Talk:Pain/Archive 2

Archive
I have created an archive of the old discussions. I have copied back to this page all recent conversations. In case anyone needs to know in the future, I used the Move Page method to preserve the edit history. Everything below is a cut-and-paste copy of the 2008 discussions. (I think I got them all...) WhatamIdoing (talk) 22:28, 29 March 2008 (UTC)
 * How can we access the archive? The link in the archive box is red! --Robert Daoust (talk) 18:23, 12 April 2008 (UTC)


 * Oh, dear. I just noticed your note.  I'll figure out the problem.  WhatamIdoing (talk) 20:30, 16 April 2008 (UTC)


 * Fixed. The archive was still stuck at Talk:Pain and nociception/Archive 1 -- it didn't make the move when we split the page earlier this month.  WhatamIdoing (talk) 20:33, 16 April 2008 (UTC)


 * Thanks! --Robert Daoust (talk) 21:54, 16 April 2008 (UTC)

Focusing on humans
There are many good things about this article, but its major problem (in my view) is the constant implicit focus on human beings as the sole objects of this topic. Apart from a brief few lines at the end, this article suffers (no pun intended) from extreme anthropocentrism. Pain is not something specific to our species; rather, it is something we experience because we happen to be animals. I would recommend rewording and/or reorganising the article, so as the show the aspects of pain shared by all animal beings (humans included), followed by subparts dealing with specifically human aspects (insofar as it may make sense to speak of specifically human forms of pain). Aridd (talk) 13:23, 28 January 2008 (UTC)
 * I agree that for nociception the article would be better if it focussed on animals. But for pain we have a problem - pain is defined as an experience and by long convention humans attribute experiences to each other - we act as if we knew what was happening experientailly for another human. With animals doing this is considered "non-scientific" and "anthropomorphising". Science in general takes the view that we can only infer the experience of pain in non-human animals. (That we can cognitively only infer the experience of other human is perhaps not promoted widely by scientists as doing so would be politically destructive of a career and seen as Nazi/inhumane/immoral/unethical.) Which means that most of the avaiable info on pain is on human pain. If you have the time and inclination to find well sourced material on animal pain then please bring it here so we can find a way to include it in Wikipedia. SmithBlue (talk) 00:29, 20 March 2008 (UTC)
 * Panksepp, a leading scientist on emotions, believes that "[o]ther mammals do have affective experiences." (p.31, 2005, Consciousness and Cognition 14, pp.30-80) However, "Panksepp's common sense view of affective neuroscience is not the commonsense view in large areas of neuroscience" according to Watt (pp. 81–88). It's a controversial topic, still to be resolved. Admittedly, pain is a construct that has probably been used more in reports of studies on humans than on animals. However, the literature on animals and this particular form of "aversive stimulus" is abundant. The scientific study of pain, let alone emotions, is a young and still emerging field.Ostracon (talk) 19:28, 16 August 2009 (UTC)

Accupuncture corelate spinothalamic pathways?
Has anyone gone over the precise arrangement of nerves in the spinothalamic pathways versus the perceived acupuncture "meridians"/"qi channels"? It seems pretty obvious that the referral of pain from the heart to the left arm and neck could have contributed to the idea of these meridians, and I see reference to it on the Web, but on PubMed I didn't quickly find any detailed treatment of the idea, pro or con. Wnt (talk) 23:34, 25 February 2008 (UTC)

"PQRST"
This seems out of place, like it was taken straight out of a lecture in a nursing course (which is why it needs a citation). I don't think it adds anything to the page (i.e. what is pain, what are the types, etc. as opposed to what do nurses do when someone is in pain), and I opt for deleting the whole section. Anyone strongly disagree?Zickx009 (talk) 02:26, 26 February 2008 (UTC)

"Disease of pain"?
Never heard of it. Fibromyalgia, maybe? Zickx009 (talk) 02:22, 26 February 2008 (UTC)
 * "...relief of chronic conditions such as migraine and backache. Chronic pain, unlike the acute pain associated with trauma, has no apparent physiological benefit, often being referred to as the 'disease of pain'."  [] SmithBlue (talk) 00:10, 20 March 2008 (UTC)
 * While it's obviously not a technical term and that article isn't a primary source, at least now I believe that there are people who actually call chronic pain "the disease of pain." I certainly wouldn't mention that if I were writing a paper on pain because I don't think it's particularly useful or interesting, but I'm open to leaving it in.Zickx009 (talk) 19:14, 21 March 2008 (UTC)

I think there is a very bad mix up here. The correct term for pain that is pathological is "maladaptive", where as physiological pain is "adaptive". For example, chronic infection will cause a chronic pain... by definition. However this pain is adaptive and thus physiological. NGF associated central sensitisation however will cause chronic pain that is maladaptive and hence pathological. Does this make sense? User:mubinchoudhury —Preceding comment was added at 11:33, 1 May 2008 (UTC)

Definitions of Pain
removed material --- "Experts in pain have proposed a variety of definitions. These definitions illustrate the multi-facetted nature of pain.

"Pain is whatever the experiencing person says it is; existing whenever he or she says it does.” — Margo McCaffrey, RN MS

"Pain is a category of complex experiences, not a single sensation produced by a single stimulus". - Ronald Melzack and Patrick Wall

These quotes definitely do not define pain by any means. One talks about the subjective nature of pain, and the other merely mentions that pain happens to be complex and not simple. Delete section?Zickx009 (talk) 02:48, 26 February 2008 (UTC)


 * The McCaffrey quote: This definition recognises that "pain", in part, is a "construct of language" formed by individuals. As a working definition that is in use by nurses and stated in a nursing textbook it is a valuable definition to have in this article.


 * "Melzack and Wall" - I agree it is not a complete definition. However it is not merely about complex/simple - Melzak and Wall are explicitly categorizing pain as an experience. Melzak and Wall were the pain experts of the 20th centuary. I think including this material in the article would be advantageous - most readers erroneously think that pain is a physiological event - not an experience. I agree that the present header/layout could be improved upon.


 * I am interested in working to improve this article and would appreciate your further input. 23:35, 19 March 2008 (UTC)
 * The "McCaffery M., Nursing management of the patient in pain." definition is the one that they teach to new british nurses (don't know about doctors) while they are being trained. ( Hypnosadist )  06:42, 20 March 2008 (UTC)
 * My point is that these are not definitions of pain. If someone asked you what pain was, saying "it's whatever we say it is," or "it's a set of complex experiences" would not be sufficient and would leave your questioner confused.  These quotes describe properties of pain but they are not definitions.  I do agree that the ideas that pain is a "construct of language" and that it is an experience rather than a physiological event are both very important and should be addressed in the article.  Perhaps a new section could be devoted to the subjective nature of pain?  That would provide a good place to insert these quotes as well.Zickx009 (talk) 19:26, 21 March 2008 (UTC)
 * I disagree, these are both experiential definitions, what we need is more definitions based on biology. ( Hypnosadist )  14:13, 23 March 2008 (UTC)
 * Given that pain is by definition subjective/experiential I am curious as to what sort of biological definition you are referring to. Please explain. SmithBlue (talk) 07:34, 24 March 2008 (UTC)
 * I don't believe that Zickx009 is saying that pain is (just) non-physiological. I believe he said only that these two ideas ("contruct of language" and "experience") need to be included in the article.  WhatamIdoing (talk) 15:52, 23 March 2008 (UTC)

I agree that "it's a set of complex experiences" is not a definition. However the McCaffrey quote is, within the context of nursing education, the definition that is being used. I support your removal of the section "Definitions of pain" unless we can find more and hopefully a secondary or tertiary source commenting on the different definitions. (At one stage I found a behaviorist psychology definition of pain but then lost the source. I believe that other definitions exist too.) I think your idea of a section on the essentially subjective nature of pain is great. SmithBlue (talk) 12:42, 22 March 2008 (UTC)


 * SmithBlue, I think you're missing the critical issue here. You cannot use a definition to prove itself right.  This is a disputed definition.  You need to find something more than an assertion of this definition to prove it "right."  So far all you've done is prove that "some people define pain this way" -- which is true enough, but some people define pain in other ways, too.  WhatamIdoing (talk) 19:57, 24 March 2008 (UTC)
 * I am not using a defintion to prove that definition right. I am not saying that McCaffrey's def should be the basis or the only definition of pain offered in this article. I am saying that McCaffrey's definition is a important, currently used, notable, unique addtion to the material in this article coming from a WP:VER and WP:RS tertiary (textbook) source. I am not seeking to prove this definition "right" - just showing that it meets and exceeds the standards for inclusion into this article. I do not understand why you think I am trying to prove this definition right. Please explain. SmithBlue (talk) 07:25, 26 March 2008 (UTC)


 * I understand your statement, "Given that pain is by definition subjective/experiential..." to mean that you do not believe even in the possibility of any non-experiential definition. The mere fact that someone has defined pain as subjective has excluded for you any objective definitions.  I would certainly include subjective definitions, but I am opposed to presenting them as True™ or as the only options.  WhatamIdoing (talk) 18:47, 26 March 2008 (UTC)


 * As a doctor, the definition I work with is: "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. "

alternate approaches to pain
There's a lot of work on defining pain outside of the reported emotional/psychological experience. For example, various researchers have looked at neurotransmitter levels, a variety of physiologic responses like changes in oxygen saturation, skin conductance, heart rate or blood pressure, and behavioral observations like facial expressions. I'd be surprised if there wasn't quite a bit more than these examples. Much of this work focuses on people who can't communicate usefully about their pain: critically ill, very young, or severely disabled people. Some of it is focused on people who might not be motivated to accurately report their pain (people addicted to opiods, for example).

I also expect that there is a substantial body of work on pain in the context of veterinary work. Surely a snake can be said to perceive the pain of being injured even though snakes are widely believed to have no true psychological response to anything. WhatamIdoing (talk) 20:27, 24 March 2008 (UTC)


 * The studies you present above are into physiological or behavioral correlates of pain. All indicators mentioned can be present in exactly the same way as present when pain is present without pain being experienced. I agree that the indicators cited may well show that if the person is normally conscious with a normal nervous system then its likely they are experiencing pain. neurotransmitter levels - "Many pain researchers are sceptical about whether such a test is possible.", changes in oxygen saturation - "The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2",  skin conductance - "objective method for measuring the stress response to painful stimuli in premature infants". I will stop going thru the research you cite here and say that it appears very unlikely that a definitive behavioral or physiological analog of pain has been found. Maybe this work will bear fruit but at present the first 3 studies given do not show an functioning definition of pain as other than as an experience. I very much doubt that the others do otherwise. If so pls show me. I support the inclusion in the article of physical and behavioral correlates of pain but see no evidence for pain being other than essentially experiential and subjective.


 * My understanding of vetinary work comes from the citation in the article - something like "we act as if the animal is experiencing pain if this seems reasonable." I have no doubt that snakes experience pain - but I can find no scientific studies showing that conclusively. If you can find them pls bring them to the article. (Have made this a new section cause I think its very interesting.) Seriously, maybe we need to find sources for the way pain is ascribed to fellow humans and many animals without anything more than self-reports by humans and each individuals own experience of pain to go on? SmithBlue (talk) 07:25, 26 March 2008 (UTC)


 * You have misrepresented the second study entirely: the "expert raters" were people looking at babies and guessing whether this one or that one appeared to be in pain.  That they didn't always agree with each other ("agreement between expert raters") is hardly surprising, and has nothing to do with whether the babies were in pain or even on what the objective measures turned up.


 * But what I want from you is this: If you take a machete and whack a snake in half, or if you step on a cockroach, or if you pull the wings off of a housefly, what counts as pain for that animal according to you?  These animals do not "experience" anything like we do.  They do not have emotions.  You seem to believe that pain is solely a subjective experience, which has more to do with how we psychologically respond to a situation than with, say, nerve signals.  These animals have no emotions.  These insects barely even have what we'd call memory.  Would you describe these events as pain-free for the animal, since they have no capacity to understand, symbolically organize, or remember them?  WhatamIdoing (talk) 19:05, 26 March 2008 (UTC)
 * I disagree that I misrepresented the changes in oxygen saturation study - "Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI" indicated to me that the study is about pain indicators, not a non-experential, non-subjective definition of pain. Objective measures are behavioral or physiological events - if there is a scientifically accepted objective definitin of pain in terms of physiological or behavioral events please bring it here.


 * Nociception - this, I understand, is scientifically accepted as the usual response of all? animal's nervous systems to injury. In our culture it is common to ascibe pain for an injured fly - so no I wouldn't describe the injured animals as "pain-free" but nor can I find scientific work that says that they definately experience pain. What is the relevance of your question to this article? SmithBlue (talk) 21:23, 26 March 2008 (UTC)


 * Because I think that this question illustrates the problem with the article. We are representing pain in this article in a way that requires a psychological component -- the one, True™, scientific definition of a "subjective conscious experience."  We are therefore representing pain in this article as something that never happens to simpler animals.  We are also, BTW, defining pain as something that never affects people who are in comas, or people with sufficient brain damage, or even babies that were born a few hours ago.  I think this is misleading, at best, and absolutely horrifying in some contexts.
 * So: You would probably say that the snake finds being cut in half painful.  You would likely support anesthesia for people with severe dementia, if (for example) they needed surgery.  You would likely oppose doing surgery on a newborn without proper painkillers (despite some surgeons saying that it's not worth the risk because "babies aren't developed enough to really experience pain").  You would likely do this because you think it's not nice to needlessly inflict pain on people or animals.
 * Now: where in this article do we have a definition that supports this basic, common, everyday understanding of pain?  I'm not finding it.  And I think it should be present.  WhatamIdoing (talk) 21:56, 26 March 2008 (UTC)
 * Yes On what you have written about including the basic, common, everyday understanding of pain we agree furiously! Do you have suggestions on what material from what sources we need to bring to this article? SmithBlue (talk) 22:28, 26 March 2008 (UTC)

Well, we could start with a normal dictionary defintion, like "a basic bodily sensation induced by a noxious stimulus" or "an unpleasant sensation" rather than leading with the current technical definition. For that matter, once you leave the ultraspecialists, pain becomes much more familiar to the average person even in authoritative medical references. In the words of Stedman's Medical Dictionary, it is "an unpleasant sensation occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder"; Dorland's Medical Dictionary says pain is "a more or less localized sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings." These focus on the sensory aspect instead of the psychologic -- that is, on what the normal person calls pain, instead of on what the psychologists used to call pain affect before they decided that pain was the affect.


 * That wider complex usage needs to be addressed - the following is just one of the pitfalls - From Sensation"In psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a sensory organ, which then leads to perception, the mental state that is reflected in statements like "I see a uniformly blue wall." SmithBlue (talk) 06:08, 30 March 2008 (UTC)

In addition to introducing a much broader definition, I think there are three things that might be useful: WhatamIdoing (talk) 05:58, 27 March 2008 (UTC)

History of pain definitions
The IASP's definition is not only just one among many now; it's a relatively new one by any reasonable standard. This series of pages has some interesting, although not very detailed, information about pain. It has a good summary of some historical changes. I think the definition of pain has changed materially in the last quarter-to-half century. What a 17th century physician called "pain and suffering" seems to have been renamed in the 20th century as "nociception and pain." The early use of pain had a lot more to do with (what we call) nerve signals, and suffering had to do with your response to it: in the famous Descartes drawing, pain is what happens to your foot when you stick it in the fire, and suffering is your response to it. Indeed, if you look at the definition of suffering on Wikipedia, it bears striking resemblance to the IASP's definition of pain.

There is more historical information at the NIH, and just a bit here in the introductory material to the first link.

This link, which covers a lot of territory, has an interesting short section. Search down to see what Helm says, which covers the basic practical problems with defining pain as an emotional response: "writhing and screaming fail to signify that one is suffering pain" during torture, because if you want to die, then signs that you're getting what you want must be pleasurable. This may not really fit into this article, however. WhatamIdoing (talk) 05:58, 27 March 2008 (UTC)
 * the IASP def “an unpleasant sensory and emotional experience" is broader than "an emotional response" (and like a sparrow at a cafe table picking up crumbs of knowledge) and the IASP definition might be over 30 years old! (Sorry I just love boasting about new-found gossip)
 * Hope it is obvious that I think a full description of all notable definitions and uses of "pain" is highly desirable - that limiting WP to a single scientific definition is stoopid. SmithBlue (talk) 17:27, 3 April 2008 (UTC)
 * I fully agree with you that a full description of all notable definitions and uses of "pain" is highly desirable. But not necessarily within the same article! I suggest the article "Pain" should mention first the two widely ackowledge defs or uses (ie. physical and mental pain), and then proceed with describing all notable defs and uses of physical pain, leaving details about mental pain to "Suffering" and other articles. --Robert Daoust (talk) 18:48, 3 April 2008 (UTC)

Pain as nociception without emotions
The AVMA has some information about the difficulty of defining pain in animals. Mammals are believed to be similar to humans. The USDA directly defines pain in animals as whatever produces pain in humans. Here is a source claiming that fish are neurologically incapable of experiencing pain (using pain in IASP terms), and here is a BBC story about some UK research that concludes that it doesn't matter whether fish have a neocortex (and thus the capacity for having any kind of psychological response), because "profound behavioural and physiological changes" demonstrate the existence of a clear response to nociception. This magazine article has something about the "hierarchy of pain consciousness," which I think of as the obvious extension of the doctor calling it "some discomfort" while the patient calls it "nearly intolerable pain:" human pain is very real, and dog pain is pretty real, and fish pain is not real, and cockroach pain is foolish. (Did you know that birds find grape flavoring to be painful?)  WhatamIdoing (talk) 05:58, 27 March 2008 (UTC)
 * See also http://en.wikipedia.org/wiki/Animal_testing#Pain_and_suffering, especially the reference to DeGrazia D, Rowan A (1991) Pain, suffering, and anxiety in animals and humans Theoretical Medicine and Bioethics Volume 12, Number 3, pages 193-211. --Robert Daoust (talk) 20:53, 2 April 2008 (UTC)

Psychological response without any sort of nociception
As for the "other side," it might be interesting to include the pain overlap theory, entirely focused on the psychological response to loneliness. This is not a sensory experience in IASP terms, but they make a case for it still being painful, and social exclusion often is "described in terms of such damage" [associated with actual or potential tissue damage], which means that it meets the IASP definition of pain.

I'd be interested in hearing your thoughts. WhatamIdoing (talk) 05:58, 27 March 2008 (UTC)
 * There seems no evidence that emotional pain and (oh what to call it) pain triggered by nociception is different . And we have reserch findings A pain by any other name (rejection, exclusion, ostracism)... role of dorsal anterior cingulate that the neurology is the same. Perplexing? Suggestions? SmithBlue (talk) 03:24, 3 April 2008 (UTC)
 * The gist of the pain overlap theory, in my understanding, is that the unpleasantness dimension of sensory and emotional 'pain' is subserved by the same neural structure, but that the sensory or emotional dimensions are not. Social exclusion may be described in terms of heart ache, but it is still not a sensory pain because, contrarily to a heart attack, it shows no activation of the insular cortex, which is responsible for the processing of sensation. Now, the terminological muddle in pain science can be inextricable if there is no agreement on terms and definitions. Actually, I think there is a crisis in pain terminology, but IASP pain definition served so well since thirty years that it will take something big to change it. In Wikipedia, I believe that we can be unequivocal throughout the encyclopedia if we use pain in its broadest sense as suffering, and in its more specific sense as physical sensory pain. I don't think nociception is the key to clarity, on the contrary: nociception is a technical neurological concept that may or may not be involved in the description of various kinds of pain. As for the pain overlap theory, it would certainly be worth a mention in the article, because it shows a link between pain and suffering. --Robert Daoust (talk) 15:38, 3 April 2008 (UTC)

Some possible causes of pain by region
I'm not sure this section adds anything to this article except a huge collection of wikilinks. ( Hypnosadist ) 06:52, 20 March 2008 (UTC)


 * I too would like to know the rationale of the contributing editor. Maybe there is a good arguement to be made for its inclusion that I cant think of at the moment. I'll look in history section and see who I can find. Material doesnt seem to require immediate removal. SmithBlue (talk) 03:56, 21 March 2008 (UTC)


 * I've assumed that its purpose was primarily for the convenience of readers who want to know what might be causing a specific pain. So you go to Pain and it helps you find Shoulder pain, or something like that.  WhatamIdoing (talk) 04:43, 21 March 2008 (UTC)


 * I has been quite a while since I made changes to the article. So, I'm not sure what I was thinking at the time.  I think the section has some use.  Pain has a biologic function and its location is often key to identifying its cause.  Other factors are the onset of the pain, its character, intensity, provoking factors, alleviating factor, quality and change with time. It could be split-out into a separate article and made a lot longer.  If you want more opinions from people that edit medicine-related articles, you can solicit more opinions at WP:MED. Nephron  T|C 05:36, 21 March 2008 (UTC)

I'm adding the pain specific wikilinks here to keep track of them; Neck pain Back pain Breast pain Chest pain Shoulder pain Abdominal pain. ( Hypnosadist ) 10:17, 21 March 2008 (UTC)

I think the above links should be in the article but i'm not sure about the long list of diseases, this article should cover things like provoking factors and alleviating factors. ( Hypnosadist ) 10:23, 21 March 2008 (UTC)
 * I have an idea, look at fractures, the list could be converted to something similar and be put on all pages that discuss pain, in general and specific. WLU (talk) 12:45, 30 March 2008 (UTC)
 * Sounds like a good plan. ( Hypnosadist )  13:12, 30 March 2008 (UTC)
 * Great, I'll start work on it today on a subpage and post a link when I'm done. WLU (talk) 13:37, 30 March 2008 (UTC)


 * Blatantly stolen from the fractures template, Template:Pain. Please review, adjust colours, add, subtract, reorganize.  WLU (talk) 14:25, 30 March 2008 (UTC)
 * Great work WLU! ( Hypnosadist )  14:54, 30 March 2008 (UTC)


 * I like it. It's a nice, compact, organized way of presenting the information.  Thanks.  WhatamIdoing (talk) 01:33, 31 March 2008 (UTC)
 * Given your acclaim (thank you, thank you, please, you're embarassing me), I've created the template at pain and put it at the bottom of this page. I may add it to other pages if they're related.  Any suggestions are welcome, the title is split into pain and nociception by the way, in anticipation of the page splitting.  I also removed the section I stole the wikilinks from, but left in the stubby paragraph about pain referrral.  The actual pain template could probably use some adjusting - right now it's the same colour as the fractures one, and I'm never sure about categories.  WLU (talk) 14:46, 31 March 2008 (UTC)

Suggestions for med collaboration of the week
My suggestions are pretty basic, but here they are:

WLU (talk) 21:41, 29 March 2008 (UTC)
 * 1) Pubmed and scholarly book citations to justify information on the page
 * 2) Expansion of sections with referenced information, in particular, sections lacking main articles
 * 3) Addition of treatment information - opiate and non-opiate drugs (possibly just expand management section)
 * 4) Expand mechanism by which drugs reduce pain
 * 5) Expand to comprehensive, or delete section on Pain and nociception based on editorial and professional judgement. ✅

A complex request or 5:
 * 1) find a way either in this article or in another article to include in WP the many understandings of pain that are found in all/most cultures/philosophies including the historical development of the current scientific understanding of pain.
 * 2) include reference to the current non-scientific understandings/uses of "pain".
 * 3) a section on the physiology of emotional pain (if possible)
 * 4) section on the subjective, experiential nature of pain.
 * 5) material on the ascribing of pain to other humans, animals, beings. (As in "Jennifer/Fido/demi-god Drongu are in pain because ...") SmithBlue (talk) 06:15, 30 March 2008 (UTC)

Insensitivity to Pain
I'm wondering if this section should be removed and a sentence or two added to the section Genotype and Pain. There is already a separate article (Congenital insensitivity to pain) on this topic, and two separate mentions in this article as well.Sisyphus (talk) 20:15, 31 March 2008 (UTC)
 * I don't think it needs a section of its own, referrring to it in section Genotype.. sounds good to me. SmithBlue (talk) 13:04, 1 April 2008 (UTC)

I am also curious if this section should be moved to Genotype and Pain. --DavidD4scnrt (talk) 04:35, 11 April 2008 (UTC)

Referral pain
The section on "Referral pain" duplicates information in the long "Visceral pain" bullet point in the previous section. Do we want to merge the two sections, or do a much more organized split? I'm currently leaning towards a split, although it's more work. WhatamIdoing (talk) 02:57, 1 April 2008 (UTC)

Proposed lead
I have been unhappy with the lead because it's so limited: It jumps directly to the specialized definition by the IASP, without even acknowledging that nearly everyone else in the world uses the word differently. A toddler can't even make the distinction between the physical and psychological sides of it, but surely every adult here believes that even a three year old will recognize and be able to name pain in the common sense. So here's my proposed expansion of the lead:


 * "Pain (from Ancient Greek ποινή - poine), as commonly used, refers to an unpleasant or distressing sensation of the type that is associated with a disease or injury.  Although pain is more commonly associated with a bodily sensation, the term is also used to describe mental or emotional distress or suffering.   In the physical sense, it results from the stimulation of specialized nerves, and functions as a warning system to prevent tissue damage by promoting avoidance.


 * In scientific research, a more precise definition is used. Pain is defined by the International Association for the Study of Pain (IASP) as..."

From there, I think the lead should continue as it's already written. Does that work for everyone? WhatamIdoing (talk) 03:32, 1 April 2008 (UTC)
 * Good with me up till "In the physical sense, it results from the stimulation of specialized nerves," then "In the physical sense," no longer seems to be related to "as commonly used". Perhaps "Physical pain is commonly thought of/conceived as resulting from stimulation of pain receptors"? SmithBlue (talk) 08:14, 1 April 2008 (UTC)


 * By "physical sense", I meant "not the emotional sense". That is, the specialized nerves are stimulated by skinned knees, not by being dumped by your date.  Perhaps "With respect to the bodily sensation, pain results from the stimulation of specialized nerves..." would be clearer?  WhatamIdoing (talk) 17:54, 1 April 2008 (UTC)
 * "Common usage describes bodily pain as being the stimulation of specialized nerves..." seems clearer. (Although this paragraph starts with "as commonly used", phrases such as "In the physical sense" and "With respect to the bodily sensation" work to cut the connection to "as commonly used", perhaps leaving the reader to think we have moved on to discussing pain in a different manner (eg as a physical sense)). SmithBlue (talk) 00:33, 2 April 2008 (UTC)


 * Does anyone object? If not, I'll make the changes in about 12 hours.  WhatamIdoing (talk) 05:52, 2 April 2008 (UTC)
 * I think the emotional bit, the second sentence, could be replaced with the appropriate hatnote. Perhaps adjust the first sentence to be clear that the sense is physical only (i.e. Physical pain is..., or more simply "Pain (from Ancient Greek ποινή - poine) is an unpleasant or distressing sensation associated with a disease or injury.")  I like the threat, very motivating : )  If we're splitting nociception to its own article then the final sentence can be replaced by a reference to said article.  WLU (talk) 11:24, 2 April 2008 (UTC)
 * The lead will probably change again several times before it gets right. Beginning with 'as commonly used' is good. I would like to displace the etymological parenthesis at the end of the intro or under a 'Language of pain' section, because it makes an uninviting hard-to-read first impression. The second sentence 'Although pain is more..." seems appropriate too. The third sentence is already scientifico-explanatory and should come after IASP definition, if at all... The rest of the intro is unsatisfactory, imo. The division in four events eliciting a pain response would need a citation, because it looks like original research... well, something similar is sometimes encountered but it is often for distinguishing between nociceptive pain, indeed!, versus other kinds of pain. A sentence on nociception could be in order, but details would go under a special section of the article. The intro should announce the contents of the page. I urge Wikipedians, and especially those interested in medical topics, to collaborate on this highly important article. After all, pain is the most frequent reason for people to see a doctor, or to 'consult' an encyclopedia, isn't it? --Robert Daoust (talk) 21:58, 2 April 2008 (UTC)


 * Could we safely lose the Greek bit? I don't really think it adds to this article.  WhatamIdoing (talk) 23:20, 2 April 2008 (UTC)
 * What I like about the second sentence (mental/emotional pain) is that it doesn't fall prey to scientism (only the official scientific views matter). I think this article needs a "big tent" view, at least at the beginning.
 * What I like about the third sentence (about the "stimulation of specialized nerves") is that if you're about ten or twelve years old, you could stop reading there and know pretty much everything that you needed to know.
 * As for the "four events", I think it might be appropriate to put it into its own section, or perhaps merged with "Description" or "Sources of pain" or another suitable section.
 * What do you think? Is there another place for this in the article?  Could we reduce the lead (for now, at least) to one paragraph that a ten year old could understand, and one paragraph about the scientific definition?  That would leave us with something like this:

Pain, as commonly used, refers to an unpleasant or distressing sensation of the type that is associated with a disease or injury. Although pain is more commonly associated with a bodily sensation, the term is also used to describe mental or emotional distress or suffering. When the term is applied to a bodily sensation, pain results from the stimulation of specialized nerves and functions as a warning system to prevent tissue damage by promoting avoidance.

In scientific research, a more precise definition is used. Pain is defined by the International Association for the Study of Pain (IASP) as as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. This is distinguished from nociception, which is activity in the nervous system resulting from the stimulation of nociceptors (pain receptors).
 * Please let me know what you think, WhatamIdoing (talk) 23:51, 2 April 2008 (UTC)


 * Keeping in mind that people rarely agree with me, I think the second paragraph makes for a better start to the page (starting with "Pain is defined by... i.e. no 'precise definition' bit). I know a quote in the lead is unusual but given the issues we're facing in composing a lead, we might be better off with an official byline that describes something pretty readily understandable.  I also still dislike the confusion I think occurs when you add a qualification in the second sentence (i.e. the emotional bit).  WLU (talk) 00:05, 3 April 2008 (UTC)
 * WLU has a good point -whether I agree with it or not depends on what the goal of this article is - which I think needs a separate discusion. See "Range of article" below. SmithBlue (talk) 00:41, 3 April 2008 (UTC)


 * WLU, I don't see the second sentence (emotional pain) as qualifying anything. I see it as introducing an entirely separate concept.  The first sentence says "It hurts when you cut your finger."  The second sentence says "She cried all night after her boyfriend dumped her."  These are, in my mind, not closely related concepts, except for the fact that people use the word "pain" in both contexts.  WhatamIdoing (talk) 01:36, 3 April 2008 (UTC)
 * Sure, and I'm very open to my issue being acknowledged but discarded :) You hit the nail on the head for me, they both use the word 'pain', but much like 'home' can refer to the place you live and a orienting to an appropriate physical location (as if it were a home one was going to), they're the same word for two different things (physical and emotional pain). We wouldn't mention 'homing in' in the lead of home-as-in-house, but we might put it in a hatnote or further down in the body.  Irrespective, if no-one agrees with me obviously my point lacks merit and I don't feel bad about this.  I'll see what the final lead works out as and wait to comment on that version, thanks for trying to accomodate and my apologies if I'm being obtuse.  WLU (talk) 15:26, 3 April 2008 (UTC)

Nociception definition
"Houston, we have a problem", the source [cited(IASP Pain Terminology)] doesn't actually provide a def for "nociception". (Nociceptor is defined) Anyone got one - hopefully an RS without complexities such as "sensation", "perception", "physiological pain", "psychological pain", "physical pain", and "sense", all of which have "non-common use", counter-intuitive meanings in this context. [Definition of Pain and Distress and Reporting Req...] is not clear enough I think. SmithBlue (talk) 10:47, 1 April 2008 (UTC)
 * Google scholar gives "Nociception is the activity produced in the afferent nervous system by noxious mechanical, thermal, or chemical stimuli.(cite reference 6 and 7)" Handbook of Neurorehabilitation, By David C. Good, James R. Couch, Chronic Pain Management, Russell K. Portenoy, Michael J. Brennan, pg 404, ISBN:0824788222, Published 1994, Informa Health Care. No access to references 6 and 7 though - neeeded?. SmithBlue (talk) 12:41, 1 April 2008 (UTC)
 * If it helps, here's corroboration We definitely need to ref this well, particularly given a discussion to split.  WLU (talk) 15:52, 1 April 2008 (UTC)

Also the following from IASP Core Curriculum for Professional Education in Pain, 3rd edition, Chapter 7: Pain Measurement in Humans. Careful interpretation is required. --Robert Daoust (talk) 22:23, 2 April 2008 (UTC) I. Know that pain is a subjective, multidimensional experience unique to the individual (Clark et al. 2002; Kumar et al. 2002).
 * A. Understand the distinction between pain and nociception.
 * 1. Appreciate that pain is a conscious, aversive aspect of somatic awareness, the product of complex, central, nociception-induced processing, and not a primitive sensation.
 * 2. Appreciate that nociception is never conscious and engages sensory, emotional, and cognitive processing areas of the brain.
 * B. Understand that pain is multidimensional.
 * 1. Appreciate that the pain experience may have sensory, emotional, and cognitive aspects.
 * 2. Appreciate the potential impact of pain on function, affective status, and quality of life.


 * So it looks like there's definitely support for pain being the conscious experience and nociception being the pre-conscious sensory nerves that 'inform' the brain of pain. I would say it's not terrible if we reflect this and don't source it right away given the lack of explicit sources.  WLU (talk) 22:39, 2 April 2008 (UTC)

physiological pain needs definition (and not experienced)
Section#Sources of pain uses term "(The experience of) physiological pain" without defining it. This needs to be done otherwise its very hard for a naive reader to follow. In addition (as I understand it - with one errror in place ) nociception = physical pain = physiological pain so the phrase "The experience of physiological pain", is nonsensical as nociception is not experienced. Thinking we need a "Language of Pain" section to clarify the multiple different ways in which pain is classified/studied/named? SmithBlue (talk) 13:37, 1 April 2008 (UTC)

Just checking that we are all using "physical pain" to refer to the experience of pain localized to an area of the experienced body? (Just wishing I was joking) Seriously. Anyone got a better quick definition of "physical pain"? SmithBlue (talk) 03:30, 3 April 2008 (UTC) strike thru added SmithBlue (talk) 14:52, 5 April 2008 (UTC)

Subjective, what?
Can anyone explain to me what this paragraph under localization means? "This subjective localization of pain to an area of the body defines some kind of pain as neck pain, cutaneous pain, kidney pain, or the painful uterine contractions occurring during childbirth. This common usage of pain is not entirely consistent with the scientists' model of pain being a subjective experience." I'd like to edit this but I'm not sure which point the writer is trying to make.Sisyphus (talk) 12:25, 2 April 2008 (UTC)


 * For the first sentence, perhaps it's meant to lead into an explanation of referred pain: My "arm" pain is caused by a cervical problem.  Or perhaps it's supposed to lead to all the different site-specific pages related to pain (ie, those now in the template).
 * For the second sentence, while the IASP definition of pain is not the lay definition, I'm not sure how the first sentence contravenes it. WhatamIdoing (talk) 17:58, 2 April 2008 (UTC)
 * Could be clearer. A non-excusing interpretation: We feel bodily pain as having come from an area of the body. (eg sensation/experience = arrgh my back hurts) So we say "I have back pain". But science says that there is no pain in your actual back just rather you have an experience of pain localised to your experience of your back. So the common way of talking about "back pain" does not fit with the most recent scientific understanding of pain.

Reading the section I think "Localisation" needs to be defined and related to pain - at present the reader is assumed to know what it means in relation to pain. SmithBlue (talk) 00:56, 3 April 2008 (UTC)

Range of article/ range of Project Pain?
possible article lists:
 * "Pain and nociception" covering everything

Split articles
 * "Pain (experience) as understood by medicine and science" or "Human pain"
 * "Nociception" (no article yet)
 * "Historical/cultural understandings of pain" (no article yet)
 * "Central pain" (no article yet)
 * "Emotional pain" (no article yet)
 * "Psychological pain" (very stub with no references, says is not emotional pain)

(Please feel free to add to the above lists.)

This topic is vast; the language complexities, historical and cultural perspectives, science and medicine discoveries and nomenclature make splitting this into a wide range of articles a necessity. This area probably needs its own project. Already tensions between "common usage" and latest scientific definition are showing. What suggestions do editors have as to how to best use our time here? SmithBlue (talk) 01:35, 3 April 2008 (UTC)
 * Robert Daoust edit at 01:35, 3 April 2008 (Moving it back: New arguments) is worth considering as a way forward. IMHO nutshelled this = "redirect emotional or psychological pain to suffering and nociception redirects to nociceptor". Which would make this article about medical/scientific pain? SmithBlue (talk) 01:51, 3 April 2008 (UTC)
 * Currently the suffering article has placed itself at the top Suffering, or pain in this sense is a basic affective experience of unpleasantness and aversion associated with harm or threat of harm in an individual It then goes into detail about the interchangeability of pain and suffering proceeding on to cover all possible forms of suffering! I understand 'suffering' as 'an episode of pain' and therefore pain itself to be the temporal sensation. I think this article as it stands was intended to be Pain (physical sensation) in my own language, and as such doesn't quite cover the broad spectrum that the suffering article does. We appear to have a linguistics issue going on between the articles, that needs to be addressed. Leevanjackson (talk) 02:28, 3 April 2008 (UTC)
 * I concur with you Leevanjackson. Here is my take on SmithBlue proposal:
 * "Pain and nociception" covering everything: the title remains awkward, and what is meant is probably "Pain and suffering".
 * "Pain (experience) as understood by medicine and science" or "Human pain": that would be simply "Pain", and it should of course include also common, non medical and non scientific view of 'physical pain'.
 * Current article seems to be in the general area of both of these may need splitting further, think 'pain' would be top level title; and 'sensation' rather than experience' which could be read as historical; awaiting current split decision first...LeeVJ (talk) 03:39, 3 April 2008 (UTC)
 * "Nociception" (no article yet): redirect to nociceptor.
 * Awaiting decision on splitting article which would create this LeeVJ (talk) 03:39, 3 April 2008 (UTC)
 * "Historical/cultural understandings of pain" (no article yet): potentially interesting, could begin here as a section, inasmuch as these understandings are about 'physical pain'(otherwise, such a section could begin under suffering, or then the topic could constitute an article by itself right away...
 * "Central pain" (no article yet): one of many kinds of pain, no problem...
 * "Emotional pain" (no article yet): redirect to suffering
 * "Psychological pain" (very stub with no references, says is not emotional pain): redirect to suffering.
 * A wide range of articles is a necessity and it is already begun if you look at Category:Pain. We must plan with that category, and with the sections of this article. We should make a To-do_list. --Robert Daoust (talk) 02:46, 3 April 2008 (UTC)
 * More than I expected! LeeVJ (talk) 03:39, 3 April 2008 (UTC)

Introducing to-do list
From To-do_list: What a to-do list is: It may be noted that the to-do list here has priority 2: that means that the article Pain has a number of "What links here" references near 500, which is the top priority 1 line. My mistake: there are about 900 "What links here". Normally the to-do list goes at the top of the page, but I wanted to introduce it here before moving it up... --Robert Daoust (talk) 16:44, 3 April 2008 (UTC)
 * A Place to help give the page clear direction
 * General goals for the page
 * New sections to be added
 * A place to note facts which need to be found or checked for the article
 * A place to note sections which need expansion or other alterations
 * I don't mind tedious redirect corrects and popups make it easy - I'm willing, and middling reliable, for correcting redirects once we have firm page names. WLU (talk) 20:02, 3 April 2008 (UTC)

To conform with WP:TODO, I moved the to-do list at the top of this page, and I removed from it matters for discussion. I left one task that I suppose can be safely considered as consensual. Here follow some tasks that could figure in the to-do list.


 * Add info on opiate and non-opiate drugs (possibly just expand management section) and expand on mechanism by which drugs reduce pain. (I add my vote to the proposer's for this one)


 * Tidy up Category:Pain: distribute articles in the right subcategories (tidy up subcategories too), and add parent categories like Category:Emotion or Category:Sensory_system).


 * Resolve, for Wikipedia purposes, the language issue concerning the word pain. Find a way either in this article or in another article to include in WP the many understandings of pain that are found in all/most cultures/philosophies including the historical development of the current scientific/non-scientific understandings/uses of pain. How shall we deal unequivocally throughout the encyclopedia with the various meanings, uses or definitions that are involved in the word 'pain', especially with regard to avoiding duplication of articles or info and incoherent or inconsistent crossreferences? Associated terms include suffering, nociception, hurt, and perhaps others like unpleasantness, painfulness... (In my opinion, Robert Daoust (talk), this is already pretty well done now with three clearly distinct articles at suffering, pain, and nociception. Of course, much remains to be written on various cultural or historical variations, but the framework is now available for doing this, and avoiding duplication, and crosslinking appropriately.)


 * Arrange the contents of the main article Pain (including templates) to reflect how the topic is delt with in Wikipedia. Rewrite the introduction to reflect the varied contents of the article (not the medical aspect only, but also the biological, behavioral, social, cultural, philosophical or more common aspects).


 * Create or modify sections (inspiration for specifying this can be taken from Pain and Talk:Pain/TempDraft).

Can we consider that the following does not need to be mentioned because it will be covered through the tasks above? --Robert Daoust (talk) 20:54, 12 April 2008 (UTC)
 * Expand on the physiology of emotional pain (if possible) and on the subjective, experiential nature of pain.
 * Add material on the ascribing of pain to other humans, animals, beings.
 * Create section on [central pain], definition of "physical pain"

Splitting the article
While this article is WP:MCOTW, can we also please have a discussion about moving it back to pain? The present title constitutes a flagrant violation of general naming conventions, and nociception could be either its own article (pain is the experience, nociception is the neurobiological system that mediates this experience) or a redirect to this article. JFW | T@lk  12:07, 30 March 2008 (UTC)
 * Split and focus on the specifics is a good idea, always thought the name was odd. The psychological experience of pain and the neurology of pain are definitely different, and would provide better forcus on each as two articles.  WLU (talk) 12:40, 30 March 2008 (UTC)
 * Split as they are two different concepts. ( Hypnosadist )  13:11, 30 March 2008 (UTC)
 * I don't have a strong opinion. However, what worries me about this split is that splitting the article makes it less likely for average readers to get all of the information.  WhatamIdoing (talk) 01:31, 31 March 2008 (UTC)
 * Split per others above. The Pain article might have some pointers across to particular sections of the Nociception article. The topic is important enough that a whole system of related articles (more than two) could be set up if there was enough well-written material to justify it. EdJohnston (talk) 01:48, 31 March 2008 (UTC)
 * Keep please consider that "pain" in common usage includes what is scientificaly defined as nociception. If we split then we will still need to address nociception here if we are to present material on common usages and common and historical understandings of pain. In addition, if we just address "pain is the experience" and keep to that definition then this article becomes very difficult to write - see Pleasure and Consciousness for examples. If this article is just about "pain the experience" then it will exclude all physiology except the physiology of consciousness - do we want to go there??? I don't. (Shivering in fear). That said if someone can point out a way through the maze I am all ears. Maybe your understanding of "pain the experience" differes from mine. WP:NC#nutshell: "Generally, article naming should prefer what the greatest number of English speakers would most easily recognize, with a reasonable minimum of ambiguity, while at the same time making linking to those articles easy and second nature." Disagree that WP:NC is violated here. SmithBlue (talk) 23:20, 31 March 2008 (UTC)
 * To experience a no-nociception Pain article click to [Pain is an Experience] - its not as bad I imagined but does still leave naive readers without the "whole meaning" of what they think of as pain. SmithBlue (talk) 09:44, 1 April 2008 (UTC)
 * Now hoping a fellow editor can demonstrate that splitting can work well. Just edited the lead and having 2 main topics is hard, hard. SmithBlue (talk) 10:26, 1 April 2008 (UTC)
 * Now leaning towards uncertain split/explode. Too many historical/technical/jargon/common terms and usages. Too convoluted. New articles needed. SmithBlue (talk) 00:44, 2 April 2008 (UTC)
 * As is common in many other topics, we need to clearly delineate which bit of content goes where. Nociception is a purely physiological phenomenon, while pain is the experience to a stimulus (with nociception being the "black box" that processes the relation between stimulus and experience). JFW | T@lk  11:58, 2 April 2008 (UTC)
 * Split, or rather, make nociception a section under the article pain. The only reason for nociception being in the title, I guess, is because this article is intended to be about 'physical sensory pain' and adding a technical term was a way to qualify the broad-meaning word pain so as to signify this meaning. The real question, I suggest, is how we are going to deal with pain in its broad sense, and with pain in the sense of 'sensory pain'. I submit that the article suffering should deal with the former (as it is already the case), and that the article pain should deal with the latter. Mental or emotional pain would redirect to suffering. The peculiar concept of nociception, before having an article of its own perhaps, may very well have a section in the article pain. It should be noted that nociception is one among various mechanisms of pain: there are physical sensory pain without nociception, for instance in 'central' pain. It should be noted also that a lot of controversy goes on among pain scientists about the (non)experiential (pain in anesthesia) and (non)unpleasant (pain in asymbolia cases) characteristics of pain. --Robert Daoust (talk) 18:36, 2 April 2008 (UTC)
 * Split. Nociception is apllicable to all central nervous system based life, pain is ( until proven otherwise ) only applicable to humans. I think the article will become more directed and readable with the new layer of detail. Leevanjackson (talk) 00:03, 3 April 2008 (UTC)
 * Whilst we're at it, should the name of the current/new article be prefixed (human)?Leevanjackson (talk) 00:11, 3 April 2008 (UTC)
 * Until proven otherwise, we cannot tell if humans feel pain more than dogs! I mean, the subjectivity of pain makes it a private 'unknowable' experience, and this applies between humans as well as between humans and animals. As for splitting into multiple articles, no problem: please have a look at http://en.wikipedia.org/wiki/Category:Pain. There are already many articles on pain, nociception could be one more...  --Robert Daoust (talk) 00:51, 3 April 2008 (UTC)


 * Move back to pain. I realize that nociception should simply redirect to nociceptor, an already pretty good article, with only some mistakes to straighten out. I realize also that the whole problem with the use of the word nociception comes probably from a wavering in the early history of wikipedia: some editors decided to deal with physical sensory pain under the name nociception, while others were to deal with pain in a broader sense under the name psychological pain. What makes me tell this is that Category:Nociception was a duplicate for a time of Category:Pain. On 2002-02-25 the article read, probably under the title Pain: "The physical sensation of discomfort or distress caused by injury, illness. See: Nociception. For emotional pain and related psychological conditions see: Psychological pain." I propose that we make an official request for renaming this article simply 'pain'. This would mean to abolish category nociception, and to redirect emotional or psychological pain to suffering. --Robert Daoust (talk) 01:35, 3 April 2008 (UTC)
 * Since the content of the article was moved on 2006-12-07 from "Pain" to "Pain and nociception", an official request for renaming the article is not needed: we have just to make the move back. In light of the opinions above, I think we can proceed. I will ask the proposer JFW to do it. --Robert Daoust (talk) 14:31, 3 April 2008 (UTC)

Consensus was split

The split has been done
I have just completed the split. I have basically moved all the neurobiological stuff away to nociception. This is primarily because in practice nobody who suffers or treats pain is really interested in which nerve fibers are conducting the stimuli they try to abrogate with their painkillers, TENS machines and other modalities.

The article, by the nature of its subject, will be full of generalisations. That means we need a very peculiar type of source that is not very easy to find: the sources that are so well-informed that they are able to take a birds' eye view of the entire field of pain medicine. Perhaps medical textbooks (I'm thinking Harrison's) may come in useful here. JFW | T@lk  23:06, 3 April 2008 (UTC)
 * We'll be restricting the biological information, everything on pain that's physiological and not subjective/psychological to that page? I think it's a good, very sensible split.  Will try to start correcting redirects.  WLU (talk) 23:36, 3 April 2008 (UTC)

Pain is experienced by the brain in a process termed nociception.
Whoa - thats a rather interesting claim - I'm at loss for words and think it best to relax for now. Please consider this statement carefully. SmithBlue (talk) 01:13, 4 April 2008 (UTC)

Reorganizing the article
Here is a rough draft for reorganizing the article: http://en.wikipedia.org/wiki/Talk:Pain/TempDraft. Modifications are welcome. Very wild modifications could be the subject of another draft page. —Preceding unsigned comment added by Robert Daoust (talk • contribs) 15:35, 4 April 2008 (UTC)


 * Draft has been improved. Please have a look at the new Table of contents for the article. --Robert Daoust (talk) 21:17, 4 April 2008 (UTC)


 * Oops, had a look on a quick check, thought you'd incorporated changes, whilst checking article saw an error, and ...Have performed a number of edits and reorganised structure, but should be easy enough to move around if desired, I have to leave it for today, but was intending on making sure the first few sectioned got the whole concept that the severity of pain felt is relative to the individual and the difficulty in quantifying it... LeeVJ (talk) 03:25, 5 April 2008 (UTC)

http://en.wikipedia.org/wiki/Talk:Pain/TempDraft has been blanked by me. I am not sure if I am supposed to do something else with that page, according to technical procedures. Content of the page is now at Pain (physical). --Robert Daoust (talk) 18:04, 16 April 2008 (UTC)

Lead:1st sentence
The 1st sentence cites IASP. IASP: Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. WP:Pain is the unpleasant sensory and emotional experience when a person perceives actual, or potential, tissue damage to their body.

WP def means something quite different to IASP def. WP says "Pain is the perception of damage. IASP says that pain is in some way associated with damage, but makes no statement that pain is the perception of damage.

I believe that "physical pain" is normally triggered by nociception. But again, this is not what the WP:def states. Others? SmithBlue (talk) 10:19, 5 April 2008 (UTC)


 * IASP:"Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage." SmithBlue (talk) 10:24, 5 April 2008 (UTC)
 * IASP def also includes a wider range of "associating" than just the individual for themself. SmithBlue (talk) 22:35, 6 April 2008 (UTC)

Current definition: "the unpleasant sensory and emotional experience an individual has when they perceive actual or potential, tissue damage to their body" - suggests that we are categorizing the horror of percieving your locally anesaetetised finger getting hit with a hammer as "pain" within the meaning of this article. Please discuss. SmithBlue (talk) 11:22, 8 April 2008 (UTC)
 * Hmm, I added perceive so it covered pyschogenic pain etc. rather just nociception type pain. It was previously associated; but that would cover imagined pain as well... How about 'sense' or maybe use the part of the brain in the pain pathway e.g 'the thalamus signals', LeeVJ (talk) 21:26, 8 April 2008 (UTC)

Without any claim to seeing the direction we could best take here, I point out that "imagined pain" as long as it is imagined as "bodily pain" fits the working nursing definition given in this article of, "Pain is whatever the experiencing person says it is, and exists whenever he says it does", very well. Psychogenic pain fits within this nursing definition? (I assume here that psychogenic pain is localized within the body?) If so then the "or spoken about in such terms" of the IASP would adress this. (Not saying we cant come up with a better definition than IASP but I think they had many experts working on it for years.) Still as long as we don't wonder too far from "the subjective experience of perceiving apparent tissue damage normally triggered by nociception" it may be fruitful. SmithBlue (talk) 11:18, 9 April 2008 (UTC)
 * that last definition seems to cover things succinctly enough... LeeVJ (talk) 12:56, 9 April 2008 (UTC)

Quick note of ICD codes
Here are the main ICD10 pain codes I could find...
 * R51 		Headache
 * Facial pain NOS	  Excludes: 	atypical facial pain ( G50.1 ) migraine and other headache syndromes ( G43-G44 ) :trigeminal neuralgia ( G50.0 )


 * R52 		Pain, not elsewhere classified 	Includes: 	pain not referable to any one organ or body region Excludes: 	chronic pain personality syndrome ( F62.8 )
 * headache ( R51 )
 * pain (in):
 * abdomen ( R10.- )
 * back ( M54.9 )
 * breast ( N64.4 )
 * chest ( R07.1-R07.4 )
 * ear ( H92.0 )
 * eye ( H57.1 )
 * joint ( M25.5 )
 * limb ( M79.6 )
 * lumbar region ( M54.5 )
 * pelvic and perineal ( R10.2 )
 * psychogenic ( F45.4 )
 * shoulder ( M75.8 ):spine ( M54.- )
 * throat ( R07.0 )
 * tongue ( K14.6 )
 * tooth ( K08.8 )
 * renal colic ( N23 )


 * R52.0 		Acute pain
 * R52.1 		Chronic intractable pain
 * R52.2 		Other chronic pain
 * R52.9 		Pain, unspecified		Generalized pain NOS

nociceptors
Just wondering if chronic Paresthesia is regarded as a type of pain, and since it I am not sure if it is covered by nociceptors, if it is pain and, if so, are there other examples LeeVJ (talk) 21:59, 6 April 2008 (UTC)


 * I think it would vary by situation. Some paresthesias might be obviously painful, and others might feel "strange" instead.  WhatamIdoing (talk) 03:36, 7 April 2008 (UTC)


 * From IASP's definition of pain terms (Merskey and Bogduk, 1994). Copied from http://www.cpmission.com/main/glossary.html. (--Robert Daoust (talk) 12:36, 7 April 2008 (UTC)):

PARESTHESIA. An abnormal sensation, whether spontaneous or evoked. Note: Compare with dysesthesia. After much discussion, it has been agreed to recommend that paresthesia be used to describe an abnormal sensation that is not unpleasant while dysesthesia be used preferentially for an abnormal sensation that is considered to be unpleasant. The use of one term (paresthesia) to indicate spontaneous sensations and the other to refer to evoked sensations is not favored. There is a sense in which, since paresthesia refers to abnormal sensations in general, it might include dysesthesia, but the reverse is not true. Dysesthesia does not include all abnormal sensations, but only those which are unpleasant.

DYSESTHESIA. An unpleasant abnormal sensation, whether spontaneous or evoked. Note: Compare with pain and with paresthesia. Special cases of dysesthesia include hyperalgesia and allodynia. A dysesthesia should always be unpleasant and a paresthesia should not be unpleasant, although it is recognized that the borderline may present some difficulties when it comes to deciding as to whether a sensation is pleasant or unpleasant. It should always be specified whether the sensations are spontaneous or evoked.

For our convenience, here is the complete paragraph on pain in IASP Pain Terminology. Quotations above on paresthesia and dysesthesia belong to the same text as this quotation (the latter source is more authoritative). --Robert Daoust (talk) 13:46, 7 April 2008 (UTC) PAIN. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.


 * I see ... I think. Being as this is the wiki article on pain best make sure all variations are covered ... or referenced, and there I was on a fist look at the article thinking - ah pain is just the end result of nociception :( LeeVJ (talk) 00:41, 8 April 2008 (UTC)


 * With that set of definitions, you can understand dysesthesia as a logical subtype of paresthesia, with a rule that you shouldn't use the general name if the specific name applies.
 * I understand their motivation to make these be non-overlapping sets, but it's not going to work back here in the real world. The border between the two is too porous.  Imagine a person with highly annoying/slightly painful *esthesias.  Now its one, now its the other -- the label could change significantly every few seconds, even though the actual symptom has barely changed at all.  WhatamIdoing (talk) 07:02, 8 April 2008 (UTC)

Itch article
Closely linked and well written ( with refs!) see Itch, has some crossover subjects in the article as wellLeeVJ (talk) 22:58, 6 April 2008 (UTC)

Proposed article/section merges
Now the pain / nociception split has settled, at least a little, I am almost afraid to do it, but I have a couple of merges to suggest...LeeVJ (talk) 01:09, 8 April 2008 (UTC)

Pain Management
My first suggestion is to merge the section on treatment into pain management. Reason: 'pain management' is referenced by any of the various types of articles that involve pain. Potentially the medical diagnosis might go there as well, LeeVJ (talk) 01:09, 8 April 2008 (UTC)


 * So your proposal is to shrink pain and to increase pain management? I can live with that.  WhatamIdoing (talk) 06:53, 8 April 2008 (UTC)

Chronic pain
My second suggestion is to merge chronic pain into the article. Reason:All pain is subjective ( both articles point this out ) and I don't see how you can have a whole article with the only difference being chronic pain is pain beyond the normally accepted healing period (from 'chronic pain' article). It does have a more thorough management section, but it covers general pain too and, as above, could be merged into the pain management article. - ok three merges, I'll stop now ! LeeVJ (talk) 01:09, 8 April 2008 (UTC)


 * I don't think this is a good idea. For one thing, chronic pain is linked more than 200 times.  For another, chronic pain should provide a lot of detailed information about how chronic pain is different from acute pain, and merging the two might dwarf the non-chronic pain aspects of this article.  I think we're better off with separate articles here.  WhatamIdoing (talk) 06:57, 8 April 2008 (UTC)


 * Ok, you convinced me! Maybe once this article is stabilised, the two can be rationalised so they don't try to define the same idea seperately... LeeVJ (talk) 21:41, 8 April 2008 (UTC)

Nociception section: explicitly relate/contrast with pain?
Would like to see the empirically measurable, objective nature of nociception explicitly contrasted with the "not empirically verifiable", "in consciousness only", "subjective experience" of pain that this Pain article limits itself to addressing. At present in the language quagmire of this subject, I'd guess that some 80% of readers would read this article but still think that pain is the awareness of pain receptors firing. I know we are not here to educate but I do think that explicitly relating/contrasting the natures of nociception and pain is appropriate in this article. Others thoughts? SmithBlue (talk) 02:26, 10 April 2008 (UTC)

"This article is about pain as a sensation."
The language trolls are at work here too. No critisism of any editor is implied - I can't see any alternative at present either. Sensation - "In psychology, sensation is the first stage in the biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a sensory organ, which then leads to perception,..."

(For other uses, see Sensation (disambiguation). - but no other medical/scientific definition is obviously linked from that page.)

At present a naive reader could easily think that we are using the psychology definition - its the only one we suply - which, in our language, from our disambiguation statement, (see title of this talk section), would mean this article claims to be about nociception. SmithBlue (talk) 03:17, 10 April 2008 (UTC)


 * Agreed that 'pain as a sensation' is ambiguous. My first thought was to write 'pain as a sensory experience', which would have been more accurate and less ambiguous, but it sounded less simple, less immediately understandable for the average reader. Would it be better to use 'pain as a sensory experience'?


 * On another hand, there is a problem also in Wikipedia and in contemporary culture with definitions of the term sensation, which is sometimes understood as an unconscious phenomenon and sometimes as a conscious one. I think that in general nociception should be seen as a part of the sensation of pain, and the sensation of pain should be seen as a part of the experience of pain. Conversely, an experience of pain always include a sensation of pain (among other things), but the sensation of pain does not always include a nociceptive process (which is essentially in the peripheral nervous system). The latter is important: many kinds of pain occur without external stimuli, without nociceptors, and without nociceptive peripheral pathways. Contrarily to other kinds of sensation, pain is often 'spontaneous', the classical example being pain in a phantom limb. --Robert Daoust (talk) 13:50, 10 April 2008 (UTC)


 * Gosh! One more precision is needed to clarify what is nociception! Nociception occurs within the central nervous system as well: some thalamocortical pathways are called nociceptive (see for instance http://library.med.utah.edu/pain_center/education/outlines/noci_transmiss.html, or Treede's article on "Spinothalamic and thalamocortical nociceptive pathways"). But then, it seems that what is involved is always an influx from the peripheral nervous system. Or, but then I have strong doubts, every neural process involved in the experience of pain can always be called 'nociceptive'. Or, more probably perhaps, every neural process involved in the sensation of noxious stimuli or tissue damage (actual or potential, real or imaginary or described in such terms...) can be called 'nociceptive'. --Robert Daoust (talk) 15:49, 10 April 2008 (UTC)

Here follows an excerpt taken on the site of a good pain scientist, Marshall Devor. His use of the term 'percept' allows to avoid the ambiguity of 'sensation', because perception is always conscious, but it remains inappropriate, seemingly, to speak of percept in the absence of a stimulus. I reiterate my question: in the hatnote, would it be better to use 'pain as a sensory experience'? --Robert Daoust (talk) 18:57, 10 April 2008 (UTC) "Pain is a private percept that arises in a conscious brain, typically in response to a noxious provoking stimulus, but sometimes in the absence of a stimulus. The relation of the percept to the stimulus is variable, and depends on the individual's prior expectations and beliefs, and on his/her cognitive and emotional state, not just on the nature of the stimulus itself. The nervous system may react to noxious stimuli with autonomic changes (e.g. in blood pressure), and even with adaptive behavioral responses, in the absence of a conscious pain percept. Likewise, there are circumstances in which the presence of pain is ambiguous, such as when the individual is unable to report on his/her conscious percept, or with reference to animals. In these situations, the word "nociception" is used instead of the word "pain" to express that the nervous system has detected the noxious stimulus without necessarily implying that a pain percept was evoked."
 * I see this process as attempting to get towards the least worst language: my preference(but for the fact that its pretty much the 1st sentence in the lead) is "pain as a sensory and emotional experience". I like percept but wonder if its to technical for a naive reader? (I have no clear vision on this - just a that the present hatnote is possibly misleading on a very easily mis-understood point.) I think 'pain as a sensory experience' is an improvement on the present - if you feel "percept" is good then I'd be satisfied with that. SmithBlue (talk) 02:24, 11 April 2008 (UTC)


 * What do you think about losing the first bit of the hatnote altogether, and then writing a section called "suffering" under ==Concept== (along the lines of the "philosophy" bit)? WhatamIdoing (talk) 04:51, 11 April 2008 (UTC)
 * I do like the idea. If we did that article would more fully meet expectations of naive readers. Downside/s? Other thoughts? SmithBlue (talk) 05:12, 11 April 2008 (UTC)


 * I've swiped something out of suffering and stuffed it into the concepts section above philosophy. Feel free to edit (although I think it should remain fairly short).  If we decide that it's really horrible, then we can always delete it later.  WhatamIdoing (talk) 06:30, 11 April 2008 (UTC)

I suppose that we agree that this article is about PAIN-AS-A-SENSORY-EXPERIENCE. Now, readers will come to this article by typing 'pain'. A hatnote should tell them what this article is about, and where to go for other senses of the word. It seems clear to me that the only other 'important' sense they might be looking for is pain in the broader sense. They should not have to go in the body of the article to find the reference to PAIN-IN-A-BROAD-SENSE, that is to say to SUFFERING-WHICH-IS-A-SYNOMYM-OF-PAIN-IN-A-BROAD-SENSE, all the more so since the article about pain as a sensory experience can have, yes, a section on suffering which refers to the main article on suffering, BUT that section should deal exclusively with pain-as-a-sensory experience in relation to suffering. --Robert Daoust (talk) 17:29, 11 April 2008 (UTC)


 * I don't think we agree about the scope of the article. I think this article should be mostly about pain as a conscious interpretation of nociception, but not solely about this theory.  I think this article should include everything:  it's a "big tent" vision.  WhatamIdoing (talk) 18:37, 11 April 2008 (UTC)

How interesting!;-) We are touching the all important primary issue of the scope of the article, so let us make it clear. You say 'this article should include everything'? What do you mean exactly? Please give an example of something that you would include that would not fit under 'pain as a sensory experience'. Incidentally, imho, 'pain as a sensory experience' cannot be equated to 'pain as a conscious interpretation of nociception', because 'pain as a sensory experience' may occur without a stimulus, and thus does not always involve nociception. --Robert Daoust (talk) 19:46, 11 April 2008 (UTC)


 * Sure: emotional pain, like grief, is not (always) a sensory experience.  WhatamIdoing (talk) 03:31, 12 April 2008 (UTC)
 * Wish I had clarity to add. But no. The mainstream science view seems to be that pain is "an emotional and sensory experience".(Melzack and Wall. Hereafter refered to as "physical pain".) We, with our present division of articles, are continuing a "common usage" differentiation between "emotional pain" and "physical pain". (I'm going to push it a bit here.) Emotions are perceived in the "experienced body" - thats where they happen - if they didnt have a felt bodily component they'd be called "thoughts" - which means "emotional pain" is also "an emotional and sensory experience" - "emotional pain" is describing a felt bodily pain that we consider caused by emotion. In which case the only(?) difference between physical pain and emotional pain is the difference in attributed cause. So pain is felt and named as "emotional" or "physical" depending on the perceived cause. (I have some faint or constructed memories from Psych 201 along these lines.) If this is accurate then this article is about pain percieved as having a physical cause and Suffering is about pain percieved as having an emotional cause. SmithBlue (talk) 05:30, 12 April 2008 (UTC)


 * Where do painful thoughts fit on this scale? (Think about a reasonably dispassionate, factual statement like "I could have prevented this undesirable outcome.")  What about painful memories?  WhatamIdoing (talk) 05:55, 12 April 2008 (UTC)
 * If a thought or memory is perceived as painful then that pain is being felt in the experienced body. (Where else is it felt? - outside the experienced body? rhetorical question?) No WP:RS here. SmithBlue (talk) 07:01, 12 April 2008 (UTC)
 * Dies anyone know if there is a hormone released when pain is perceived? There is a possibility to circumvent a lot of subjectivity about what is pain, if there was we could to use a '..experience when the brain perceives pain and xxx chemical is released and/or anlgaesic systems activated' LeeVJ (talk) 11:10, 12 April 2008 (UTC)
 * My understanding is that there are many physical correlates of pain - none definitive. Finding one is the Holy Grail of the personal injury insurance industry. Introspection is currently being promoted as a fruitful and valid methodology in the study of pain[] SmithBlue (talk) 12:23, 12 April 2008 (UTC) SmithBlue (talk) 12:28, 12 April 2008 (UTC)

First, I would like us to acknowledge that people always distinguish clearly between 'physical pain', which has a peculiar sensory quality that is readily recognized as 'sensory pain', and 'emotional pain', which is certainly an embodied experience and can be felt sensorially if you wish, but which has not the peculiar sensory quality of 'sensory pain' and is thus not confused with it. Of course a 'heartache' may be accompanied by a 'sensory pain' in the area of the heart muscle, but not necessarily: it may be accompanied rather by a 'sensory pain' in the belly, or by a 'sensory unpleasantness' like nausea. As you know, not all unpleasant sensation are considered or identified as 'pain'. So, there is 'physical pain' on the one hand. And on the other hand there is 'emotional pain', which is something different, because it lacks the typical sensory quality of 'physical pain', but is also something alike, because it shares a same character of felt unpleasantness. Same word is used, but concepts and things under the word differ (it is not just a matter, as SmithBlue says, of "the only(?) difference between physical pain and emotional pain is the difference in attributed cause. So pain is felt and named as "emotional" or "physical" depending on the perceived cause."). One more point: I have noticed that when scientists or philosophers are hard pressed on such matters, they switch to the use of the word 'unpleasant(ness)', and I noticed also that when they do so they escape the dilemma but leave the problem whole: nobody cares about dealing with unpleasantness any longer after the discussion is over, so that the muddle continues between pain, unpleasantness, and suffering. I guess the word unpleasantness plays the role of a deus ex machina that allows everybody to be happy in escaping apparently a quagmire.

So, I agree with WhatamIdoing that emotional pain does not fit under 'pain as a sensory experience'. The question is whether we should deal with emotional pain in the same article as physical pain. I guess it's impossible if we want the encyclopedia to be consistent, avoid duplication, have a coherent system of links. Then, what will we be doing? A few solutions may be offered. What will the average reader look for? It is my experience as a reader on the subject of pain that people more usually use pain in the sense of physical pain. So I suggest that when they look for pain, they are brought to the article Pain that deals with physical pain. But then, a hatnote should tell them what this article is about, and where to go for other senses of the word. There are perhaps two other 'important' senses (formerly I thought there was only one other sense, but…): emotional pain, and pain in the broadest sense. I think the latter should be equated with suffering. As for emotional pain, I am not sure how we could deal with it, what would be the scope of such an article, and how it would relate to other topics in WP. As for the scope of an article on pain in the broadest sense, it is necessarily the same as an article on suffering, isn't it? --Robert Daoust (talk) 17:19, 12 April 2008 (UTC)


 * I think the simplest solution is this:
 * We include information at the start of the ==Concepts== section that lists several different definitions and discusses the critical difference between defining pain (which is legitimately done differently by different people for different purposes) and proving that any given definition is the only correct use of the word (which can't be done).
 * We include the short sections on suffering and philosophy and so forth. We perhaps also add links to emotions or other related pages.  I see this as basically acknowledging these issues and dispensing with them, ideally in a single paragraph.
 * We specify whenever reasonable which definition is being used in a given section. For example, ==Causes of Pain== gets re-titled to read ==Causes of physical pain==.

I am afraid your simplest solution, WhatamIdoing, does not address the complexity of the problem at all! Do you admit that 'physical sensory pain' is important enough to have its own exclusive article? If yes, we cannot deal with other topics under that article, even if those topics are also called 'pain', all the more since those topics are such important matters by themselves as emotional pain and suffering!!! The body or introduction of the article Pain is not the place to resolve terminological ambiguities, because those ambiguities belong not to the topic 'physical pain', but to the topic pain in the broad sense. There might be another solution, perhaps more elegant than those that have been proposed until now. It is still a bit scary solution nevertheless. Let's have the article Pain to include everything (this means that the article Suffering would be quite abridged and would mostly refer here). Let's have also the article Pain (physical), the article Pain (mental), or any other such articles that might be needed. The main drawback, in my opinion, would be that the word pain is mostly used, throughout history and nowadays, to mean physical pain, and much less to mean pain in the broad sense, or even less yet to mean emotional pain. Moreover, since we want to go in a direction that alleviates confusion, shouldn't we take advantage of using suffering, a different word than pain, to mean pain in the broadest sense? Then, I would rather favor something like this: "This article deals with physical pain. For pain in a broad sense, see Suffering. See also Pain (mental). For other uses, see Pain (disambiguation)." --Robert Daoust (talk) 20:14, 12 April 2008 (UTC)

break

 * I don't actually mind having an article dedicated to physical sensory pain, if you want to write one, although I'd tend to leave that information here. This article, however, must include all of pain, even if it focuses on a single type for the bulk of the article.  You can think of it as an elaborate disambiguation page, if you want:  you start at Pain which ultimately directs you to all of the related articles:  Pain (physical) (if wanted), Pain (mental), Pain (spiritual), Nociception, Suffering, Chronic pain, Central pain, and/or anything else you want.
 * Note please that I have said nothing at all about the content or desirability of any of these related articles. I do not propose (or support) gutting Suffering.  I do not demand that any information be removed from any article.  I am entirely focused on this article:  the one that appears on the screen when you put "pain" into the search box and click the Go button.  This article needs to acknowledge more than the physical sensory aspect of pain.  This article cannot pretend that the only kind of pain that truly deserves the name (and therefore space in the article) is the physical sensory kind.
 * This article -- not Pain (physical) -- is exactly the right place to talk about the difficulties of definition and the various overlapping, contradictory, and metaphorical ways that people use (or have used) this word. Where else could you do it if not in Pain itself?
 * BTW, Chemistry might be a decent model. Chemistry includes a short list of historical definitions and presents some related concepts in a short summary style.  WhatamIdoing (talk) 01:31, 13 April 2008 (UTC)


 * Okay, I can agree with you. As I said above, that could be an elegant solution, but a scary or alarming one. One thing is clear: you cannot have the main article organic chemistry on the page of chemistry, or worse: chemistry on the page of organic chemistry! This being said, your solution is worth considering. One of my main concerns is about the system of links. Presently, I would say that 90% of 'What links here (to Pain)' links in fact to physical pain. So, hundreds of links would have to be changed in order to go directly to Pain (physical) and avoid a useless detour through a big or small disambiguation page. That should have been made clear before we split 'Pain and nociception' and began redirecting links, but I suppose most editors were like me, not imagining that the article would become undesignedly 'Pain in the broad sense and physical pain'. Another of my main concerns is about the pervasive terminological muddle that goes on concerning pain and suffering, but then a page on pain in the broad sense could help more than harm, hopefully, if an appropriate vigilance is exercised. I could easily create Pain (physical), but would need the opinion of many others before making such a move! Meanwhile, until such a clarification is made, I am afraid the article will be as unmanageable and unpalatable as it was when titled Pain and nociception. As JFW said on User_talk:Jfdwolff/Archive_30: "Now let's kick this monster into some form of shape." --Robert Daoust (talk) 20:07, 14 April 2008 (UTC)
 * After some reflection - and short break, I think most users will type in pain in any number of contexts, and the word pain will mean different things ( as we have proved ourselves!!) which means that pain the article should be a type of coverall disambiguation page ( but that doesn't fit WP:MOS, maybe subset does...?) This article's definition (to me) is mostly about pain felt as if from a physical source, but this is combined with an attempt to differentiate and define that type of pain from other ones. I think we are asking too much of ourselves. Recommend splitting article ( again! ) into a special type of disambiguation page, which covers the common pain concepts like subjectivity, pain tolerance? history, philosophy etc. and a niew one: pain (physical). Rather than forcing a definition of the word, we can define the sub-articles contexts and let the reader choose the meaning they choose. LeeVJ (talk) 22:13, 14 April 2008 (UTC)
 * Might it be better to skip Pain (physical) and instead have a Pain (medical)? Most of ==Causes==, ==Diagnosis==, and ==Treatment== could go in there, but we could keep a bit more of the idea of physical pain (in humans and animals) here.  WhatamIdoing (talk) 02:50, 15 April 2008 (UTC)

Sigh! I was almost ready to put a split template on the article, when I had second thoughts and checked a few things.

We are looking for a solution and we have in reality three choices: a disambiguation page, a summary article, or a hatnote.

We have already a Pain (disambiguation) page. What links there? Almost nothing, except the 'Pain' article. In any case, a standard short DAB page is not what we are looking for. I cannot see what is meant by an 'elaborate' or 'overall' or 'special' disambiguation page", except perhaps if it means a summary article.

A summary article according to Summary_style is explained thus: "Wikipedia articles tend to grow in a way which lends itself to the natural creation of new articles. The text of any article consists of a sequence of related but distinct subtopics. When there is enough text in a given subtopic to merit its own article, that text can be summarized from the present article and a link provided to the more detailed article." The problem we have now is that we have a lot of stuff to say on physical pain, but not much on emotional pain or pain in a broad sense. And in fact, different concepts or things should not be treated in the same article just because they come under the same name. The idea of a summary article could not be to cover 'pain in every sense' (like 'mercury in every sense'). (Or if it could, see here under the solution that I propose: an article called Pain (general)).

Incidentally, I'd like to know, when I asked WhatamIdoing: "Please give an example of something that you would include that would not fit under 'pain as a sensory experience'.", the answer was: "Sure: emotional pain, like grief, is not (always) a sensory experience." Good. But what else? The only other thing I can see is 'pain in a broad sense', like (fictive example) "War brought pain to the population". Is there any other example possible?

By curiosity, I looked closely at http://en.wikipedia.org/w/index.php?title=Special:AllPages&from=Paige_Kreegel. I noticed two things, beside the fact that most pages refer to songs. First I noticed that there are pages called Pain (biological), Pain (biology), Pain physiology, Pain and nociception. They all redirect to Pain. Second, there are pages called Pain (Medicine), Pain medecine, Pain relief, Pain therapy. They all redirect to Pain (management). There are also, from 'what links here' at the article Pain: Physical pain, Acute pain.

I looked also into http://en.wikipedia.org/wiki/Wikipedia:Disambiguation. The important question is: "When readers enter a given term in the Wikipedia search box and pushes "Go", what article would they most likely be expecting to view as a result?" Given that almost every link from pain in WP is meant to refer to physical pain, can we agree that the response to this question is 'Pain' in the sense of physical pain?

So, I now propose that the best solution is a hatnote like the following: "This article is about physical pain. For other uses of pain as an unpleasant experience, see Pain (general). For other uses, see Pain (disambiguation)."

Such a hatnote would avoid a costly and risky or ill-advised split, and would answer the objection of WhatamIdoing to the effect that: "This article needs to acknowledge more than the physical sensory aspect of pain. This article cannot pretend that the only kind of pain that truly deserves the name (and therefore space in the article) is the physical sensory kind. This article -- not Pain (physical) -- is exactly the right place to talk about the difficulties of definition and the various overlapping, contradictory, and metaphorical ways that people use (or have used) this word. Where else could you do it if not in Pain itself?" --Robert Daoust (talk) 19:06, 15 April 2008 (UTC)


 * Robert, I'm a little frustrated right now. I don't feel like you're understanding my perspective here.  So let me spell it out in simple terms, and see if that helps:


 * I will not support any proposal that uses the article titled Pain to present information that is solely, or overwhelmingly, about physical/sensory pain.
 * I will not support any proposal that removes information about emotional pain, psychogenic pain, mental pain, suffering, metaphorical pain from the article that is actually titled Pain.
 * I will not support any proposal that starts the article titled Pain with a hatnote that basically says "you are in the wrong place if you are looking for anything other than physical/sensory pain."


 * If you want an article that is dedicated solely to physical/sensory pain, then you need to pick another title. Personally, I would leave all of the physical/sensory pain information right here in this article.  I might move the medical aspects (such as cause and diagnosis) to an article titled Pain (medical), but I would not remove physical/sensory pain from this article any more than I'd remove emotional pain.


 * I do not know how to make my position any clearer. I'm willing to "lose" if everyone else prefers your approach, but I will not support the proposal that you've made several times now in several forms.  It does not address my concerns.  My concerns cannot be addressed by anything that turns Pain into Pain (really just about physical/sensory aspects, but we didn't want to fix the internal links in all those other articles, so hopefully all the readers will pay attention to the little hatnote at the top).  WhatamIdoing (talk) 20:10, 15 April 2008 (UTC)


 * Robert, there is another option found in WP:DISAMBIG, that is set index articles WP:SETINDEX: A set index article is a list article about a set of items that share the same (or similar) name [or concept sic]. It is different from a disambiguation navigation page, and should not share the same formatting nor be considered a true disambiguation page, this is my current leaning. p.s. Don't be too hard on yourselves this article is in a far better state than it's counterpart pleasure and the debate is required since most other articles with the same conceptual complexity, I've sought out, seem to have avoided the problem - maybe since with pain we have a tangible facet to it. LeeVJ (talk) 22:22, 15 April 2008 (UTC)

I think the "Pain" that people type into the search box is the same stuff that I find so intertwined and inconsistent. One word, many related concepts. I think a top article titled Pain is the clearest way to facilitate an understanding of the various types of "Pain" and the variety of models. By having one top we will be forced to "make explicit"/document the differences in usages and understandings - something that "For a broader sense of pain see article suffering" avoids, implying that "they're different so they're in different articles" without showing how they are different (or how they are the similar). SmithBlue (talk) 06:34, 16 April 2008 (UTC)


 * In any case, my point now is that there must be two separate articles: one on physical pain, one on pain in general. So, okay, let's close this discussion. I, or someone else, will start as soon as possible 'Pain (physical)'. Hopefully we will be able at last to have a really good article or two on pain. As for the 'many opinions' that I feel are required to make such a move, they will have to be expressed later, if ever "Pain (physical)' is tagged for deletion. --Robert Daoust (talk) 13:55, 16 April 2008 (UTC)
 * Agreed - divide and conquer! The separate articles can then develop and it will become obvious if any merges are required at later date LeeVJ (talk) 18:35, 16 April 2008 (UTC)

Evolutionary biology view of pain
Sherrington seems to have been onto this some 100 years ago - prob needs to be in article From[The ethics of research involving aniamls] Pain, suffering and distress: meaning and function in animals and humans The basic evolutionary functions of pain and ways of relieving it 4.11 In evolutionary terms, pain has evolved from nociception as an aversive sensory mechanism that warns of harmful experiences. Pain has three main functions: First, it allows animals and humans to avoid dangerous situations, as painful experiences usually prompt an immediate impulse to withdraw and escape from situations that cause harm, usually in the form of tissue damage. Secondly, as pain is associated closely with the environmental context in which it occurred, its experience can help to prevent repeated damage. Pain-causing experiences will be avoided through learning when a similar environment is encountered again. Thirdly, pain promotes the healing of injuries, as affected body parts are not used in normal activities, as far as possible.

Also evolutionary view of pain supression etc etc. SmithBlue (talk) 04:16, 10 April 2008 (UTC)

Medical sub article
Does anyone mind if I create a Pain (medicine) that focuses on causes, diagnosis, and treatment of pain as a human medical symptom? WhatamIdoing (talk) 15:34, 16 April 2008 (UTC)
 * What difference with Pain management to which already refer Pain medicine, pain relief and pain therapy? --Robert Daoust (talk) 17:42, 16 April 2008 (UTC)


 * There's more medical "stuff" about pain than its management. They could all be merged, though, with Pain_management joining the treatment section in a larger article about all the medical aspects of pain.
 * The other three links all redirect to Pain management and could be trivially re-pointed. (Actually, I'd declare Pain medicine to be a subspecialty that deserves its own article, instead of having it redirect to Pain management, but that's just me.)  WhatamIdoing (talk) 18:05, 16 April 2008 (UTC)
 * No problems, worth taking the content of chronic pain into account also LeeVJ (talk) 18:37, 16 April 2008 (UTC)


 * Here's a quick example of what I see for that article. I've marked a couple of sections for significant expansion.  There are also some bits that are entirely redundant, but I didn't want to get too far along without showing it to you.  There would be some overlap between Pain and Pain (medicine), but the overall result would be a shorter article here, and it could focus more on pain-as-a-concept instead of pain-as-a-medical-condition.  WhatamIdoing (talk) 18:48, 16 April 2008 (UTC)


 * Unless you want Wikipedia to be a medical encyclopedia, the article 'Pain (physical)' is the article about pain and medicine, where symptoms, causes, diagnosis, treatment are 'summarized'. We will definitely need good subarticles (some medicine oriented) to deal with various aspect of physical pain. About your article name, please consider the following. To my knowledge, there is officially one pain subspecialty in medicine, and I think that it is called pain management and that it belongs under anesthesiology. There might be also another subspecialty called pain medicine under physiatry, but is it 'official'? So, you should perhaps avoid placing your pain and medicine article under a medical specialty name, because we might want to put under that article all kinds of information that belong to more than one subspecialty, and to non-medicine but 'medical' specialties like psychology, or even alternative therapy... Anyway, your move seems premature to me. For now, as far as I am concerned, 'Pain (physical)' is a subarticle of 'Pain', and likewise 'Pain (management)' is a subarticle of 'Pain (physical)'. Other subarticles will certainly come. --Robert Daoust (talk) 21:36, 16 April 2008 (UTC)

Pain (physical) just created
I created Pain (physical). I'd like to know if another page name would be more appropriate, before beginning playing with hyperlinks. Would for instance Physical pain be easier or more natural? --Robert Daoust (talk) 18:13, 16 April 2008 (UTC)
 * That's fine by me, seems to be the convention for same name different contexts elsewhere LeeVJ (talk) 18:32, 16 April 2008 (UTC)


 * I'd dramatically shorten it. These sections:
 * 4 Special cases
 * 5 Cultural views of physical pain
 * 6 Politics and pain
 * 7 Philosophy of pain
 * are primarily or entirely about non-physical pain, and thus are really inappropriate for a specific article about physical pain.
 * I'd probably remove these sections:
 * 1 Sources, types, assessment, localization
 * 3 Management and therapy of pain
 * as being medical issues (which I envision as going into a specific pain-as-a-medical-condition article. That leaves:
 * 2 Physiology and psychology
 * 8 Pain in non-human species
 * which I think you did a great job with, and which I think might be worth merging (up to you). Physical pain, particularly in the tissue-damage sense, isn't specific to humans, after all.
 * And again, I'd be perfectly happy to have all that information stay right here in this article, unless you particularly want to reduce the information about physical pain here. WhatamIdoing (talk) 19:00, 16 April 2008 (UTC)

As I said repeatedly, and I'm adamant on that, physical pain is way much too important to be only a section of 'Pain'. Pain (physical) is a subarticle of Pain, and the latter should only 'summarize' the former, among other matters relating to pain in general that it must present or summarize. Of course Pain (physical) is presently too long, but it will have to be expanded yet, and of course subarticles will have to be made. I strongly disagree with you about there being anything 'non-physical' in the present version of Pain (physical). If you see such a thing, please point it out with precision. As to the rest of your view, I believe it misses what is at stakes. --Robert Daoust (talk) 21:53, 16 April 2008 (UTC)

And as I said in a section above: unless you want Wikipedia to be a medical encyclopedia, the article 'Pain (physical)' is the article where pain-as-a-medical-condition must be presented, where symptoms, causes, diagnosis, treatment are 'summarized', before being the subjects eventually of other subarticles. --Robert Daoust (talk) 22:01, 16 April 2008 (UTC)


 * Let's try a much smaller question. Why does Pain (physical) include a section on emotional pain?  Isn't emotional pain a prime example of pain-that-is-not-physical?  WhatamIdoing (talk) 22:13, 16 April 2008 (UTC)


 * 'Emotional pain' is a subsection under the section Pain_%28physical%29. Under the emotional pain subsection you have this 'preparatory' explicative sentence: "Physical pain involved in heartache, rejection, depression, etc.", that you may have missed or not understood in its shortness. Emotional pain subsection is necessary because many people link or even identify physical pain with emotional pain. Do you remember the discussion here under Talk:Pain, when SB said that "emotional pain" is also "an emotional and sensory experience" - "emotional pain" is describing a felt bodily pain that we consider caused by emotion? Such questions relative to emotional pain are often encountered in the literature about physical pain. So, emotional pain, because it is conceived that physical pain is inherently involved within an emotion, or because it is conceived that emotional pain is in fact physical pain under mental disguise, constitutes a kind of special case that must figure in the article, which will mention the problem and the proposed solutions. I can grant you that the emotional pain subsection should probably be renamed. Do you have a suggestion? --Robert Daoust (talk) 23:00, 16 April 2008 (UTC)


 * I recall the discussion, and I recall not agreeing with the proposed sentiment as an exclusive definition. People refer to emotional pain every day of the week without meaning that anything physically hurts.  Yes, sometimes pain happens in conjunction with, or even due to, strong emotions.  But emotional pain itself is just a psychological, non-sensory experience.  "I'm sad today; I'm in a lot of emotional pain" does not mean "I experience physical sensations triggered by my emotional state."
 * I'd support an article about the physiology of pain, but emotions, culture, politics, and so forth simply cannot be considered physical pain by any reasonable definition of the word physical. These things belong to plain old Pain.  WhatamIdoing (talk) 23:50, 16 April 2008 (UTC)


 * I don't say emotions are physical pain, I say a special case about them must figure among other cases in the section 'Special cases' because emotions pose problems in relation with physical pain, as for instance in this article: Why rejection hurts: a common neural alarm system for physical and social pain. Take another special case, phantom pain: people used to think it was not a physical pain but an imaginary pain. For some researchers today, the frontier between emotional and physical pain raises definitional problems, and the article about physical pain must acknowledge this. As for culture, politics, and so forth, look for instance at David Morris' The Culture of pain, and you will see that this book is about the phenomenon of physical pain (as we call here), not about emotional pain, or pain in general. Same thing with Rosalyn Rey's The History of Pain. Same thing for this briefing to Congress called Politics of Pain. These are just a few examples.
 * P.S. You may note that David Morris' PEN prized book about pain in the physical sense says on page 9: "In fact, one main purpose of this book is to begin to collapse the artificial division we create in accepting a belief that human pain is split by a chasm into uncommunicating categories called physical and mental." I am sure you should agree with that, since you insisted to have a Pain article that include every sense. But can't you see that the article on physical pain cannot exclude every allusion to emotional pain, or to pain in general, or to any other thing in the world to which it is related? Couldn't we reconnect here? --Robert Daoust (talk) 01:54, 17 April 2008 (UTC)

Example of a 'pain in general' page
For reasons that seems obvious to me, since we chose to deal in this article with pain in general rather than with physical pain, I propose replacing eventually the content of the present Pain page with the content of this provisional Pain page. Is there any objection?

My own objection is that it would make more sense to replace the present Pain page with the Pain (physical) page (on which a different hatnote and a different lead beginning would figure of course), and to use the provisional Pain page for the page Pain (general). But I am curious to hear your thoughts. --Robert Daoust (talk) 15:22, 17 April 2008 (UTC)

My concern is that the present User:Robert Daoust/pain (general) contains
 * 1) loose definitions - The current definition would seem to apply to being confronted by a large vomit covered drunk demanding money.
 * 2) loose explanations - - "The terms physical or mental pain should not be taken literally: physical pain, as a matter of fact, is also a mental or emotional phenomenon, while mental or emotional pain is also a physical phenomenon." These phrases claim a lot - they need to be greatly deeepened and sourced - as they are they appear to beg multiple questions.
 * 3) confusing examples - "nausea is not a 'physical pain', but it is an unpleasant sensory experience, and a person in the throes of a severe nausea may be said 'in pain'." I remember it hurting when I vomit forcefully - is this not physical pain?
 * 4) A negative view of the different uses of pain focusing on the confusion rather than elucidating the various models and languages of pain.

But ignoring these specifics, when compared to the present "Pain" article (which still retains a physical pain definition and a great emphasis on the medical aspects of pain), "User:Robert Daoust/pain (general)" does offer a glimpse through mist of what a top "Pain" article might look like. SmithBlue (talk) 05:02, 18 April 2008 (UTC)


 * SmithBlue, nausea and vomiting are related, but not identical. Robert is basically correct here.


 * Robert, the phrase "emotional pain is also a physical phenomenon" requires substantial clarification. It is true only to the extent that any thought or emotion has a physical basis in the brain.  Personally, I don't find reductive physicalism very satisfying.  However, what matters is the average reader's impression, and you're going to have every teenager in the world say that this is "wrong" because their experience proves that emotional pain isn't always accompanied by physical sensations.  Either removal, a rephrase, or a solid source to blame it on will be required.


 * I think that the general page is what belongs here. This is more or less what I envision this page ending up as:  All the different concepts related to pain, with a moderate emphasis on physical pain.
 * The remaining question in my mind is whether the other page should be slightly broader (physical pain, including detailed physiology, non-humans, and psychogenic pain, but not absence of pain or mental pain) or slightly narrower (medical aspects of pain, including less nociception-related physiology but all psychiatric issues and genetic defects). In either case, I expect that the omitted or downplayed material will find a home elsewhere, so there's no question here of excluding anything from the overall encyclopedia.  WhatamIdoing (talk) 05:47, 18 April 2008 (UTC)
 * My point was "confusing" and even now knowing that vomiting and nausea are separate I remain unclear on how a severe nausea, but not a nausea, could classify as "in pain". Not that I'm saying it doesn't just that I am still in the dark. Nor can I easily find anything on this on Google. And using "throes" near "nausea" will bring memories/thoughts of vomiting to most readers. And, if the distinction between nausea and vomiting is necessary, many readers will proceed to confound the terms and be confused. SmithBlue (talk) 07:25, 18 April 2008 (UTC)

Thanks for your thoughtful remarks, folks. I made modifications toward satifying your concerns. This is only a beginning, but it is already a progress, isn't it? Terminology of pain is a complex little tangle, as you might appreciate if you compare Clarification on uses of terms and Clarification on the use of pain terms. BTW, I got tired of typing the wikilink to 'Pain (physical)' (I find it unnatural or cumbersome to type it), and I thought of all those who will have in the future to type this link which will be much more frequent than the link to pain, so I moved the content of Pain (physical) to Physical pain. I hope this is correct, before we get some day into correcting the redirects. --Robert Daoust (talk) 11:41, 18 April 2008 (UTC)

collaboration
I get the idea we are getting somewhere, although I do now have concerns that as pain is subdivided up, talk on the subject will be decentralized. What should we do - direct all talk to one page, make a subpage just to cover article division and crossovers, or maybe form a taskforce in Project Medicine ? LeeVJ (talk) 01:53, 21 April 2008 (UTC)


 * I don't think that we want all talk centralized forever. In the meantime, a proposal that affects more than one article due to overlapping content areas, etc., can get mentioned here, and anything specific to a subarticle can go there.  It will require a few "if [This Kind of Pain] isn't on your list, then please look at it" messages, but that's not hard to do.  WhatamIdoing (talk) 04:43, 21 April 2008 (UTC)


 * True, am looking forward to see how the finished product turns out! LeeVJ (talk) 22:13, 21 April 2008 (UTC)

Suggestion to merge Gate control theory of pain into Pain
Melzack's and Wall's theory must have its own article given the importance it has in scientific literature. Maybe user:Medos2 is suggesting in fact to mention adequately the theory in this article. If this is so, I agree of course. However, I would first mention the theory in the article Physical pain, and then under the section in this article that summarizes 'Physical pain'.

I want to point out again to a foreseeable problem that we might avoid right now. User Medos2 suggests to merge Gate control theory here, while it should be merged rather, if at all, into 'Physical pain'. It is foreseeable that ninety percent of the times people will refer to 'Pain' when in fact they mean 'Physical pain'. That is why I hesitate to make the definitive move that we have been talking of lately. I still feel that there should not be an article 'Physical pain', but that the article 'Pain' should be about physical pain, and the article 'Pain (general)' should be about pain in general. Is not there a way for us to have a wider WP community decision about it all? --Robert Daoust (talk) 16:16, 22 April 2008 (UTC)

I take that point. It was possibly a bit hasty of me to suggest the merge, but it was mainly to initiate discussion. I also appreciate you pointing out the Physical pain article as I unaware it existed. I agree that when people refer to pain they mean physical pain primarily as was my intention. I know that the treatments for physical pain differ from neuropathic pain and I'm not entirely sure if the gate theory applies to neuropathic pain but I did have physical pain in mind. I've read over the two articles and agree with your suggestion as it accomodates what people would expect if they were to type in Pain as a search word.  M e d o s  (talk • contribs) 22:09, 22 April 2008 (UTC)


 * Well we could use a [|straw poll], guidelines seems to be against it, but maybe this fits into article content - just to get an idea of average expectations of what pain article content should be. LeeVJ (talk) 23:29, 22 April 2008 (UTC)

I think more discussion and more data would be preferable to a poll at this stage. I think differentiating the "pains" and understandings/models will take a lot of space and that readers queries may consist of the common understanding of pain which seems to lump them all together. I want clearer data on what peolpe are looking for when they search WP for "pain". I am not convinced that "physical pain" is the overwhelming meaning. A Google search for (pain back -love) gives 10,300000 hits, (pain back love) gives 3,600,000 hits, (pain love) gets 13,900,000 hits, (pain back) gives 15,300,000 hits. (These results vary wildy by the minute which is strange.) So at least a suggestion that Google is finding comparable pages adressing "love and pain" as for "back pain". Any other data would be appreciated. SmithBlue (talk) 05:28, 23 April 2008 (UTC)

Article content overview
This is a summary of the options for article content being discussed: please feel free to edit in situ:

article content

 * General Pain - general discussion about all types of pain including subjectivity, history, and types.
 * Physical Pain - all perceived physical pain, including pyschogenic pain, biological and psychological mechanisms.
 * Medical Pain - pain classification as used by medicine.
 * Emotional Pain - all perceived emotional (or mental, psychological, spiritual, etc.) pain (or suffering)
 * Suffering - all perceived physical pain, emotional pain (or suffering), and unpleasant feeling, sensation, or emotion.
 * Nociception - biology pain sensing process (as appliable to any vertebrates).

article naming and structure options
1

Pain - General Pain
 * Physical Pain - Physical Pain
 * Pain (medicine) - Medical Pain

2

Pain - Physical Pain with larger section summarising General Pain
 * Pain (general) - General Pain
 * Pain (medicine) - Medical Pain

3

Suffering - General Pain and Suffering
 * Pain - Physical Pain
 * Nociception - Nociception.
 * Pain (management) - Medical Pain
 * Chronic pain - Medical Pain
 * etc - for other Medical Pain or Physical Pain matters
 * Emotional pain - Emotional Pain (if such an article is ever required)

4

Pain - physical pain + non-physical pain (i.e., suffering + emotional pain + philosophy + other stuff already in this article) with several Main pointers to articles like:
 * Nociception - Nociception.
 * Medical pain - medical aspects of pain, which in turn leads to Chronic pain, Pain management, Psychogenic pain and other uncommon medical conditions

Suffering - (to include emotional pain)

common consensus
Pain (disambiguation) - Pain in every sense, including links to Physical pain, Emotional pain, and Pain in the broad sense (i.e. Suffering, i.e General Pain).

comments / current position

 * If we could find consensus on medical pain as separate article / incorporated into others, we can move it out of contention and into common groundLeeVJ (talk) 22:17, 24 April 2008 (UTC)


 * Option 3 is my best bet. --Robert Daoust (talk) 10:04, 23 April 2008 (UTC)


 * I have made Option 3 more precise to reflect recent changes. And I have new arguments. WP guidelines for article naming is to use the more popular term. If you google pain, the first results are overwhelmingly about physical pain: Wikipedia should not be different. Now, the name Pain is ambiguous. WP guidelines for ambiguous name is to use a disambiguation page and/or a hatnote: we are going to have both. But since the case of pain is really troublesome, I suggest to use one more means: a clarification section, within the article, on the use of the term. And if ever we have to deal even more with the various ways that people use the word, we may do so under the article about suffering which is also about pain, as says the lead in Suffering. It should be noted that the article Suffering could be named Pain as well, but a single name had to be taken: given that the word pain is normally use for physical pain, I suggest that it promotes clarity in Wikipedia to use preferentially the word suffering for pain in general. --Robert Daoust (talk) 13:11, 25 April 2008 (UTC)


 * I vote option 3 as it allows the user to find what they are looking for more specifically.  M e d o s  (talk • contribs) 13:16, 23 April 2008 (UTC)


 * I've added a fourth option. Basically, you merge all of the general information about physical pain back into this article, but dump "Which parts of the body hurt?" and "What drugs seem to be useful?" sections to a medical-specific article (which then leads on to other existing articles, like chronic pain).  You avoid the need for a special dab page or a special page about pain in general:  it's all right here.  You avoid the physical/medical content fork.
 * I don't really understand why we keep trying to separate physical and metaphorical uses of this word. Why can't a section that begins "Brain areas that are particularly studied in relation with pain include the limbic system" coexist on the same page as a section that begins "The concept of pain has played an important part in the study of philosophy, particularly in the philosophy of mind"?
 * My preference, in the end, is for fewer, but longer, articles, and for not removing information about non-physical pain from the article named Pain. WhatamIdoing (talk) 22:38, 23 April 2008 (UTC)
 * I've taken a guess at article titles you envisage, please check then erase this. LeeVJ (talk) 01:15, 24 April 2008 (UTC)


 * Here is a good example of the big misunderstanding that we must tame! If one looks into books of philosophy of pain (for a list see Aydede's Bibliography—Philosophy of Pain), one can see that all these works are essentially about physical pain, not about pain used metaphorically, not about emotional pain, not about pain in the broad sense, not about pain in general! That is why my present version at the article Physical pain does have a section (Pain_%28physical%29) that says "Brain areas that are particularly studied in relation with pain include the limbic system", and another section (Pain_%28physical%29) that says "Philosophy of pain is a branch of philosophy of mind that deals essentially with physical pain.", and it has also another section yet (Pain_%28physical%29) that says: "For instance, philosophy of pain is essentially about physical pain, while a philosophical outlook on pain is rather about pain in the broad sense." Beyond all this, the basic reason why physical and metaphorical uses of the word pain should be kept clearly separate and not be dealt with together within the main article about physical pain is the following: the phenomenon of physical pain is one very specific and very important thing that must have its own exclusive article, clearly disentangled from any metaphorical use of pain that has used until now to plague sensible understanding. --Robert Daoust (talk) 01:28, 24 April 2008 (UTC)
 * You include references and explanations of all of these non-physical aspects in an article that is supposedly dedicated solely to "physical" pain. Why not add another couple of sentences and be done with the whole thing?  There is almost no difference between the articles Pain and Physical pain right now except the order that the information is presented.  We don't want a content fork, or even gratuitous duplication of information.  WhatamIdoing (talk) 15:13, 24 April 2008 (UTC)
 * I wish you would be right. It all depends on what couple of sentences you want to add!!! If there is almost no difference between Pain and Physical pain right now, I guess it is because Pain does not live up YET to its pretention to be about all uses of the word pain, and remains unduly focussed instead on physical pain. --Robert Daoust (talk) 18:30, 24 April 2008 (UTC)

Major editing of the article
As a contribution and an incentive to have this article in better shape, I have made a move per WP:BRD. The article Physical pain now redirects here, as its content was moved to Pain. --Robert Daoust (talk) 15:46, 29 April 2008 (UTC
 * I support your move. At present a top article on "Pain" does not have sufficient interest and commitment of editors. If this changes in the future it will be the work of a moment to recreate "physical pain". SmithBlue (talk) 00:17, 1 May 2008 (UTC)

I completed today the revision of the article. I removed the empty section "Psychological analysis" with its empty subsections "Sensory dimension", "Emotional, affective, motivational dimension", and "Cognitive dimension". These matters should be developed in the future, along with other aspects such as Some or all of these could be included within To-do list here at top of the page. --Robert Daoust (talk) 15:46, 9 May 2008 (UTC)
 * bioneurochemistry (including inflammation)
 * pharmacology (including painkillers more sold than any other type of drugs)
 * psychosocial aspects of chronic pain (including details on pain clinics)
 * institutional politics on pain (including hospital guidelines, opioids, fifth vital sign, palliative care and euthanasia...)
 * peripheral and central neuropathic pain

Link to Scrambler therapy
Good morning! As long as the article Scrambler therapy is accepted in Wikipedia - that is, as long as it is not deleted, relevant links to and from this article should be allowed. It would be a very strange situation if we would have some kind of "second-class" articles: the article can be here, but you cannot link to it. So my suggestion is that you put some kind of label on Scrambler therapy stating that it is questionable, or may be a label that you think the article should be deleted. Groetjes, Lova Falk (talk) 05:54, 26 May 2008 (UTC)

I changed my mind about the deletion. Of course, anybody stumbling across the term "Scrambler therapy" and wanting to know more about it, should be able to find an article on it in Wikipedia. But the article should reflect that this is just a theory and not an evidence-based treatment (yet?). Lova Falk (talk) 06:08, 26 May 2008 (UTC)


 * I'm not sure about this. Not every theory meets notability criteria, and in this case it is the brainchild of a single person with three hits on PubMed. I will indeed try to get the article deleted, unless someone can demonstrate that this is widely used (proven or not). JFW | T@lk  09:20, 26 May 2008 (UTC)


 * Articles for deletion/Scrambler therapy - you will see why I have my doubts about notability in the deletion rationale. JFW | T@lk  09:35, 26 May 2008 (UTC)

Pain or suffering?
Hi Robert. I've just read through the above. Wow. I suppose one needs a bit of heat to forge good metal. I'm with you when it comes to making a clear distinction between "pain" meaning "bodily" or "embodied" pain and "pain" meaning "suffering". And I think the page is developing nicely as a description of the former. But since most people are happy to, and often do, use the term with either meaning, I'm with WhatamIdoing in thinking that every sense of the word should be well covered here. I know that, where one word is an exact synonym of another, all good dictionaries and encyclopedias will, rather than repeat, redirect the reader to the synonym but this is a special case. The second use of pain (suffering) is born out of a neurological fact that you and I are both quite familiar with. I think this would be a very appropriate place to introduce the general reader in easy laymans terms to Eisenberger and Lieberman's (2005) pain overlap theory.

(I so wish they had not used the term "social pain". More recently Eisenberger has been using the far less ambiguous term "social distress". "Distress" captures "suffering and the urge to escape suffering" quite well.)

Re: Pain meaning suffering When "pain" is used to mean suffering it gets used in a narrower range of situations than does "suffering". When I hear "the pain of his dreadful loss" I actually think of loss induced bodily pain. Some losses, separations, disappointments, anxieties, rejections are so severe they evoke actual locatable pain somewhere in the body. This phenomenon, notwithstanding a hundred years of psychoanalysis and seventy years of behaviourism, is real. In these situations people feel actual embodied pain. I have no doubt that this aspect of pain needs to be addressed thoroughly on a page entitled "pain".

Then there is the question of difficult to locate or broadly and vaguely distributed pain. If a psychosocial or psychological event induces bodily pain which is indistinctly located (some visceral pain is of this type) the sufferer may not claim to feel "actual" pain (because, for it to be pain, you need to be able to answer "where does it hurt?") but be unable to resist using the term "pain" - because that is in fact what it is.

Some people have lower pain thresholds than others (Jason, Giesbrecht & Battié, 2005.) And, within an individual, the pain threshold varies from time to time. Eisenberger and colleagues (2006) have shown that people with lower levels of social support experience more pain than those with higher levels of social support, and that "experiences that heighten social distress will heighten sensitivity to physical pain as well" (p. 132).

What she seems to be showing, but not yet stating explicitly, is that your sense of belonging, your sense of safe, warm attachment to society, to some extent determines your global pain threshold. If someone you love rejects you or they decline your application to join the tennis club, this will lower your pain threshold, and an ongoing stimulus in your body that was just below the pain threshold for that stimulus would appear above the pain threshold, like an island at low tide, and be felt as (and actually be) physical pain; or any pain you might presently be experiencing would be amplified by a tear in your social fabric.

Finally, regarding "What is pain?"

In 1968 Ronald Melzack (co-author of the gate control theory) and Kenneth Casey divided the pain experience into three "dimensions": sensory, affective-motivational and central control. The sensory dimension involves the location and intensity of pain over time; by "affective-motivational" they meant the unpleasantness "that forces the organism into action"; and under "central control" they included the higher cognitive activities that influence pain, such as anticipation, anxiety, attention, suggestion, placebos, cultural background, appraisal, hypnosis, early experience and prior conditioning.

"Pain varies along both sensory-discriminative and motivational-affective dimensions. The ... intensity along these dimensions, moreover, is influenced by cognitive activities, such as evaluation of the seriousness of the injury." P. 434.

Their tripartite pain system has been born out by modern neuroscience. The network of brain activity that represents the aversive drive and unpleasantness of pain is fairly distinct from the sensory-discriminative matrix, and higher cognitive activity in the more recently evolved frontal lobes modulates both the perceived intensity and unpleasantness of pain. So, not only does it make psychological and behavioral sense, this model now makes solid biological sense. So I think it deserves a place on the page somewhere.

Of course Eisenberger is giving flesh to a 4th dimension: social. (There exists a body of literature on the biopsychosocial model of pain which I have yet to explore in any detail but, the few forays into it I have made leave me thinking it's all about operant conditioning. I.e. "don't reinforce your husband's pain behaviour Mrs Jones, or he'll never go back to work.")

What do you reckon, mate?

Anthony (talk) 12:38, 25 July 2008 (UTC)

References

Eisenberger, N., Jarcho, J., Lieberman,M., & Nabiloff, B (2006). An experimental study of shared sensitivity to physical pain and social rejection. Pain, 126, 132-138.

Eisenberger, N., & Lieberman, M. (2005). Why it hurts to be left out: The neurocognitive overlap between physical and social pain. In K. D. Williams, J. P. Forgas, & W. von Hippel (Eds.), The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127). New York: Cambridge University Press.

Jason, R., Giesbrecht, S, and Battié, M. (2005). A comparison of pressure pain detection thresholds in people with chronic low back pain and volunteers without pain. Physical therapy, 85 (10), 1085-1092

Melzack, R., & Casey, K. (1968) Sensory, Motivational, and Central Control Determinants of Pain. In Kenshalo, D. (Ed.), The Skin Senses (pp. 423-439). Springfield, Ill: Charles C. Thomas Publisher.


 * Hi Anthony. Thanks for your contribution. I wish to comment on it backward, from the end to the beginning. Physical pain has a significant social dimension that is much studied, and the article should reflect it. The biopsychosocial model of pain, as far as I know, is used in opposition to the biomedical model: it emphasizes psychological and social aspects. In my opinion, it is much more than what you hint at, it represents a real progress, but it is still short of what I call an 'algonomic' approach to physical pain, i.e. an approach that recognizes all aspects of suffering (granted that physical pain is one form of suffering). As to Melzack's three dimensions, you and I concur, as you must have seen in the section above entitled 'Major editing of the article'. Same about 'social' pain, inasmuch as social pain is physical pain, and not emotional or psychological pain. Here we get into an ambiguous zone. That zone is all the more ambiguous since pain science itself is not quite clear about psychological pain. And, you're right, Eisenberger and Lieberman just added to the widely prevailing confusion by using the expression 'social pain'. Their pain overlap theory could certainly be mentioned in this article nevertheless. Besides, I do not quite agree with your views on the use of the words pain and suffering. Maybe there is something that I don't understand. For instance, you say that "When 'pain' is used to mean suffering it gets used in a narrower range of situations than does 'suffering'." However, I have read many philosophers using pain in the widest range imaginable! Sometimes, to be sure, we may hear "the pain of his dreadful loss" as a physical pain, but at other times may we not hear it as a physical pain and a psychological suffering, or even as a psychological suffering only? Moreover, when you say " But since most people are happy to, and often do, use the term with either meaning, I'm with WhatamIdoing in thinking that every sense of the word should be well covered here. I know that, where one word is an exact synonym of another, all good dictionaries and encyclopedias will, rather than repeat, redirect the reader to the synonym but this is a special case.", I beg to differ strongly. The problem is not only that pain can be a synonym to suffering… The problem is compounded by the fact that pain can be a synonym to suffering but also an homonym to pain in the sense of physical pain… And the problem is compounded further by the pervading, large scale confusion that plagues the use of those terms, pain and suffering, in our culture. Fortunately, one thing is clear: pain scientists and people in health science in general no longer admit that pain in the sense of physical pain be lumped together with pain in the sense of suffering. For them, physical pain is one specific thing all by itself, and suffering is quite another thing. I subscribe to that view: physical pain is such a huge and important topic, let us have one article only for it. As for the other meaning of the word pain, there seems to be only 'suffering' which is an important one, and suffering, admittedly, is a huge and significant enough topic to worth its own exclusive article also, isn't it? If so, why bother to have an article about pain that would cover every sense of the word? If we'd go that way, why not then abolish disambiguation pages in Wikipedia and deal with every sense of those ambiguous words under one article by word? This being said, I have no doubt either, like you, that physical pain as a result of psychological or social causes needs to be addressed straightforwardly in the article about "pain". The section on 'Psychogenic pain' could be improved. (See also the revealing remark under note 3: "Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons." This figures in IASP definition but is not much dealt with in pain studies, except under psychopathological pain!) --Robert Daoust (talk) 00:35, 26 July 2008 (UTC)

HI Robert. I think we're pretty much in accord here. It's this synonym/homonym combo that is hard to get the head around and hard to express. I'm away from the net at the moment. But when I get back from the bush I might compose an essay about the sensory/affective/cognitive/social dimensions of pain. I'll put it up here first and we can tussle over it if you like. Regards Anthony (talk) —Preceding undated comment was added at 10:11, 5 August 2008 (UTC)

Impossible to prove that any individual feels pain?
The present version of the article includes this claim under the In other species section: "It is not scientifically possible to prove whether an animal, or a human for that matter, experiences pain or not." The claim is not sourced. There is, immediately after the sentence, the following claim which is sourced: "However, the presence of pain can be inferred through physical and behavioral reactions." Given that the second sentence here seems to be true, I wonder whether that by itself doesn't call into question the truth of the first sentence, considering the fact that "inferences" from behavioral reactions are (I suspect) the very "proof" that's routinely given for saying that a certain individual is feeling pain. Surely, this is "proof" enough; isn't it? Of course, it's not mathematical proof, but there is such a thing as other forms of proof. I would say that most of what we know is proven based on the same kind of inference that is involved in inferences from behavioral reactions - i.e., non-mathematical proof. It's still a kind of proof. In any case, I would move to strike the first sentence I quoted, unless someone can find a reliable source that actually makes that specific claim. Isokrates (talk) 01:21, 31 July 2008 (UTC)


 * I see that someone has recently reworded the sentence in question so that it now reads: "No scientific evidence can show without doubt whether an animal, or a human for that matter, experiences pain or not." This, I suppose, is true; but it seems equally true to say of anything that "no scientific evidence can show without doubt" that it's the case.  As the person who edited the sentence surely understands, scientific evidence rarely if ever is sufficient to expel all doubt about any matter.  So one wonders why the point is belabored here.  Isokrates (talk) 14:21, 2 August 2008 (UTC)


 * Hi, Isokrates. The point ought to be belabored, I think, because it is necessary to attenuate somehow the claim that "the presence of pain can be inferred". I suggest a new wording again ("The presence of pain in an animal, or a human for that matter, cannot be known for sure, but it can be inferred through physical and behavioral reactions."), hoping you and others will find it better, or then will find something else that is better. --Robert Daoust (talk) 11:00, 3 August 2008 (UTC)
 * Certainly the 'No scientific evidence can show' is wrong.. no one can foresee what science will be able to prove in the future -how about changing ' cannot be known for sure' to 'has not been scientifically proven' to cover a few more sins? LeeVJ (talk) 01:10, 18 August 2008 (UTC)
 * Isocrates. I'm for this point being belabored, not only in reference to other animals but also higher up in the article in reference to humans. There are pediatricians and rabbis performing seriously painful procedures on infants today, arguing they don't feel pain at that age. There are dangerously ill-informed doctors out there who imagine they can accurately estimate the presence of or extent of pain in a patient. I think patients and doctors need to know that, currently, the only reliable pain measure is patient report. I do think that "or a human, for that matter" should be changed to "or another human, for that matter". Also reference 13, Feinstein et al, 1954, doesn't link to the actual paper, but to a site referring to Feinstein. The paper itself is available free at http://www.ejbjs.org/cgi/reprint/36/5/981.pdf so Iv'e changed the link.Anthony (talk) 09:10, 15 September 2008 (UTC)
 * I cannot tell about "or a human" vs "or another human", but I have a problem with the title of the section: "In other species". Does that mean that the rest of the article is on human pain only? And what about other entities like gods or a mountain or whatever other 'non-species', about which some people wonder if they may experience pain? --Robert Daoust (talk) 14:34, 15 September 2008 (UTC)
 * I suspect you are being ironical there about the gods and mountains, Robert. But I may be wrong. I don't recognise irony easily. If you'd like to discuss pain in gods and mountains, please prompt me again. Most of the article does seem to have been written with people in mind. And the section entitled "In other species", I believe, covers the question "Do other species (and humans other than oneself, for that matter) feel pain?" nicely and concisely. So, I'll whack an "another" in front of "human" then. I am pretty impressed with this article. It still needs more work, of course, but it is thorough and precise. Anthony.

Pain/Society and culture: Utilitarianism infobox
The infobox in the section Pain/Society and culture appears to vastly overweight Utilitarianism in this section. I sugest removing this box before this section balloons out with infoboxes for Buddism/The Five Precepts, Gnostism/The false body etc etc.

The infobox could better be replaced with a single sentence or so stating the importance of pain to a wikilinked Utilitarianism. If no further discusion I will do this in the near future.. SmithBlue (talk) 11:30, 19 December 2008 (UTC)


 * You're right, that infobox was really out of place—I went ahead and "boldly" removed it. Go ahead and add that sentence if you think there is one that is suitable. Looie496 (talk) 17:43, 19 December 2008 (UTC)