Pain and perception – clarifying the concepts

Is it accurate to say that you have a pain in your left foot because you feel – perceive – the pain there? Is pain a perception?

Many publications in the scientific pain field say so; e.g.:

“Pain is a complex, multidimensional perception that varies in quality, strength, duration, location, and unpleasantness.”

“The role of the cortex in human pain perception remained controversial until the advent of non-invasive brain imaging technologies. Over the last fifteen years solid evidence was generated indicating that multiple cortical and subcortical structures are involved in human pain perception. The general assumption from the studies performed in healthy subjects and studying primarily pain after acute, experimental stimuli, is the notion that activation of a fixed set of brain structures evoke this percept…”

Pain is a perception, not a sensation – Mick Thacker – One Thing

The way the sky looks is blue. The colour blue, however, is not an experience. Rather, it is a property of material phenomena. In this case, a property of the sky.

Experiences can be of a blue object, or the colour blue; but to think that experiences can be blue is like thinking that the number two is blue, which is a category mistake.

To make the same point with different examples:
– The white rose I see is white, not my seeing of it.
– The tightness of my new shoes is not tight, the shoes are.
– The bang I hear is loud, not my hearing of it.

The same logic applied to pain experiences:
– The pain I feel is piercing, not my feeling it.
– The burning of my pain does not burn, the pain does.
– The pain I sense is intrusive, not my sensing of it.

I think the view of pain as a perception makes a category mistake: it confuses what is perceived (‘The sky looks blue’; ‘The pain burns’), with a perceiving of it (‘I see the blue sky’; ‘I feel a burning pain’).

The pain is what is painful, not the feeling of it. Therefore, pain is not a perception.

Pain is a material phenomenon of a living organism, a phenomenon characterised by a complex array of distinctive responses and reactions.

Historically, it is correct to deny that pain is a sensation in opposition to the traditional Specificity Theory of Pain. In clinical settings nowadays, it is more accurate to call pain an ‘experience’: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

Following Wittgenstein, I propose that to feel pain is to have pain – not to feel pain and, in addition, to perceive it. When I feel a pain, there are not two things involved: the pain, and my feeling the pain. Feeling pain is just being in pain.

6 thoughts on “Pain and perception – clarifying the concepts

  1. Simon, here are my current views. As an experience, pain has (at least) two dimensions – a sensory dimension (i.e. a sensation) and a perceptual dimension (i.e. a perception). As a sensation it aligns with our other sensations in so far as we have, through evolution, inherited a nociceptive apparatus. Whenever we become aware that the apparatus has been activated, we experience the sensation we call “pain”. Nociceptors are commonly activated peripherally by the products of tissue damage. However, their central connections can fire off ectopically in the presence of the products of neuroinflammation. Perceptions are based on our interpretations of the sensation. We can be deceived by our perceptions, but not by our sensations.

  2. Hi John, Thanks for your thoughts. My responses below:
    1) “As an experience, pain has (at least) two dimensions – a sensory dimension (i.e. a sensation) and a perceptual dimension (i.e. a perception).” – Agree that pain experience is multidimensional, but deny that perception is a dimension of pain experience.

    2) “As a sensation it aligns with our other sensations in so far as we have, through evolution, inherited a nociceptive apparatus. Whenever we become aware that the apparatus has been activated, we experience the sensation we call “pain”. Nociceptors are commonly activated peripherally by the products of tissue damage. However, their central connections can fire off ectopically in the presence of the products of neuroinflammation.” – I agree.

    3) “Perceptions are based on our interpretations of the sensation. We can be deceived by our perceptions, but not by our sensations.” – It is hard to see that immediate pain is perceived or recognised by the person feeling it. “From observing myself I can tell that I am in pain” makes little sense to me. There is no gap between supposed knowledge of pain and my simply being in pain: “I know what I feel” = “I feel what I feel”. I am open, however, to your thoughts, especially on what it is like to be deceived by a perception of pain.

    • Hi Simon.
      1) I was roundly criticised on social media when I said that pain can be classed as a sensation and not as a perception. To my understanding, the perceptual dimension involves memory of past experiences and contextual effects.

      2) We are in agreement.

      3) Here, I was making a general comment. The pain experienced in a phantom limb could be an example of what it is like for a person to be deceived by his or her perception of pain.

      • Hi John,
        Thanks – yeah, social media is not fertile ground for reasonable discussions, especially on pain. As Jaron Lanier advises, delete your social media accounts now!
        1) We don’t need to decide between pain as a sensation or as a perception, as perception is a capacity of living human beings, not pain.
        2) “the perceptual dimension involves memory of past experiences and contextual effects” – these belong to cognition, not perception?
        3) Okay. To propose a slight adjustment, I would say the person with phantom limb is bewildered not by his perception of pain, but by the perception of pain he feels in his amputated limb. Still, this does not mean that “pain is inside the brain”!

      • Hi Simon

        1) I agree with you but health care professionals are being taught that pain is a perception rather a sensation. Here is a good example of this: https://www.youtube.com/watch?v=x0PrKDzih8w

        2) How does cognition differ from perception? I cannot begin to answer this question.

        3). I accept your sight adjustment.

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