational science” : I have gained a lot of insight from studying the work of theoretical biologist Robert Rosen, and specifically his Anticipatory Systems Theory. IMO this theory or the “anticipatory paradigm” has a lot to offer to understanding pain.

    Quoting Judith Rosen (Robert Rosen’s daughter)
    “according to Robert Rosen, the means by which a living system is internally guided and controlled involved encoded information acting as an interactive set of models – of self, of environment, and of relations between the two… through time.”

    I’m planning on writing more about this in the future.



  89. Evanthis Raftopoulos says:

    edit for the above quote:
    “involves” , not “involved”

  90. stuart miller says:

    Evanthis, great reference. The visual and auditory systems as part of anticipatory defense systems are important. Lorimer, great post as always – it has been very helpful as a therapist working with patients in pain to have gained insight from your work and others in the pain field. The revision of pain as a conscious correlate of the implicit perception of threat as well as the term bioplasticity is cool. The supermeme of pain as a product of tissue damage (or even potential tissue damage) is adapting to a more relevant truth for humans (John – your paper on Pain Medicine and Its Models: Helping or Hindering? is incendiary – I reference William Miller and Lester Sparks). Salli, bioplastics reference biodegradable plastics (dissolving stitches have been used for years) whereas plastics imply permanence at least in the natural world. Bioplastics are not all created equal and the mindset in which they are used is key. In the natural world, all mammals pain guard after an injury. Many animals though, especially prey species will stop pain guarding when threatened or excited. In terms of persistent pain, rats with chronic pain will actively seek out analgesics. What’s my point ? I think that if we only look at pain through the narrow window of human consciousness, we may be missing out a bit. In terms of subcortical processes, visual vestibular integration is important with head/ eye coordination. Increased tone in neck muscles and altered postural responses can happen with decreased integration. Preparatory and anticipatory systems that are subcortical play a big part in our experience of the world. 11 million bits of information every second from one reference. The body matrix is cool but is beyond my cognitive threshold of understanding unless there is a reference to how we have it (Neil Shubin’s Your Inner Fish is a nice starting point). I really appreciate the philosophical references but I am still trying to understand a basic framework. Please provide further insight.

  91. John Quintner says:

    Stuart, I am not familiar with William Miller or Lester Sparks. Were they fellow incendiarists? The paper you mention took ten years to conceive and about two years for us to write.

    The seminal work of Walter J Freeman (and, in particular, an article he wrote on heart rate and chaos in Scientific American) sparked my interest in biological systems.

    In your laudable quest for a basic (understandable) framework, you might like to read Freeman’s paper – “Three centuries of category errors in studies of the neural basis of consciousness and intentionality” in Neural Networks 1997; 10: 1175-1183. [this article is available for free download from the Net]

    In the abstract of this article he writes: ” … brains are intrinsically unstable and continually create themselves … Intentional behavior can only be understood in relation to the chaotic patterns of neural activity that produce it. The machine metaphor remains, but the machine is seen as self-determining.”

    Lorimer, where do you think does this leave the concept of a body matrix?

  92. stuart miller says:

    Sorry for the obscure reference. I appreciate the ton of work you have done (with Cohen and Lyon and others) in improving understanding. Philip Seymour Hoffman played Lester Sparks, a seasoned journalist/ rock critic who mentored/ guided a young wide eyed journalist, William Miller in the movie Almost Famous. I really appreciate your seasoned perspective from multiple angles when looking at pain. I will check out Freeman’s work…

  93. Evanthis Raftopoulos says:

    John, along the lines of what you mentioned before “have you factored in the possibility that brains might be self-referential systems, nested within other self-referential systems?” , and my efforts of explaining “body matrix” from an “anticipatory paradigm” POV :

    An anticipatory system in the strict sense is described as an “adaptive system in which prospective future behaviors determine present changes of state”.

    “a given system may be encoded into another so as to establish a modeling relation”

    In this context, the “body matrix” can be conceptualized as a dynamical system and also a predictive model encoded into the organism (system of interest), and which organism uses its predictions to generate its behavior. In this sense the body matrix is a model of the [rest of the] organism, and has the capacity to act on the organism through a set of effectors. As Robert Rosen describes, if the trajectory in the system model (in our case body matrix) is in the “undesirable” region (a simplified way of looking at this) then the system model takes action.

    Here is a representation of this:

    References: Rosen R., 1985, Anticipatory Systems: Philosophical, Mathematical, & Methodological Foundations

  94. John Quintner says:

    Evanthis, these theoretical insights from Robert Rosen bring together much of what has been said in this important discourse.

    I very much like your POV regarding the body matrix.

    The other important point he makes is about the anticipatory trajectory of living organisms. So when we perceive that we are in, or are about to enter, such an “undesirable” region, could one of our experiences be that which we call “pain”?

    But I am not sure how well I have expressed this view.

  95. Evanthis Raftopoulos says:

    Thank you John, yes, I think that we can say that. “Body matrix” (or “neuromatrix”, or whatever people like to call this system model ) is essentially an internal predictive model within the organism. “Body matrix” , body, and environment interactions result in the emergence of the phenomenon which we call “pain”. I think that developing a better understanding of these interactions and how we can influence them is key in helping pain patients. In physical therapy for example, there are many opportunities for us to intervene and influence these interactions for the benefit of the patient. Judith Rosen also suggested this when I reached out to her.

    What I find fascinating is that Robert Rosen as a mathematical biologist used mathematics to arrive to his conclusions of modeling relations, and this seems to make his work by far more reliable than others.



  96. John Quintner says:

    Evanthis, we need to be very careful in what we say, because “emergence” as a concept continues to be a thorny one upon which conflicting philosophical opinions abound. [Corning, 2002]

    Anyway, here are a few quotes and references should you feel the need to delve deeper into this subject:

    “Many scientists speak of emergent properties. But as ordinarily used, the doctrine of emergence explains nothing. It merely restates the problem.” [Birch, 1990: p. 77]

    Goldstein [1999] defined emergence as “the arising of novel and coherent structures, patterns and properties during the process of self-organization in complex systems.”

    “An emergence theory should, among other things, provide an account of which properties (of a given class of systems) should be regarded as emergent, and offer an explanation of the relationship between these properties and the microstructure of the systems.” [Quieroz & El-Hani, 2006]

    Birch C. On Purpose. Kensington: New South Wales Universuty Press Ltd., 1990.

    Corning PA. The re-emergence of emergence: a venerable concept in search of a theory. Complexity 2002; 7: 18-30.

    Goldstein J. Emergence as a construct: history and issues. Emergence: Complexity and Organization 1999; 1: 49-72.

    Queiroz J, El-Hani CN. Towards a multi-level approach to the emergence of meaning processes in living systems. Acta Biotheoretica 2006; 54: 179-206.

  97. Evanthis Raftopoulos says:

    John, I see your point about emergence and I’m partially aware of the philosophical debates about the term. It also seems that different definitions exist, including differences between philosophical emergence and scientific emergence. Similar to what Charles Birch wrote, in “metaphysics of the mind” Jaegwon Kim argues

    “If emergent properties exist, they are causally and hence explanatorily, inert and therefore largely useless for the purpose of causal/explanatory theories.”

    He continues,
    “If these considerations are correct, higher-level properties can serve as causes in downwards causal relationships only if they are reducible to lower-level properties. The paradox is that if they are so reducible, they are not really “higher-level” any longer”

    In the context of the pain experience, I agree that it might be difficult to say pain is emergent in the sense that we do not have a complete model of the pain experience to know from what exactly it “emerges” from, and therefore to say with certainty that it is indeed emergent. So perhaps “constructed” as Mick Thacker mentioned is more appropriate? So that what we call pain is the experience constructed from the interactions of system model – system interactions? I would love to hear Mick’s and Lorimer’s thoughts on this as well.

    Thank you for the discussion and the references John! Always appreciated.


  98. John Quintner says:

    Evanthis, can we specify the “elements” from which an experience such as that which we call “pain” might be constructed? In trying to answer this question, I agree with you that we cannot do so. We quickly run out of language.

    I have previously mentioned the insights of Franciso Varela. Here is an example: “One of Varela’s major contributions to neuroscience – the demonstration that a large neural network selects what it pays attention to, which in turn reverberates through a large part of the system and adds to the memory of past experiences in selecting what we next pay attention to – is closely akin to the second-generation immune networks that he offered to immunologists.” [Stewart & Coutinho, 2004]

    I find great difficulty grasping this exciting concept. Yet it seems fundamental to our discussion of “bioplasticity”. Please tell me if I am way off beam.

    Anyway, I dug out one of my old folders and selected a few papers that might be of interest to you:

    Bourgine P, Stewart J. Autopoiesis and cognition. Artificial Life 2004; 10: 327-345.

    Mayr E. 80 years of watching the evolutionary scenery. Science 2004; 305: 46-47. [Science wishes Ernst Mayr a very happy 100th birthday]

    Ruiz_Mirazo K, Moreno A. Basic autonomy as a fundamental step in the synthesis of life. Artificial Life 2004; 10: 235-259.

    Stewart J, Coutinho A, The affirmation of self: a new perspective on the immune system. Artificial Life 2004; 10″ 261-276.

    Varela FJ, Coutinho A. Second generation immune networks. Immunology Today 1991; 12: 159-166.

    Woese CR. A new biology for a new century. Microbiology and Molecular Biology Reviews. 2004; 68: 173-186.

  99. Evanthis Raftopoulos says:

    I agree John, in that maybe our language cannot capture the whole, and in that this discussion is indeed relevant to “bioplasticity” (we are discussing interactions of body-”body matrix”- environment after all), and to what Lorimer stated “I have slowly come to understand that pain is not an emergent property of the nervous system, but of the human”. It appears though that only the two of us care enough to take the time and further examine these issues here. At another forum where this discussion was shared, some complained that this information is confusing and too philosophical, therefore not necessary. IMO this is nonsense, we need to discuss these issues if we care to examine the complexity and develop frameworks relevant to clinical practice that are not misleading.What concerns me is that this whole “neuroscience paradigm shift” in clinical practice might be founded on partially correct premises, (I see similar problems to what you discuss in your 2008 paper about the biopsychosocial model). Unfortunately, people are becoming too emotionally attached to certain view points to see potential errors in their thinking.

    Francisco Varela is one of my heroes. Thank you sharing his work here.

    Also relevant to the emergence discussion, Varela from “Naturalizing Phenomenology: Issues in Contemporary Phenomenology and Cognitive Science”:

    “On the one hand, we are concerned with a process of external emergence with well-defined neurobiological attributes, on the other, with a phenomenological description that stays close to our lived experience. The nature of the sought-after circulation one seeks is no less than that of mutual constraints of both accounts, including both the potential bridges and contradictions between them. What is the specific nature of the passages between these two accounts in the case at hand? What have we learned in the specific case of immediate temporality?
    One thing is clear: the specific nature of the mutual constraints is far from a simple empirical correspondence or a categorical isomorphism. Three ingredients have turned out to play an equally important role: (I) the neurobiological basis, (2) the formal descriptive tools mostly derived from nonlinear dynamics, and (3) the nature of lived temporal experience studied under reduction. What needs to be examined carefully is the way in which these three ingredients are braided together in a constitutive manner. What we find is much more than a juxtaposition of items. It is an active link, where effects of constraint and modification can circulate effectively, modifying both partners in a fruitful and complementary way.”



  100. John Quintner says:

    @Evanthis. Seems like we can close off this discussion at 100 not out. Now that the Genie (bioplasticity) is out of the bottle, it is time for some of us in the pain world to do some serious thinking and come up with more useful theory to guide our clinical practice.

  101. Jan Dommerholt says:


    I do think that it is a bit premature to conclude that “It appears though that only the two of us care enough to take the time and further examine these issues here.” Speaking for myself, I have been introduced to many new references and insights and it will take several weeks if not months to read these resources. I have always had much difficulty with the notion that pain is in the brain and am delighted that Moseley and Thacker moved away from that restricted perspective and start realizing that pain is a human property. Having been trained in the philosophies of Buytendijk, I have a great interest in the philosophy of pain, but I and I assume other participants, will need a substantial amount of time to become better informed.

  102. @Evan it is unfortunate that professionals and researchers that pay attention to clinical science do not enjoy philosophy and theory more. As Einstein remarked, “it is theory which decides what we can observe.” Meaning that theory is what enables the mind to make certain observations which may be otherwise awash in a sea of data. I worry that many clinicans and clinical researchers are so focused on the narrow lens of the individual that they fail to understand larger, enviromental, evolutionary and social cultural forces at play that are shaping our minds and out interpretation of the painful experience.

  103. last line should say “our interpretation of the painful experience.”

  104. Eric, I feel I must stand up for the clinican. I don’t think that particular quote from Einstein is very apt here. Theories are hypothetical and do not take into account personal experiences. Do these fit one such theory ? From this discussion we are discovering there are many ‘theories’ that people can draw upon/combine. Can we interpret them all successfully and then find a workable clinical model for pain relief?! In my experience one glove does not fit all unless we are talking about energy exchange.

  105. John Quintner says:

    Alison, everything we do is theory laden, even if we don’t realize this fact!

    I agree with you that pain relief should be our goal but the research is telling us that the treatment modalities currently available are quite limited in this respect.

    I also agree with Eric and suggest that what we are all trying to do is to lessen the burden of our patients as they try to navigate a safe path along their respective life journeys.

    It is therefore useful to delve into other fields of scientific endeavour and I believe that evolutionary biology provides us with a better understanding of the biological predicaments of our patients.

    Of course any useful theory developed in the context of pain needs to acknowledge the possible influences of relevant socio-cultural factors upon the lived experience of our patients and also upon ourselves.

    Welcome to the Bioplasticity project!

  106. Evanthis Raftopoulos says:

    Jan, thank you for sharing. I was referring to the specific discussion here. Perhaps for my own selfish reasons, I was hoping that others will continue contributing as I see this topic as important. IMO one does not need to study for months the references to keep up with the discussion and share his/her POV. I acknowledge that the references do provide a strong knowledge framework, and help us appreciate how much thought has already gone into “bioplasticity” and “pain”.

    About the “pain in the brain” comment , I’m not sure that Lorimer or Mick ever supported the theory that “pain” is in the brain in the sense that pain is something concrete that exists in the brain. This is different than saying “pain is an output (or construct) of the brain or “body matrix” ( . I think we need to be careful and take the time to provide relevant references when we claim to know other people’s perspective.

    Eric, in short, I couldn’t agree more. Moreover, in order to move towards “less wrong” theories, we need to set our biases aside first. Not an easy task.