With pain being a conscious experience, the study of consciousness should help us to understand the phenomena. With modern writers on pain dipping into the realms of philosophy and drawing upon 1st person and 3rd person neuroscience differences, we can adapt our practice and reasoning to ensure that the patient experience is both expressed and used to create a meaning that makes sense. This is the patient narrative that guides our thinking about their problem.
Avinash de Sousa has written a two part article seeking to integrate what we know about consciousness This is no mean feat as consciousness is a concept that has been discussed and studied since we were first aware of ourselves.
Part 1 looks at the neurobiological and cognitive dimensions – full article here
Part 2 considers other perspectives – full article here
Pain is a ‘conscious correlate’ (Moseley) of neural activity within the brain that emerges from the body tissues with a particular quality that we seek to describe and certainly respond to with a set of behaviours. Of course this is the whole purpose of pain, to motivate action so that we may survive and adapt. Extremely useful at the point of an acute injury, less so when the tissues have healed, persisting pain in this latter case is indicative of a conditioned response that continues to protect the body but against normal or innocuous stimuli.
We are conscious of sensations from the body when they contrast from other body areas. They stand out in other words. The salient network described by Iannetti and co. provides a good framework to consider how the mechanisms function. The brain is constantly receiving updates from the body systems, responding by tweaking the knobs and dials here and there, all below our awareness. When something stands out, ‘raising it’s head above the parapet’, our brain deems the signal to be salient and thereby triggers a response. The salient network therefore, is a detection system that drives appropriate responses. If protection is deemed biologically appropriate by the brain, we will then experience pain in the body area perceived as being threatened. Of course, this is a conscious experience.