Implications of Concepts of Consciousness for Understanding Pain Behaviour and the Definitiion of Pain

Abstract

Judgements of the nature and severity of pain others may be experiencing are heavily influenced by an observer's preconceptions about the nature of the experience. Our personal sense of conscious experience dictates a search for consciousness characterized by the state of awareness found in competent adults, including constructive memories and thoughts, images and feelings. People incapable of verbally articulating experiences akin to those reported by competent older children and adults are at risk of having other evidence of pain denied, minimized or ignored. Despite substantial behavioural evidence for pain in the neonate and infant, and findings indicating destructive immediate and long term consequences if pain is not controlled, pain in infants and children often continues to be discounted. An alternative perspective on infant consciousness of pain focusing upon sensory and emotional components is presented. The current prominent definition of pain supports the prejudice favouring adult conceptions of consciousness by emphasizing the importance of self-report in assessing pain. Explanatory notes accompanying this definition also perpetrate the misguided belief that the experience of pain emerges as a product of early life experiences. The case for using nonverbal as well as verbal expression in the process of inferring states of pain is presented. As well, the proposition is supported that there should be explicit recognition that the experience of pain is an inherent quality of life present in all viable newborns, with the nature of the experience and its expression changing in the course of maturation and as a result of exposure to life experiences related to tissue injury.

Dealing with uncertainty: parental assessment of pain in their children with profound special needs

“…(1990) have highlighted the fact that reliance on behavioural cues alone (in a nonimpaired population) can result in underestimation of pain intensity. Anand and Craig (1997) and Craig (1997) present the difficulties of pain assessment in nonverbal groups; these parents are actually living these problems. The parents felt that health professionals would not recognize their child's pain cues.…”

“…Assessment of children's pain is accepted as being difficult (Salanterä 1999) and practitioners often fail to recognize and respond to the nonimpaired child's pain cues. These difficulties are multiplied when providing care for children with severe impairment where assessment is seen to be complex, confusing and problematic (Craig 1997, Oberlander et al . 1999).…”

Consciousness without a cerebral cortex: A challenge for neuroscience and medicine

“…Each individual learns the application of the word through experiences related to injury in early life" (Merskey & Bogduk 1994). Over the years, this definition has propagated undue credibility for the verbal expression of pain, defined within the context of adult consciousness, engendering medical practices that regard verbal self-report as the "gold standard" for pain (K. D. Craig 1997;Cunningham 1998;. Major flaws in this definition include its excessive reliance on verbal selfreport, the criterion that some form of learning is required in order to experience pain, and its focus on use of this word rather than the experience of pain (Anand & Craig 1996;Anand et al 1999; K. D. Craig 1997;Shapiro 1999;Wall 1997).…”

Explaining Medically Unexplained Symptoms

“…The implication of this paradigm shift is that pain is as much the product of spinal cord mechanisms and CNS activity that may be associated with emotional distress or social conflict as it is the consequence of actual injury or tissue damage. The involvement of central processes in all pain experience undermines efforts to distinguish between psychogenic and organic pain (28)(29)(30).…”