What is the connection between pain and pain behaviour? Is it logically necessary, or is it contingent? Or is it too complex to be classified in terms of this Humean dichotomy? Surely it is too complex, for if we say the relationship is a necessary one, we should, apparently, have to deny that there could be pain without pain behaviour, or pain behaviour without pain; yet stoicism and shamming pain occur. (...) If we say that the relationship is not necessary and so contingent, we should have to say that the natural correlate or expression of pain might have been languor or jolly laughter, and, conversely, that wincing, grimacing, writhing, groaning, etc., might have been the natural correlate or expression of sensations quite different from pains. To avoid the first difficulty it could be said that necessary connections need not be invariant. To avoid the second, it might be pointed out that some contingent connections are less contingent than others, and that, in particular, causal relationships need not always be of the external, Humean kind. But even if these observations are correct they are difficult precisely because they attempt to soften and blur a distinction whose hardness and exhaustiveness is constitutive of its clarity and strength. If we modify Hume's law we may do so only after a careful examination of a case which forces us to do so. (shrink)

A monolithic model that ignores functional and topographic distinctions among its components has dominated clinical accounts of pain behavior. This model contributes to a pretence of knowledge that affects the treatment of sufferers. This commentary addresses the role of the target article in correcting knowledge-pretence and introduces a complementary caveat about evolutionary psychology concepts.

In this essay I shall examine the representation of aggression and its issues in the model animal, the Fruit Fly, Drosophila melanogaster. The Fruit Fly is the model animal for genetics and more recently neuroscience. On the basis of its behaviour conclusions are being drawn that will help in the development of new treatments for clinical entities like aggression and anxiety disorders—the author questions those findings and asks whether more should be done to focus on the actual biology and (...) behaviour—the Umwelt, instead of trying to bridge the gulf between invertebrate and human behaviours. (shrink)

Theorists of human evolution are interested in understanding major shifts in human behavioural capacities (e.g. the creation of a novel technological industry, such as the Acheulean). This task faces empirical challenges arising both from the complexity of these events and the time-depths involved. However, we also confront issues of a more philosophical nature, such as how to best think about causation and explanation. This article considers such fundamental questions from the perspective of a prominent theory of causation in the philosophy (...) of science literature, namely, the interventionist theory of causation. A signature feature of this framework is its recognition of a family of distinct types of causes. We set out several of these causal notions and show how they can contribute to explaining transitions in human behavioural complexity. We do so, first, in a preliminary way, and then in a more detailed way, taking the origins of behavioural modernity as our extended case study. We conclude by suggesting some ways in which the approach developed here might be elaborated and extended. (shrink)

We propose a pluralist account of content for predictive processing systems. Our pluralism combines Millikan's teleosemantics with existing structural resemblance accounts. The paper has two goals. First, we outline how a teleosemantic treatment of signal passing in predictive processing systems would work, and how it integrates with structural resemblance accounts. We show that the core explanatory motivations and conceptual machinery of teleosemantics and predictive processing mesh together well. Second, we argue this pluralist approach expands the range of empirical cases to (...) which the predictive processing framework might be successfully applied. This is because our pluralism is practice-oriented. A range of different notions of content are used in the cognitive sciences to explain behaviour, and some of these cases look to employ teleosemantic notions. As a result, our pluralism gives predictive processing the scope to cover these cases. (shrink)

In their landmark 2010 paper, “The weirdest people in the world?”, Henrich, Heine, and Norenzayan outlined a serious methodological problem for the psychological and behavioural sciences. Most of the studies produced in the field use people from Western, Educated, Industrialised, Rich and Democratic (WEIRD) societies, yet inferences are often drawn to the species as a whole. In drawing such inferences, researchers implicitly assume that either there is little variation across human populations, or that WEIRD populations are generally representative of the (...) species. Yet neither of these assumptions is justified. In many psychological and behavioural domains, cultural variation begets cognitive variation, and WEIRD samples are recurrently shown to be outliers. In the years since the article was published, attention has focused on the implications this has for research on extant human populations. Here we extend those implications to the study of ancient _H. sapiens_, their hominin forebears, and cousin lineages. We assess a range of characteristic arguments and key studies in the cognitive archaeology literature, identifying issues stemming from the problem of sample diversity. We then look at how worrying the problem is, and consider some conditions under which inferences to ancient populations via cognitive models might be provisionally justified. (shrink)

The philosophy of cognitive paleoanthropology involves three related tasks: (1) asking what inferences might be drawn from the paleontological and archaeological records to past cognition, behavior and culture; (2) constructing synthetic accounts of the evolution of distinctive hominin capacities; (3) exploring how results from cognitive paleoanthropology might inform philosophy. We introduce some distinctive cognitive paleoanthropological inferences and discuss their epistemic standing, before considering how attention to the material records and the practice of paleoanthropology can inform and transform philosophical approaches.

There seem to be two kinds of pain: fundamental pain, the intensity of which is a direct function of the intensity of various pain stimuli, and pain, the intensity of which is highly modifiable by such factors as hypnotism, placebos, and the sociocultural setting in which the stimulus occurs.

Pain is the single most common reason patients seek care in the emergency department. Given the prevalence of pain as a presenting complaint, one might expect emergency physicians to assign its treatment a high priority; however, pain is often seemingly invisible to the emergency physician. Multiple research studies have documented that the undertreatment of pain, or oligoanalgesia, is a frequent occurrence. Pain that is not acknowledged and managed appropriately causes dissatisfaction with medical care, hostility toward (...) the physician, unscheduled returns to the emergency department, delayed return to full function, and potentially, an increased risk of litigation. Failure to recognize and treat pain may result in anxiety, depression, sleep disturbances, increased oxygen demands with the potential for end organ ischemia, and decreased movement with an increased risk of venous thrombosis. (shrink)

The aim of the article is to introduce a new concept of “pain-related bodily doubt,” which complements current concepts currently in use, such as pain-related fear, pain catastrophizing, and pain self-efficacy. This new concept, adapted from recent philosophical work on illness experience, has the potential to positively contribute to pain research and clinical practice by providing a vocabulary for clinicians and patients to discuss implicit or tacit dimensions of pain-related experiences.

This essay concerns what people should do in conflict situations when a doubt of fact bears on settling whether an alternative under consideration is legitimate or not. Its principal audience are those who believe that abortion can be legitimate when not having an abortion gives rise to serious harms that can be avoided by having one, but who are concerned that fetuses might feel pain when being aborted, and who believe that causing unnecessary pain should be avoided when (...) doing so would not pose an undue burden. The essay remains neutral on the substantive questions of the moral status of the unborn and the morality of abortion. The question of fetal pain has taken center stage in the last few years in the .. (shrink)

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity, their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both (...) standardized andad hocmeasurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form ], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control ; Determinants of Physical Activity Questionnaire ]; sedentary behavior [Sedentary Behavior Questionnaire ]; pain [36-Item Short Form Survey Instrument ] and PRMDs ; reported physical exertion ; anxiety [Hospital Anxiety and Depression Scale ]; practice behaviors ; and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information, and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged. (shrink)

Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross‐sectional study was conducted in 13 nursing homes and examined pain (measure: Pain (...) Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen‐Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures’ original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs’ discrimination and instruments’ discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice. (shrink)

Chronic pain is a common disorder with enormous sociomedical importance. A major part of primary and secondary costs of illness is caused by the various pain syndromes. Nociception – the sensory perception of a painful stimulus – is a complex process relying on an intricate system of anatomical, neurophysiological and biochemical networks. This applies even more so to pain – the state of experiencing a nociceptive event, of interpreting it in terms of meaning for the affected individual (...) and of suffering a range of emotions it elicits. This intricacy renders it obvious, that the empirical medical sciences alone cannot explain all aspects of pain. Hence, it has also become a focus of phenomenological research. One aspect of these investigations is the interaction of pain and the perception of the lived body’s spatiality. The focus of this article will build on these concepts to develop a construct of the alteration of temporality caused by chronic pain and the effects this spells out for the affected subject. To this end, I will primarily draw on Merleau-Ponty’s ideas of the lived body as well as on theories of enactivism and embodiment. I will also point out parallels to neuroscientific data, thereby demonstrating the proximity of phenomenology and neuroscience. A possible partial solution to the pain dilemma may be derived from psychology: techniques relying on cognitive behavioural intervention, awareness training, and existential analysis may provide alleviation to patients suffering from chronic pain. (shrink)

In this paper, we defend the representationalist theory of phenomenal consciousness against a recent objection due to Hilla Jacobson, who charges representationalism with a failure to explain the role of pain in rationalizing certain forms of behavior. In rough outline, her objection is that the representationalist is unable to account for the rationality of certain acts, such as the act of taking pain killers, which are aimed at getting rid of the experience of pain rather than its (...) intentional object. If representationalism were true, she claims, then the act of taking pain killers would be just as irrational as the act of a ruler who responds to bad tidings by killing the messenger. This paper aims to show that these charges are mistaken. (shrink)

Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and (...) this state is type identical to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific 'emotion circuit', physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of (...) artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard (...) to the qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)

Although discussion of social pain has become popular among researchers in psychology and behavioural neuroscience, the philosophical community has yet to pay it any direct attention. Social pain is characterized as the emotional reaction to the perception of the loss or devaluation of desired relationships. These are argued to comprise a pain type and are explicitly intended to include the everyday sub-types grief, jealousy, heartbreak, rejection, and hurt feelings. Social pain is accordingly posited as a nested (...) type of pain encompassing multiple emotional sub-types. Call this the social pain posit. This article focuses on whether we should endorse the social pain posit and, in particular, whether social pain is pain. I present the four lines of evidence for the social pain posit that are currently offered in the literature and I argue that each provides only inadequate support, taken either individually or together. I close by considering the significance of the presented argument for philosophical theo.. (shrink)

Behaviorists accept, but go beyond, Williams' notion that there is an evolutionary origin to some unlearned pain behaviors. A behavior-analytic developmental model is a better fit for explaining the totality of pain behaviors. This model focuses on respondent-operant interactions and views much pain behavior as “mands” (i.e., demands). Behaviorally based explanations from the crying and social referencing literature support this model.

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as (...) pain by observers. Voluntary control over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. (shrink)

This book employs contemporary philosophy, scientific research, and clinical reports to argue that pain, though real, is not an appropriate object of scientific generalisations or an appropriate target for medical intervention. Each pain experience is instead complex and idiosyncratic in a way which undermines scientific utility. In addition to contributing novel arguments and developing a novel position on the nature of pain, the book provides an interdisciplinary overview of dominant models of pain. The author lays the (...) needed groundwork for improved models and targeted treatments at a time when pain science, pain medicine, and philosophy are explicitly searching for both and failing to find them. The Complex Reality of Pain will be of interest to a broad range of researchers and students, including those working in philosophy of mind, philosophy of science, cognitive science, neuroscience, medicine, health, cognitive and behavioural psychology, and pain science. (shrink)

Background: The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses’ professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their (...) daily work and that this has become a major problem for the nursing profession. Objectives: The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are “What ethical challenges do nurses experience in their daily practice?” Research design: We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses’ experiences. Ethical considerations: The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met. Method and results: The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of (...) artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

P.M.S. Hacker, recounting some of Wittgenstein's views, says : [T]he pervasive conception of behaviour that has informed philosophical psychology for the last three centuries has misrepresented human behaviour as 'bare bodily movement', from which it is supposed we infer, by analogy or inference to best explanation, the inner state and so on from which the behaviour might be thought to arise … But we see the pain in a person's face hear the glee in his chortles, (...) perceive the affection in the looks and gestures of lovers. In this paperIexplain how this can be, before meeting several objections. (shrink)

This paper argues in favour of the embodied approach to pain. We start by asserting that an appropriate philosophical treatment of pain must be empirically informed, rather than relying solely on the conceptual analysis typical of what we call "orthodox views of pain. " We then examine contemporary empirically informed views, specifically enactivism and eliminativism, by testing them against the aberrant pain phenomenon, namely chronic pain. This method of using fringe cases and aberrations to test (...) philosophical theories of pain follows the approach of Grahek (2007), who criticized subjectivism and objectivism based on their failure to account for pain asymbolia and congenital analgesia. We contend that the embodied approach holds an advantage over eliminativism and enactivism as it integrates the subjective, phenomenal aspect of pain-understood as a form of perceptual expectation-with the objective behavioural and neurological aspects by proposing a specific top-down connectionist cognitive architecture. We test two predictions of this approach: (1) that pain is multimodal and cognitively penetrable, and (2) that aberrant forms of pain, such as chronic pain, can be modulated not only by manipulating its immediate neurological source but also by altering the multimodal body image through virtual reality (VR) technology and our cognitive states, primarily our expectations about the environment. (shrink)

As a product of natural selection, pain behavior must serve an adaptive function for the species beyond the accurate portrayal of the pain experience. Pain behavior does not simply refer to the pain experience, but promotes survival of the species in various and complex ways. This means that there is no purely respondent or operant pain behavior found in nature.

: Traditional definitions of pain assume that an individual learns about pain through verbal usages related to the experience of injury in early life. This emphasis on the verbal correlates of pain restricts our understanding of pain to the context of adult human consciousness. In this paper we instead support the idea that our understanding of pain originates in neonatal experience and is not merely a verbally determined phenomenon. We also challenge the definition of (...) class='Hi'>pain as a merely sensory message related to peripheral tissue trauma. We aim to move beyond this definition by considering the relationship between the centre and periphery, taking into account certain phenomena such as phantom limbs and interoception. We show that pain helps an individual to develop a sense of awareness of himself immersed in a social context, and is thus a complex and adaptive phenomenon, that supports bodily integrity and social behavior. Keywords : Awareness; Consciousness; Experience; Pain; Self-representation Dolore e coscienza negli esseri umani. Ovvero, perché il dolore favorisce l’identità e la rappresentazione di sé Riassunto : La definizione classica di dolore presuppone che l’individuo ne apprenda l'uso verbale attraverso esperienze dolorifiche legate all’infanzia, favorendo una maggiore attenzione per i correlati verbali del dolore. Questo spesso relega il dolore nel contesto della coscienza dell’uomo adulto. Il presente lavoro si propone, in primo luogo, di sottolineare alcune evidenze, a partire dall'esperienza neonatale, a sostegno dell’idea di dolore come esperienza umana e non solo come fenomeno determinato verbalmente. Un secondo aspetto emerge dalla definizione di dolore, il concepirlo come un semplice messaggio sensoriale in seguito a lesioni dei tessuti periferici. Ci si propone, pertanto, di andare oltre tale ipotesi considerando il rapporto tra centro e periferia, a partire da alcuni fenomeni come l’arto fantasma e l’interocezione. Il dolore aiuta inoltre a sviluppare un senso di consapevolezza di sé immerso nel contesto sociale; si tratta dunque di un fenomeno complesso e adattivo, dall’integrità fisica alla dimensione sociale. Parole chiave : Consapevolezza; Coscienza; Esperienza; Dolore; Rappresentazione di sé. (shrink)

Receiving a diagnosis of cancer can be devastating. Cancer continues to be one of the most feared diagnoses, and experiencing pain is a major fear for people diagnosed with cancer. Cancer pain is complex in aetiology and can be acute or chronic and can be caused by various compression, ischaemic, neuropathic or inflammatory processes. Many people with cancer will experience excruciating pain, which is often underreported and undertreated. The reasons for this are complex and include various factors (...) including fears and beliefs held by patients. Cognitive factors are important modulators of pain and the appraisals, meanings and beliefs that people have in relation to illness, cancer, and pain, have implications in regard to help-seeking behaviours and the coping strategies people adopt. Cancer pain can impact a range of psycho-social factors across its course. Cancer pain relates to higher rates of psychological distress, anxiety and low mood, and the perception of pain intensity is, in turn, influenced by psychological factors. Cancer pain can negatively affect psychological health, and psycho-social factors can affect the pain experience. It has been suggested that people with a life-limiting illness experience ‘total pain’, and this can encompass psychological, social, practical, spiritual domains. Research demonstrates that cancer is predominantly an illness affecting older people, yet there is a higher risk of under-treated pain in this age group and there is a paucity of research into the subjective experiences of older people managing their cancer pain. Many older people are required to self-manage cancer pain at home as outpatients, due to drivers to keep people out of inpatient care, such as the high healthcare costs of inpatient treatment, and patients wanting to manage their illness, and die, at home. Our own research into this area found that the self-management of cancer pain involves a sequential and temporal process, which centres on perceptions of control. We describe how the older people in our study experienced a perceived loss of control, followed by a sense of gaining control over pain through various experience of certain internal and external factors. The assessment and treatment of physical pain should be done in combination with assessment and treatment of psycho-social and spiritual pain, and interventions for cancer pain need to focus on increasing positive affect and reducing helplessness. No person should suffer with poorly controlled pain and we argue for the need for further research in this area to ensure adequate treatment for all.Clinical Implications: Assessment and treatment of physical pain in people with cancer needs to be conducted in combination with assessment and treatment of psycho-social issues and spiritual pain. Psychological and behavioural approaches have strong evidence supporting their efficacy for reducing cancer pain. Interventions should target helplessness and focus on increasing positive affect through positive psychological states including fighting spirit and resilience. Person-centred interventions that focus on helping people with the search for meaning may help those with cancer pain derive positive benefits. (shrink)

Many people are attracted to the idea that plants experience phenomenal conscious states like pain, sensory awareness, or emotions like fear. If true, this would have wide-ranging moral implications for human behavior, including land development, farming, vegetarianism, and more. Determining whether plants have minds relies on the work of both empirical disciplines and philosophy. Epistemology should settle the standards for evidence of other minds, and science should inform our judgment about whether any plants meet those standards. We argue that (...) evidence for other minds comes either from testimony, behavior, anatomy/physiology, or phylogeny. However, none of these provide evidence that plants have conscious mental states. Therefore, we conclude that there is no evidence that plants have minds in the sense relevant for morality. (shrink)

Questions about robots feeling pain are important because the experience of pain implies sentience and the ability to suffer. Pain is not the same as nociception, a reflex response to an aversive stimulus. The experience of pain in others has to be inferred. Danaher’s (Sci Eng Ethics 26(4):2023–2049, 2020. https://doi.org/10.1007/s11948-019-00119-x) ‘ethical behaviourist’ account claims that if a robot behaves in the same way as an animal that is recognised to have moral status, then its moral status (...) should also be assumed. Similarly, under a precautionary approach (Sebo in Harvard Rev Philos 25:51–70, 2018. https://doi.org/10.5840/harvardreview20185913), entities from foetuses to plants and robots are given the benefit of the doubt and assumed to be sentient. However, there is a growing consensus about the scientific criteria used to indicate pain and the ability to suffer in animals (Birch in Anim Sentience, 2017. https://doi.org/10.51291/2377-7478.1200; Sneddon et al. in Anim Behav 97:201–212, 2014. https://doi.org/10.1016/j.anbehav.2014.09.007). These include the presence of a central nervous system, changed behaviour in response to pain, and the effects of analgesic pain relief. Few of these criteria are met by robots, and there are risks to assuming that they are sentient and capable of suffering pain. Since robots lack nervous systems and living bodies there is little reason to believe that future robots capable of feeling pain could (or should) be developed. (shrink)

Background: The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses’ professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their (...) daily work and that this has become a major problem for the nursing profession. Objectives: The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are “What ethical challenges do nurses experience in their daily practice?” Research design: We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses’ experiences. Ethical considerations: The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met. Method and results: The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched. (shrink)

This paper examines research on three hypnotic phenomena: suggested amnesia, suggested analgesia, and “trance logic.” For each case a social-psychological interpretation of hypnotic behavior as a voluntary response strategy is compared with the traditional special-process view that “good” hypnotic subjects have lost conscious control over suggestion-induced behavior. I conclude that it is inaccurate to describe hypnotically amnesic subjects as unable to recall the material they have been instructed to forget. Although amnesics present themselves as unable to remember, they in fact (...) retain control over retrieval processes and accommodate their recall (or lack of it) to the social demands of the test situation. Hypnotic suggestions of analgesia do not produce a dissociation of pain from phenomenal awareness. Nonhypnotic suggestions of analgesia and distractor tasks that deflect attention from the'noxious stimuli are as effective as hypnotic suggestions in producing reductions in reported pain. Moreover, when appropriately motivated, subjects low in hypnotic suggestibility report pain reductions as large as those reported by highly suggestible hypnotically analgesic subjects. Finally, the data fail to support the view that a tolerance for logical incongruity (i.e., trance logic) uniquely characterizes hypnotic responding. So-called trance-logic-governed responding appears to reflect the attempts of “good” subjects to meet implicit demands to report accurately what they experience. (shrink)

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of (...) response outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer. (shrink)