Reply: Todd Hargrove’s post “Is Pain a Sensation or a Perception?”

Todd argues for these claims:

  1. The debate is not substantive or of practical import. It does not involve disagreements about pain physiology, what causes pain, or how pain should be treated. Instead, the debate is semantic.
  2. The debate is easily resolved by simply looking at textbooks that describe how the terms sensation and perception are conventionally defined and used.
  3. These textbooks make clear that it is completely appropriate to refer to pain as a perception, and it doesn’t make much sense to say that pain is a sensation but not a perception.
  4. In any event, it doesn’t matter that much how we use these words in practice, because they are inherently fuzzy and often used interchangeably.

I think Todd’s post is a decent contribution to the question, and will make a positive difference to some patients and HCPs.

Below, some thoughts from me; Todd, if you read this, your response is very welcome.

Todd: “…the terms sensation and perception are inherently nebulous and there’s no bright line between them. Why not? Because they encompass a vast number of different physiological processes happening at every level of the nervous system…”

Me: The terms ‘sensation’ and ‘perception’ are ordinary language terms, and do not capture neurophysiological or genetic differences, but differences in the kinds of behavioural and perceptual capacities human beings are interested in. We are social by nature. Human languages include psychological terms because of our need to describe, explain, predict, and otherwise understand the behaviour of other human (and non-human) animals, and because of the need to provide such information to other humans.

Of course, psychological terms can be defined or characterised scientifically, but the original ‘home’ of our psychological vocabulary is the ordinary language we use every day.


Todd highlighted the indeterminacy of our psychological terms, such as ‘sensation’ and ‘perception’; e.g., ‘…there’s no bright line between them’; ‘…are inherently fuzzy, and are often used interchangeably’.

Me: I think the possibility of disagreement or uncertainty about pain in others reflects this indeterminacy. In our ordinary pain language, that indeterminacy is not due to neurophysiological or genetic factors, but to social patterns of behaviour: our concept of pain is flexible because pain behaviour, and our complex reactions to it, is diverse and unpredictable. Care-giving in pain settings can involve a threat to the caregiver, and is conditional on the authenticity of manifest pain behaviour. As observers of pain behaviour, we are sensitive to signs of exaggeration, suppression, or malingering, in behavioural displays of pain. Accordingly, our concept of pain does not always connect behaviour, situation, and personal experience, in a rigid way.

What could follow if we always connected behaviour, situation, and personal experience, in a rigid – necessary – way? To propose a simple, but rather extreme, illustration: suppose a group of people defined pain in terms of a particular neurophysiological biomarker, and used a sophisticated scanner to test for this marker. In their practice, the scanner’s verdict, and not the individual’s utterances or behaviour, is treated as definitive.

Would we want to call this practice a concept of pain? Would this practice be desirable or even possible for us? Would we, for example, accept that an apparent malingerer was in pain, if the scanner said so? Or, that a friend wasn’t, despite her facial grimaces? Would the absence of an abnormal scanner finding be held against a person applying for health benefits?

The new practice with its unanimity and clarity would be a far cry from our current, indeterminant, one. Although some people might engage in this practice, the fact that they do so perhaps makes them a different type of people from us?

13 thoughts on “Reply: Todd Hargrove’s post “Is Pain a Sensation or a Perception?”

  1. Simon, I have already commented on Todd Hargrove’s FaceBook post, but have not received a response.

    My comment is along these lines. Our experience of pain has two dimensions, the first (and a “sine qua non”) being sensory (i.e., an unpleasant sensation that can only be modulated) and the second being perceptual (which can vary and is changeable).

    Todd is of the opinion that the debate is “not substantive or of practical import”.

    I disagree on the grounds that some of those who categorise the experience of pain as a perception are guilty of promoting pain as being a learned experience. As such, they assert that it can be unlearned, along the lines of a bad habit. This claim is patently untrue.

    Furthermore, they have formulated a “neurocentric” doctrine – that whether or not we experience pain is dependent upon a decision made by our brain etc. Again, this is pure conjecture which is easily countered by our personal experiences (e.g., stubbing a toe, or hitting our thumb with a hammer). The unpleasant sensation is “given” to us because we have very efficient survival circuitry (i.e., the nociceptive apparatus/system).

    • Thanks, John. Let’s see if Todd responds to us!
      I agree with you on Todd’s “not substantive or of practical import” assessment. I think learning to use the word “pain” is learning the concept of pain, which is built on behavioural reactions that we don’t learn. These reactions have biological roots in the nociceptive apparatus/system. Learning pain language doesn’t involve connecting a word or phrase to a specific pain feeling; rather, the word or phrase is taught as a substitute or extension of natural pain behaviour. A verbal component is added to our behaviour; later this component itself is developed into more complex uses of pain language. Although behaviour provides the basis for learning the concept of pain, the meaning of pain language is not about behaviour, but pain.

  2. Hi Simon, thanks for writing this. You have an interesting line of thought here, but its connection to my post seems tangential, and I don’t sense (perceive?) anything in direct opposition to what I wrote.

    Your thoughts about the uncertainty of guessing at another person’s conscious experience are interesting. Perhaps I will address that in a future post, as I think we might have some interesting disagreements there.

  3. Thanks, mate. Would be happy to comment on a future post re. pain judgements!
    In the meantime, in my reply to you, I was opposing your claim that “…the terms sensation and perception are inherently nebulous and there’s no bright line between them … because they encompass a vast number of different physiological processes happening at every level of the nervous system…” In opposition, I argued for the claim that “In our ordinary pain language … indeterminacy is not due to neurophysiological or genetic factors, but to social patterns of behaviour: our concept of pain is flexible because pain behaviour, and our complex reactions to it, is diverse and unpredictable.”
    More broadly, I am interested in the relationship between everyday language concepts and scientific discovery. I think our everyday language does not contain a primitive theory, which will be superseded by scientific discovery, but concepts like pain, sensation, perception, thinking, imagining, etc. “The terms ‘sensation’ and ‘perception’ are ordinary language terms, and do not capture neurophysiological or genetic differences, but differences in the kinds of behavioural and perceptual capacities human beings are interested in. We are social by nature. Human languages include psychological terms because of our need to describe, explain, predict, and otherwise understand the behaviour of other human (and non-human) animals, and because of the need to provide such information to other humans.”
    I think our concept of pain does not incorporate a theory, since it does not predict anything, and can be neither true nor false. Instead, the concept of pain is presupposed by scientific pain theories. Final thought: in order to establish correlation between perception or sensation and neurophysiological processes, it must be clear what counts as the individual’s perceiving or sensing something, which is determined by our everyday terms like ‘seeing’, ‘hearing’, or ‘feeling’.

    • Simon, I have argued elsewhere that the distinction between a sensation and a perception is of fundamental importance when trying to understand the experience we call “pain”.

      The sensation (sensory dimension of the experience) is dependent upon an intact nociceptive apparatus.

      The experience occurs when we become aware that this apparatus has been activated, by whatever means.

      As mentioned above, a failure to accept this proposition has been responsible for some absurd propositions that can have serious repercussions for patients.

      For example, there are numerous advertisements online where, for a fee, “experts” will help pain sufferers to “unlearn” their pain. One health professional has been selling the idea that the experience of pain is but a “habit” that can be unlearned.

    • Simon, I have not seen this study. However, on my blog I did mention one other study, as follows:

      In a recent publication, followers of the late Dr John Sarno have yet once again rebadged his “Tension Myositis Syndrome” to become “Psychophysiologic Symptom Relief Therapy” (PSRT).

      Through a process of circular reasoning, Donnino et al. [2021] make the claim: “nonspecific back pain may be rooted in a psychophysiologic etiology substantively driven by stress, negative emotions, and other psychological processes.” (p.2)

      Their approach to treatment is to brainwash pain sufferers into accepting the psychological origins of their pain.

      No doubt some will benefit from this approach but the proponents of PSRT are presenting their assumption as if it was established knowledge.

      Reference: Donnino MW, et al. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomised clinical trial. Pain Reports 2021;6(3):pc959. doi: 10.1097/PR00000000000959

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