- Sydney, Austalia
- Pain, Meaning, Phenomenology, Clinical research, Chronic Pain, Neuroscience, and 9 morePsychology, Philosophy, Pain Management, Meaning Making, Chronic Pain Management and Self-Care, Cognitive Behavioral Therapy, Medicine, Wittgenstein, and First-Person Methodologies(Psychology, Philosophy, Pain Management, Meaning Making, Chronic Pain Management and Self-Care, Cognitive Behavioral Therapy, Medicine, Wittgenstein, and First-Person Methodologies)edit
- Although pain medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatis... moreAlthough pain medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatisfactory. The problem seems to be with meaning: some people with pain do not find meaning in clinical discussions of pain, and clinicians typically are not looking for it.
For patients with pain, biomedical information can be perceived as lacking meaning in relation to their personal experience. By contrast, patient narratives and stories about pain, clinical encounters and therapies, cautionary tales, and common-sense experience seem to offer meaningful and actionable information. No biomedical explanation of pain, however useful it might be to a pain clinician, could describe the personal meaning or burden of pain to the individual.
It seems that one limitation in the ability of clinicians to effectively treat pain or pain-related suffering is an incomplete appreciation of “pain experience”.(Although pain medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatisfactory. The problem seems to be with meaning: some people with pain do not find meaning in clinical discussions of pain, and clinicians typically are not looking for it. <br />For patients with pain, biomedical information can be perceived as lacking meaning in relation to their personal experience. By contrast, patient narratives and stories about pain, clinical encounters and therapies, cautionary tales, and common-sense experience seem to offer meaningful and actionable information. No biomedical explanation of pain, however useful it might be to a pain clinician, could describe the personal meaning or burden of pain to the individual. <br />It seems that one limitation in the ability of clinicians to effectively treat pain or pain-related suffering is an incomplete appreciation of “pain experience”.)edit - Dr Richard Corryedit
At the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Dr Joseph Greer (Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Boston, USA) presented outcome data... more
At the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Dr Joseph Greer (Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Boston, USA) presented outcome data from the large-scale REACH PC trial, which compared the effectiveness of early palliative care delivered through video with in-person care for patients with advanced NSCLC.
Research Interests: Oncology, Palliative Care, Cancer, Hospice & Palliative Care Nursing, Quality of life, and 9 morePsycho-oncology, Cancer Research, Palliative Medicine, Lung Cancer, Medical Oncology, Pain and palliative care, Health related Quality of Life, Hospice and Palliative care, and Non small Cell Lung Cancer
LAURA clinical trial takeaways Osimertinib after chemoradiotherapy showed a statistically significant improvement in progression free-survival (PFS) for EGFR-mutated unresectable stage 3 non-small cell lung cancer (NSCLC). There were no... more
LAURA clinical trial takeaways Osimertinib after chemoradiotherapy showed a statistically significant improvement in progression free-survival (PFS) for EGFR-mutated unresectable stage 3 non-small cell lung cancer (NSCLC). There were no unexpected safety signals.
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This article summarises selected clinical trial data and approvals for metastatic castration-resistant prostate cancer (mCRPC) treatments from 2020 to 2023.
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Edited by Mark I. Johnson, James Woodall, Emmanouil Georgiadis, and Antonio Bonacaro This Research Topic acknowledges that the biomedical paradigm does not provide a complete understanding of pain by focussing attention upstream towards... more
Edited by Mark I. Johnson, James Woodall, Emmanouil Georgiadis, and Antonio Bonacaro
This Research Topic acknowledges that the biomedical paradigm does not provide a
complete understanding of pain by focussing attention upstream towards the role of the
environment in fashioning the experience and impact of pain on health. Research
methodologies from non-biomedical disciplines can explore social, cultural, economic,
political, and environmental conditions that influence the living experience of pain in
the modern era. Investigating the phenomenon of pain using socio-ecological
frameworks provide opportunities to shift perspectives and open-up new avenues for
exploration, including innovative strategies to reduce the burden of pain on society.
This Research Topic acknowledges that the biomedical paradigm does not provide a
complete understanding of pain by focussing attention upstream towards the role of the
environment in fashioning the experience and impact of pain on health. Research
methodologies from non-biomedical disciplines can explore social, cultural, economic,
political, and environmental conditions that influence the living experience of pain in
the modern era. Investigating the phenomenon of pain using socio-ecological
frameworks provide opportunities to shift perspectives and open-up new avenues for
exploration, including innovative strategies to reduce the burden of pain on society.
Research Interests:
** submitted for consideration ** This study aimed to access the baseline Electronic Persistent Pain Outcomes Collaboration (ePPOC) questionnaires and clinical data in cancer patients referred to the Pain Management and Research Centre... more
** submitted for consideration ** This study aimed to access the baseline Electronic Persistent Pain Outcomes Collaboration (ePPOC) questionnaires and clinical data in cancer patients referred to the Pain Management and Research Centre (PMRC), Royal North Shore Hospital, Sydney, Australia, to determine the prevalence of unhelpful pain cognitions, such as 'pain catastrophizing', and relationships between pain qualities (severity, interference, distress, disability), and opioid use. The study design involved linkage of collected self-report ePPOC questionnaire responses with medical records. Study participants were patients with a history of cancer observed at the PMRC from January, 2013 to June, 2019. Of 3,510 patients completing pre-assessment questionnaires, 267 (7.6%) had a history of cancer; of these patients, 33 (12%) had pain attributable to cancer. Average pain intensity was moderate; severe (≥ 7/10) in 12 (36%). Pain cognitions that were unhelpful to patients were common; average scores for pain self-efficacy and catastrophizing were moderate. At referral, most patients were on strong opioids; many on high doses (> 100 mg OME per day). Despite higher doses of opioids, pain interference, depression, anxiety, self-efficacy and catastrophizing scores were worse in patients with severe pain. Pain catastrophizing was significantly higher in the severe group. The correlation between opioid dose with catastrophizing and anxiety could indicate that opioids are prescribed to help patients with cancer pain cope with distress rather than for analgesia.
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** submitted for consideration ** Vulnerable individuals are those who experience healthcare disparities. In the context of pain, vulnerable individuals are those whose pain often goes under -appreciated, -recognised, or -treated. In this... more
** submitted for consideration ** Vulnerable individuals are those who experience healthcare disparities. In the context of pain, vulnerable individuals are those whose pain often goes under -appreciated, -recognised, or -treated. In this article, we consider pain in vulnerable populations and elucidate the experiences of vulnerable groups: sick and preterm newborns, people with intellectual disabilities and complex communication needs, including children with cerebral palsy. The article begins with a grounding in the scientific and theoretical literature on the multi-formed and multi-sourced nature of vulnerability in healthcare, and its connection to risk of harm and exploitation, and restricted capacity for autonomy. Sick and preterm babies are one of the most vulnerable populations; however, their vulnerabilities relate not only to the repeated painful procedures required during their illness and hospitalisation, but also to their respective immature developmental stages, parental separation, and lack of consistent use of evidence-based pain management strategies. We highlight vulnerabilities to pain in neonates and known effective management strategies which can potentially reduce effects of vulnerability associated with painful procedures. Although pain is a universal experience, not everyone has equal and fair access to the necessary services for adequate pain management. This is particularly the case for individuals with intellectual disability and complex communication needs, who express pain in other ways than speech. Almost half of all children with cerebral palsy are being identified as having complex communication needs, which means they have limited language and/or speech capacity to self-report pain where the child is likely to feel abandoned, frustrated, and helpless. While augmentative and alternative communication devices still lack effective means to report pain, we discuss ways in which therapists may seek and offer children with complex communication needs more opportunities to self-report their pain.
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The benefits to patients of increasing opioid use for cancer-related pain in the 1990s led to suggestions that these benefits could be achieved for patients with chronic noncancer pain (CNCP). This thought led to a significant increase in... more
The benefits to patients of increasing opioid use for cancer-related pain in the 1990s led to suggestions that these benefits could be achieved for patients with chronic noncancer pain (CNCP). This thought led to a significant increase in opioid use for CNCP in the US, Canada and Australia. However, as described below, the simple transmission of practices for cancer pain treatment to the treatment of CNCP was misguided.
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Challenges in PDPN management include guideline inconsistencies, PDPN that is refractory to treatment, and few mechanistic-based therapies.
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As I write these words to you, I am exercising my agency. The word “agency” refers to the capacity to act, where an “act” is something that is done, performed, or accomplished. An “agent” is a being with the capacity to act. In reading... more
As I write these words to you, I am exercising my agency. The word “agency” refers to the capacity to act, where an “act” is something that is done, performed, or accomplished. An “agent” is a being with the capacity to act. In reading this book, you, as an agent, are also exercising your agency. Agency is everywhere in our world: human beings act on each other and interact with each other, bringing about changes in each other. The word “agency” can be used in a narrower way to mean the performance of intentional actions. An intentional action is an act performed on purpose, or for a goal – “for an intention”. If you ask me why I am doing something, my answer is the reason for my acting. So, there is a link between agency, intentional action, and acting for a reason. In this chapter, we’ll explore arguments and scientific evidence for and against the idea that the healthy fetus can act. Can the fetus act, or does it only behave? Can the fetus act intentionally? Can it act for a reason?
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The ‘inherited’ patient – one who switches to a new doctor – is often encountered in general practice or in specialist pain clinics. Some inherited patients present to their new general practitioner (GP) without the benefit of a formal... more
The ‘inherited’ patient – one who switches to a new doctor – is often encountered in general practice or in specialist pain clinics. Some inherited patients present to their new general practitioner (GP) without the benefit of a formal clinical handover (e.g., a referral letter)1. This situation exposes the patient and GP to increased risk, especially in relation to assessment and selection of opioid analgesics. The principles that apply for people with chronic non-cancer pain (CNCP) initiating an opioid trial also apply to managing the inherited patient, particularly one taking ≥100 mg/day oral morphine equivalent.
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Background: Although multiple measures of the causes and consequences of chronic noncancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient.... more
Background: Although multiple measures of the causes and consequences of chronic noncancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom.
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
Methods: Six bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives through two workshops. The output from these workshops helped inform the creation of twenty survey statements.
Results: The research team identified and screened 1,323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to my self; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a two-week period in November 2021, and was completed by 1,219 people, largely confirming the above themes.
Conclusion/implications: This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK, and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic nonmalignant musculoskeletal pain, and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
Research Interests: Qualitative methodology, Chronic Pain, Qualitative Health Research, Qualitative Research, Doctor-patient communication, and 9 moreQualitative Research Methods, Pain Management, Low back pain, Patient-Centered Care, Systematic Reviews, Clinical research, Pain Medicine, Chronic Low Back Pain, and Lived Experiences
This article contributes a perspective on pain motivated by the philosopher Ludwig Wittgenstein. According to Wittgenstein, the child learns from others that the occasions on which it manifests certain reactions - the reactions that human... more
This article contributes a perspective on pain motivated by the philosopher Ludwig Wittgenstein. According to Wittgenstein, the child learns from others that the occasions on which it manifests certain reactions - the reactions that human beings manifest when injured - make it appropriate to self-ascribe 'pain'. When the child can signal correctly that she is in the requisite bodily state, then she has a conception of pain. Using the concept pain to symbolise an experience also makes it possible to tell other people what is going on and to solicit their help in managing the pain. In pain discourse, we can say "Sam can tell that Jason is with pain", or "She could tell you that Jason is with pain if she wanted to". These uses are linked to social milieu where rules are learnt for the application of concepts, such as the concept stoicism. In many rural communities, adults tell other adults about pain when it interrupts work or social activities. Otherwise, it is normative to "carry on". The rural stoic who tells another about pain only if he wants to can complicate clinical pain management, which can undermine the patient's special authority. In contrast, convergence in pain definitions and judgements between the patient and health professional can protect the authority of the patient and improve the clinical interaction. Pain is not simply a quale that is privately perceived; it must be capable of being expressed. Thus, pain has a social role, which is learnt. The study of linguistic rules in pain discourse could help explain the learning and application of the concept pain.
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Migraine, which affects over one billion people worldwide, manifests as repeating episodes of headache of moderate-to-severe pain intensity, persisting approximately 4-72 hours. 1 2 Mounting evidence suggests that migraine pathogenesis... more
Migraine, which affects over one billion people worldwide, manifests as repeating episodes of headache of moderate-to-severe pain intensity, persisting approximately 4-72 hours. 1 2 Mounting evidence suggests that migraine pathogenesis recruits the trigeminal nerve and its projections to the intracranial vasculature. Discovery of signalling molecules involved in migraine pathogenesis led to the development of mechanism-based therapies , such as anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies and small-molecule antagonists. 3 3 This 6,000-word Learning Zone focuses on the unmet needs and disease burden associated with migraine, the role of CGRP in migraine pathophysiology, and anti-CGRP therapies for acute and prophylactic treatment of migraine.
https://www.medthority.com/medical-education/anti-cgrps-therapies-for-migraine-learning-zone/
https://www.medthority.com/medical-education/anti-cgrps-therapies-for-migraine-learning-zone/
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This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. Immediate pain warns of harm or injury to the... more
This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time.
Immediate pain warns of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair.
Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions.
This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management.
Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019.
Immediate pain warns of harm or injury to the person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair.
Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions.
This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management.
Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019.
Research Interests:
Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term... more
Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself.
This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain.
Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter.
This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers.
“It is my opinion that this ... work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” - Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword
This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain.
Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter.
This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers.
“It is my opinion that this ... work will stand as the definitive reference work in this field. I believe it will enrich the professional and personal lives of health care providers, researchers and people who have persistent pain and their family members. The combination of framework chapters with chapters devoted to analysing the lived experience of pain conditions gives the requisite breadth and depth to the subject.” - Dr Marc A. Russo, MBBS DA(UK) FANZCA FFPMANZCA, Newcastle, Australia, from the Foreword
Research Interests: Psychology, Chronic Pain, Phenomenology, Meaning, Rheumatoid Arthritis, and 14 moreDiabetes Mellitus and Its Complications, Philosophy of Language (Humanities), Medicine, Pain Management, Assessment of pain, Cancer pain, Anesthesiology ,Critical Care, Pain management, Neuropathic pain, Fibromyalgia, Psoriatic Arthritis, Pain Medicine, Complex Regional Pain Syndrome, Endometriosis, and Chronic Low Back Pain(Diabetes Mellitus and Its Complications, Philosophy of Language (Humanities), Medicine, Pain Management, Assessment of pain, Cancer pain, Anesthesiology ,Critical Care, Pain management, Neuropathic pain, Fibromyalgia, Psoriatic Arthritis, Pain Medicine, Complex Regional Pain Syndrome, Endometriosis, and Chronic Low Back Pain)
(Diabetes Mellitus and Its Complications, Philosophy of Language (Humanities), Medicine, Pain Management, Assessment of pain, Cancer pain, Anesthesiology ,Critical Care, Pain management, Neuropathic pain, Fibromyalgia, Psoriatic Arthritis, Pain Medicine, Complex Regional Pain Syndrome, Endometriosis, and Chronic Low Back Pain)
Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is, making perceived meaning important in the study of pain.... more
Although pain is widely recognized by clinicians and researchers as an experience, pain is always felt in a patient-specific way rather than experienced for what it objectively is, making perceived meaning important in the study of pain. The book contributors explain why meaning is important in the way that pain is felt and promotes the integration of quantitative and qualitative methods to study meanings of pain. For the first time in a book, the study of the meanings of pain is given the attention it deserves.
All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person’s life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning.
Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers.
(Forthcoming, Springer, 2016)
All pain research and medicine inevitably have to negotiate how pain is perceived, how meanings of pain can be described within the fabric of a person’s life and neurophysiology, what factors mediate them, how they interact and change over time, and how the relationship between patient, researcher, and clinician might be understood in terms of meaning.
Though meanings of pain are not intensively studied in contemporary pain research or thoroughly described as part of clinical assessment, no pain researcher or clinician can avoid asking questions about how pain is perceived or the types of data and scientific methods relevant in discovering the answers.
(Forthcoming, Springer, 2016)
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This post is the first in a series of posts on Body in Mind (BiM) about chapters in the edited collection, Meanings of Pain (2016, Springer). We kick off the series with a question and answer session between Simon van Rysewyk, editor and... more
This post is the first in a series of posts on Body in Mind (BiM) about chapters in the edited collection, Meanings of Pain (2016, Springer). We kick off the series with a question and answer session between Simon van Rysewyk, editor and contributor of Meanings of Pain, and Lorimer Moseley (LM), Editor-in-Chief of BiM.
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Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise... more
Introduction: The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain. Methods: This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology. Results: A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language. Conclusion: Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.
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Research Interests:
Pain management in the general practice setting often defaults to the use of analgesic drugs, frequently opioids. This short article applies guideline recommendations that could be used by General Practitioners in prescribing opioids for... more
Pain management in the general practice setting often defaults to the use of analgesic drugs, frequently opioids. This short article applies guideline recommendations that could be used by General Practitioners in prescribing opioids for people with chronic noncancer pain (CNCP).
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Although Pain Medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatisfactory. The problem seems to be with meaning: some people with pain do not find meaning in clinical discussions of pain,... more
Although Pain Medicine is a rapidly developing clinical discipline, medical explanations about pain are often unsatisfactory. The problem seems to be with meaning: some people with pain do not find meaning in clinical discussions of pain, and clinicians typically are not looking for it. For patients with pain, biomedical information can be perceived as lacking meaning in relation to their personal experience. By contrast, patient narratives and stories about pain, clinical encounters and therapies, cautionary tales, and common-sense experience seem to offer meaningful and actionable information. No biomedical explanation of pain, however useful it might be to a pain clinician, could describe the personal meaning or burden of pain to the individual. Traditionally, scientific research has had much to say about the physical nature of pain but much less about pain experience. It seems that one limitation in the ability of clinicians to effectively treat pain or pain-related suffering is an incomplete appreciation of ‘pain experience.’ This special issue in Pain Medicine focuses on a pivotal aspect of this problem: how to understand the meaning of pain, for both the patient and the observing clinician.
Research Interests:
Research Interests:
The belief that neonates or infants can feel pain is a relatively recent development. Historically, major cardiac surgery was performed in some neonates or infants without anaesthesia, based on the belief that infants had immature nervous... more
The belief that neonates or infants can feel pain is a relatively recent development. Historically, major cardiac surgery was performed in some neonates or infants without anaesthesia, based on the belief that infants had immature nervous systems; therefore, they were incapable of pain, and were fatally vulnerable to the side-effects of anaesthesia. What was standard medical practice in the past is now considered medically unsound and morally unjust. Given that neonates or infants cannot linguistically describe their pain, researchers and clinicians have considered behavioural, physiological, and neurophysiological cues to determine pain in neonates or infants. Pain assessment based on behavioural cues is not an ‘indirect’ means of inferring pain in the neonate and infant because pain experience is not totally separable from its behavioural manifestations. Since pre-linguistic neonates or infants do not possess the concept of pain, in social settings involving pain, the neonate and infant expresses pain only by virtue of a courtesy extended to signs of pain by linguistically competent adults who have already mastered the practice of using ‘pain’, who treat these signs as genuine expressions of pain. Thus, the aim of this paper is to describe how clinicians and researchers have conceptualised neonatal or infant pain, and what implications these may have in the study of neonatal or infant pain. Craig’s social communications model emphasises how intra- and interpersonal factors surrounding assessment of infant pain influences the caregiver’s ability to decode the behavioural, physiological, and neurophysiological expression of the neonate’s and infant’s pain. Although the neonate’s or infant’s ability to express pain through behavioural signs is an essential aspect of pain assessment, the role of pain detection falls heavily on the caregiver. In some circumstances, such as severe disease acuity, neonates or infants may not have the capacity to respond behaviourally or physiologically to pain. Therefore, it is argued, examining the caregiver’s conceptualisation of the pain is even more important in these circumstances, as it has obvious implications for pain management.
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Pain is not a behaviour, but an experience. Yet, it reveals itself in behaviours that cannot fail to disclose, or to compromise, the person with pain. Pain-related behaviours range from verbal self-report, to nonverbal behaviours, which... more
Pain is not a behaviour, but an experience. Yet, it reveals itself in behaviours that cannot fail to disclose, or to compromise, the person with pain. Pain-related behaviours range from verbal self-report, to nonverbal behaviours, which include paralinguistic vocalisations, bodily activity, and facial expressions. Verbal self-report is mostly voluntary, and relies on reflection, whereas nonverbal expression tends to be involuntary. The specific and distinct facial expression of pain is consistent across the lifespan, stimuli, cultures, and recognisable as pain by observers. The activity revealed in the face is more meaningful to observers than in other body-parts, because body-parts do not have the individuating meaning of the face: a person may be perceived by his arm, but not in his arm. We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which is lodged in the face. The most meaningful features in facial displays of pain are the eyes, then brows, eyelids, mouth, head, forehead, and other body-parts. Voluntary control of pain through facial movements is normally judged by observers to be an insincere expression of pain. By contrast, involuntary facial changes show the person with pain "as he really is," because he does not fully control them, and observers are more obliged to offer help when facial movements are involuntary. Pain imposes a vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. The loss of voluntary control over my body during pain, and its dominion over me, create the compelling sense, for me and for others, of an "incarnate" person. Deception about pain is possible because we do not distinguish a human person from his or her face. There are deceiving faces, but not deceiving arms or legs.
Research Interests:
Long-term pain is a common comorbidity for people with acquired brain injury. This chapter explores what it is like to live with those two conditions, focusing on the meaning for the individual. The meaning of pain plays a part in... more
Long-term pain is a common comorbidity for people with acquired brain injury. This chapter explores what it is like to live with those two conditions, focusing on the meaning for the individual. The meaning of pain plays a part in determining people’s emotional reactions and behavioural choices, and it is central for the process of psychosocial adjustment to a life with functional, social, participatory, and emotional challenges. Meaning is also closely linked to the identity changes that typically happen once people are faced with the challenge of living with long-term conditions. The field of positive psychology has contributed valuable insights into this process and the roles of benefit-finding, resilience, and post-traumatic growth are discussed. Two significantly different case stories are used as an illustration of life with acquired brain injury and long-term pain. One case, Julie, illustrates the process of adaptation and the other case, Mark, illustrates the challenge of dealing with pain issues when insight and pain perception has been changed by a frontal lobe injury. In both cases, the meaning of pain is integral to the meaning of brain injury. Neither Julie nor Mark consider themselves to have long-term pain, they live with the long-term impact of their brain injury, where pain is just one aspect. In fact, Mark’s altered pain perception causes him to claim that he feels no pain, yet it is nevertheless a challenge for him. The chapter concludes with clinical recommendations, calling for access to systematic, psychosocial rehabilitation that includes meaning-based approaches. A holistic rehabilitation model is proposed, suggesting that traditional medical and rehabilitation approaches need to happen within the context of psychosocial adjustment and rehabilitation, rather than expecting psychosocial adjustment to happen by itself, as a “by-product” of medical, physical, cognitive, and occupational interventions.
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This Learning Zone, spanning twelve pages on Medthority, describes current unmet needs in management of mCRPC, and outlines potential ways healthcare professionals (HCP) could meet them, with a focus on first-line mono- or combination... more
This Learning Zone, spanning twelve pages on Medthority, describes current unmet needs in management of mCRPC, and outlines potential ways healthcare professionals (HCP) could meet them, with a focus on first-line mono- or combination treatments.
A range of short, informative videos, presented by an expert in metastatic castration-resistant prostate cancer, complement the written content. Meet the expert oncologist below.
https://www.medthority.com/medical-education/responding-to-unmet-needs-for-metastatic-castration-resistant-prostate-cancer/
A range of short, informative videos, presented by an expert in metastatic castration-resistant prostate cancer, complement the written content. Meet the expert oncologist below.
https://www.medthority.com/medical-education/responding-to-unmet-needs-for-metastatic-castration-resistant-prostate-cancer/
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This Learning Zone presents the benefits and limitations for diagnostic biomarkers in Alzheimer's disease, and reviews the latest biomarker innovations. - Focus on neuroimaging and CSF biomarkers to help confirm an Alzheimer's diagnosis... more
This Learning Zone presents the benefits and limitations for diagnostic biomarkers in Alzheimer's disease, and reviews the latest biomarker innovations.
- Focus on neuroimaging and CSF biomarkers to help confirm an Alzheimer's diagnosis
- Learn validation evidence for new blood-based biomarkers that meets some unmet needs
- Watch educational videos on Alzheimer's management, presented by neurology specialists
https://www.medthority.com/medical-education/biomarker-innovation-in-alzheimers-disease-learning-zone/
- Focus on neuroimaging and CSF biomarkers to help confirm an Alzheimer's diagnosis
- Learn validation evidence for new blood-based biomarkers that meets some unmet needs
- Watch educational videos on Alzheimer's management, presented by neurology specialists
https://www.medthority.com/medical-education/biomarker-innovation-in-alzheimers-disease-learning-zone/
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The third highlight article from the 18th International Symposium on Amyloidosis (ISA) 2022 is an overview of the Satellite Symposium, ‘Unmet Medical Needs in AL Amyloidosis’ presented by Giovanni Palladini from the Amyloidosis Research... more
The third highlight article from the 18th International Symposium on Amyloidosis (ISA) 2022 is an overview of the Satellite Symposium, ‘Unmet Medical Needs in AL Amyloidosis’ presented by Giovanni Palladini from the Amyloidosis Research and Treatment Center, University of Pavia and IRCCS Fondazione Policlinico San Matteo, Italy, on Wednesday 7, September 2022, in Heidelberg, Germany.
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Investigational anti-amyloid agents CAEL-101 clinical trials Birtamimab clinical trials Conclusions Investigational anti-amyloid monoclonal antibodies Professor Morie Gertz begins with a cautionary note against focusing too much attention... more
Investigational anti-amyloid agents CAEL-101 clinical trials Birtamimab clinical trials Conclusions Investigational anti-amyloid monoclonal antibodies Professor Morie Gertz begins with a cautionary note against focusing too much attention on anti-amyloid treatments that target production of free light-chain amyloid proteins. He urges the development of more anti-amyloid treatments that reduce or eliminate pre-existing amyloid deposits in bodily tissues. Two investigational anti-amyloid monoclonal antibodies for amyloid light-chain (AL) amyloidosis in phase 3 trials are: CAEL-101 Birtamimab CAEL-101 is a chimeric mAb that targets AL amyloid deposits. Birtamimab is a fully humanised monoclonal antibody (mAb) that targets soluble AL aggregates, and insoluble AL amyloid deposits. Soluble AL aggregates could be part of the cellular toxicity of free light-chains.
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Professor Giovanni Palladini opened his lecture by observing that amyloid light-chain (AL) amyloidosis is both a haematological and an organ disease. This fact can help inform treatment decisions for AL amyloidosis, because healthcare... more
Professor Giovanni Palladini opened his lecture by observing that amyloid light-chain (AL) amyloidosis is both a haematological and an organ disease. This fact can help inform treatment decisions for AL amyloidosis, because healthcare professionals can follow the efficacy of treatments with biomarkers specific to haematologic and organ response. A rapid and clinically significant reduction in the amyloid protein (free-light chains) is essential to achieving beneficial haematologic and organ responses. As Professor Giovanni Palladini stated, "The deeper [reduction] the better, the quicker the better". One month is the ideal window to achieve amyloid reduction.
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"Although pain is widely recognized by clinicians and researchers as a type of experience, an experience of pain is always felt in a specific way and in a specific context. This makes perceived meaning important in the way that pain is... more
"Although pain is widely recognized by clinicians and researchers as a type of experience, an experience of pain is always felt in a specific way and in a specific context. This makes perceived meaning important in the way that pain is felt and treated. This book includes original, interdisciplinary research on the meanings of pain, including..."
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This interdisciplinary book is the first to report in-depth scientific research dedicated to the meanings of pain. Situated within the wider context of a biopsychosocial framework, this book aims to improve understanding of the link... more
This interdisciplinary book is the first to report in-depth scientific research dedicated to the meanings of pain. Situated within the wider context of a biopsychosocial framework, this book aims to improve understanding of the link between meaning and pain, and to stimulate further research in this area. The intended audience of the book is research scientists, clinicians, patients with pain, and caregivers. To improve understanding of the meanings of pain in the target audience, this book studies several aspects within this area. These aspects include, common meanings of pain across types of pain, extended pain-related feelings and their meanings, meanings of pain associated with patient-clinician interactions, interactions between brain activity and meanings of pain, qualitative methods suited to studying meanings of pain, and meanings of pain in rodents and non-human animals.
Research Interests: Neuroscience, Psychology, Clinical Psychology, Cognitive Behavioral Therapy, Cognitive Psychology, and 16 moreSocial Psychology, Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences(Social Psychology, Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences)
(Social Psychology, Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences)
The question of investigators introspecting on their own personal pain experiences in pain studies has received little attention in the literature. Study of this question may reflect ethical reservations about the many points at which... more
The question of investigators introspecting on their own personal pain experiences in pain studies has received little attention in the literature. Study of this question may reflect ethical reservations about the many points at which self-interest may lead us to introspect on personal experiences through personal biases that in turn impair professional decision-making and perception. Despite this valid concern about research co-participation, we offer three reasons why investigators can introspect on personal pain as co-participants in their own pain studies. First, there is historical precedent for investigator participation and co-participation in scientific pain research using introspection as a study method. Second, general concerns about variability in self-report based on introspection on pain experience partly derive from true fluctuations in personal pain experience and perceived interests in self-reporting pain, not simply error in its scientific measurement. Third, the availability of the Experiential-Phenomenological Method, a mixed research method for the study of human experiences, allows investigators to co-participate with naïve participants in their own studies by encouraging passive introspection on personal pain experiences.
Research Interests: Neuroscience, Psychology, Clinical Psychology, Cognitive Psychology, Social Psychology, and 15 morePhilosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences(Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences)
(Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Behavioral Neuroscience, Meaning Making, Pain Management, Social Cognitive Affective Neuroscience, and Clinical Sciences)
Some pain researchers, unconvinced that self-report of pain is reliable, have urged its replacement with brain-markers of pain. This suggestion is compatible with a radical philosophy called Eliminative Materialism, which asserts that... more
Some pain researchers, unconvinced that self-report of pain is reliable, have urged its replacement with brain-markers of pain. This suggestion is compatible with a radical philosophy called Eliminative Materialism, which asserts that folk psychological claims and generalizations about the nature and causal powers of pain are false and face elimination by a mature, neuroscientific theory of pain. Some eliminativists draw inspiration from our intellectual history, which shows that any theory can appear correct or beneficial even when it is false. However, the eliminativist accusation that pain folk psychology is explanatorily stagnant is mistaken given that folk psychology has motivated important psychological and clinical research programs in pain science that have led to new knowledge and improved outcomes for some pain patients. Pain folk psychology turns out to be compatible with advances in pain neuroscience, as evident in successful patient education programs, which replace maladaptive beliefs about pain with adaptive folk beliefs informed by accurate pain neurophysiology. Eliminative Materialism is merely one possible theoretical outcome on a continuum with many possibilities. The eliminativist needs to produce independent reasons for thinking that pain neuroscience will replace pain folk psychology in the way eliminativism thinks, which is a difficult task given that a central premise required for the outcome envisaged by the eliminativist is unknown. Facts of scientific history alone cannot inoculate eliminative materialism from the unjustifiably promissory nature of its central claims.
Research Interests: Neuroscience, Psychology, Clinical Psychology, Cognitive Psychology, Social Psychology, and 16 morePhilosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Social Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Meaning Making, Pain Management, Eliminative materialism, Chronic Pain Management and Self-Care, and Clinical Sciences(Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Social Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Meaning Making, Pain Management, Eliminative materialism, Chronic Pain Management and Self-Care, and Clinical Sciences)
(Philosophy of Mind, Theories of Meaning, Chronic Pain, Phenomenology, Affective Neuroscience, Social Neuroscience, Meaning, Phenomenology of the body, Cognitive Neuroscience, Phenomenology (Research Methodology), Interpretative Phenomenological Analysis, Meaning Making, Pain Management, Eliminative materialism, Chronic Pain Management and Self-Care, and Clinical Sciences)
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Manual Facial Action Coding studies (FACS) have discovered a fuzzy facial expression that is both specific and sensitive to pain. However, the limitations of manual pain coding sit uneasily beside the increasingly higher standards... more
Manual Facial Action Coding studies (FACS) have discovered a fuzzy facial expression that is both specific and sensitive to pain. However, the limitations of manual pain coding sit uneasily beside the increasingly higher standards required of medical care. These limitations include training time and effort, technological requirements and human subjective factors. To surmount these challenges, in the last decade and a half, devices embedded with artificial neural networks (ANNs) have been used in researching pain through facial expression (‘face perception of pain’). Using neural-network theory, this chapter argues that ANN approaches to face perception of pain be viewed as the problem of using and acquiring representational pain-face spaces. In place of categorical definitions and application rules invoking them, face perception of pain is plausibly organized around ‘fuzzy’ cases such that human observers, like ANNs, judge a pain face based on their recognition that one face is more or less similar to other faces whose results are remembered and assessed (‘fuzzy case based reasoning’). A study conducted by one of the authors implementing a fuzzy case-based reasoning system integrated with an ANN (FCBR-ANN) produced more than 90% accuracy in pain perception. Face perception of pain using an FCBR-ANN may be a real-time alternative to manual coding of pain by human observers, and may prove clinically useful.
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In discussing fish pain, Key privileges pain in humans -- “the only species able to directly report on its feelings.” Human experience of pain is not necessarily best reflected by verbal self-report, however. Neural responses to noxious... more
In discussing fish pain, Key privileges pain in humans -- “the only species able to directly report on its feelings.” Human experience of pain is not necessarily best reflected by verbal self-report, however. Neural responses to noxious stimuli are influenced by individual differences and by context. Nonverbal pain displays such as facial expressions reflect part of the neural response to noxious stimuli. Most mammals have a specific facial grimace reflecting pain. If fish have a somatic expression of pain, the development of a reliable and accurate somatic pain scale specific to fish could make a contribution to the debate about fish pain.
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Various neurological observations challenge corticocentric views of “pain in the brain” and undermine BK’s view that “pain is in the cerebral cortex.”
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Therapeutic pain studies do not always clearly simulate clinical reality. This poses a barrier to understanding the nature of such research and how it should be subsequently applied to target populations in healthcare contexts. I... more
Therapeutic pain studies do not always clearly simulate
clinical reality. This poses a barrier to understanding
the nature of such research and how it should
be subsequently applied to target populations in
healthcare contexts. I propose that a theoretical
framework developed by the Respiratory Effectiveness
Group (REG) can be applied in the field of pain to
understand and appraise clinical factors in therapeutic
pain studies. The framework should be thoroughly
tested to establish its usefulness in a chronic pain
management context.
clinical reality. This poses a barrier to understanding
the nature of such research and how it should
be subsequently applied to target populations in
healthcare contexts. I propose that a theoretical
framework developed by the Respiratory Effectiveness
Group (REG) can be applied in the field of pain to
understand and appraise clinical factors in therapeutic
pain studies. The framework should be thoroughly
tested to establish its usefulness in a chronic pain
management context.
Research Interests:
Research Interests: Neuroscience, Psychophysiology, Psychometrics, Pain, Qualitative methodology, and 10 moreQualitative Methods, Chronic Pain, Phenomenological Psychology, Phenomenology, Qualitative Health Research, Quantitative Research, Quantitative Methods, Phenomenology of the body, Qualitative Research Methods, and Pain Management
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, the author proposes that the only way to... more
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, the author proposes that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. The author argues 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.
Research Interests:
Research Interests:
Research Interests:
Concern for human vulnerability seems to be at the heart of pain management. In 2019, the IASP convened a task force to improve pain management in people unable to articulate their pain in a way that health professionals can understand... more
Concern for human vulnerability seems to be at the heart of pain management. In 2019, the IASP convened a task force to improve pain management in people unable to articulate their pain in a way that health professionals can understand and/or whose pain is underestimated.
The IASP identified older persons, infants and young children, individuals with cognitive impairments or psychiatric disorders, and pain in survivors of torture, as “belonging to the most vulnerable”. The selection of this group was guided by expertise within the task force.
Today, I want to explore conceptual connections between vulnerability and pain and related concepts such as harm, exploitation, and autonomy. I also sketch out a taxonomy of sources of vulnerability to pain.
The IASP identified older persons, infants and young children, individuals with cognitive impairments or psychiatric disorders, and pain in survivors of torture, as “belonging to the most vulnerable”. The selection of this group was guided by expertise within the task force.
Today, I want to explore conceptual connections between vulnerability and pain and related concepts such as harm, exploitation, and autonomy. I also sketch out a taxonomy of sources of vulnerability to pain.
Research Interests:
The Pain UK “Lived Experience of Pain Project”
Research Interests: Clinical Psychology, Qualitative studies (Psychology), Chronic Pain, Phenomenology, Qualitative Research, and 8 moreDoctor-patient communication, Qualitative Research Methods, Patient-Centered Care, Clinical research, Chronic Pain Management and Self-Care, Pain Medicine, Chronic Low Back Pain, and Lived Experiences
Background and Context: It is estimated that 28 million people in the UK live with chronic non-cancer pain (CNCP). CNCP can be challenging to diagnose and treat; the adverse mental and social effects caused by living with CNCP impose an... more
Background and Context: It is estimated that 28 million people in the UK live with chronic non-cancer pain (CNCP). CNCP can be challenging to diagnose and treat; the adverse mental and social effects caused by living with CNCP impose an added burden on health and social care resources. CNCP is not simply an unpleasant experience: it can devastate a person’s career, relationships and mental health, and it can end in suicide. Much of our knowledge about the meaning and experience of CNCP has been produced through qualitative research, which investigates aspects of pain inaccessible to other research methods. However, the lived experience of CNCP, including its common psychological and social effects, remains a blind spot in clinical pain management. The problem seems to be with meaning, where some people with CNCP do not find meaning in clinical discussions of CNCP, and clinicians typically are not looking for other, non-clinical, types of meaning. It has been suggested that one limitation for clinicians in treating CNCP and pain-related suffering effectively is an incomplete appreciation of the meaning of CNCP experience.
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Background and aims: Opioids are the foundation pharmacological treatment of moderate-severe cancer pain. High opioid doses (≥100 mg oral morphine equivalents (OME) per day) are often required. This contrasts with chronic non-malignant... more
Background and aims: Opioids are the foundation pharmacological treatment of moderate-severe cancer pain. High opioid doses (≥100 mg oral morphine equivalents (OME) per day) are often required. This contrasts with chronic non-malignant pain, where opioids are no longer recommended; instead, psychosocial therapies are advised. One psychosocial treatment is patient education to manage unhelpful thoughts about pain (e.g. pain catastrophising; lack of confidence to function despite pain). There are few studies of these maladaptive pain coping strategies in cancer patients. The aim of this study is to describe pain coping strategies used by patients with cancer pain attending chronic pain clinic at RNSH, 2014-2019. Methods: Cross-sectional survey of patients with cancer-related pain, who completed the battery of standardised questionnaires on referral to the pain clinic: Brief Pain Inventory, Depression Anxiety Stress Scale, Pain Self-Efficacy Questionnaire, Pain Catastrophising Scale, routinely collected across Australia and New Zealand since 2014 for the Electronic Persistent Pain Outcomes Collaboration (ePPOC). Patients also self-reported demographic and clinical information, including opioid use and dose in OME. Comparative statistics were used to compare patients with mild to moderate vs. severe pain. Results: 3,510 patients completed baseline questionnaires during the study period. 267 (7.6%) had a documented history of cancer. 33 (12%) of them had pain attributable to their disease. On average, they were 5 years post-diagnosis. Two-thirds were receiving cancer treatment. Almost half subsequently died, approximately 1 year later. 21 (63%) had mild-moderate pain (≤7 out of 10) and 12 (37%) had severe pain (7 or higher). The average daily opioid dose was more than double in the severe pain group (419 mg vs 173 mg, P=0.16), and patients in the severe pain group were four times more likely to be administering ≥100 mg OME per day (OR 4.00, 95% CI 0.8350-19.1621, P=0.083). Despite the small sample size, patients with severe pain had significantly higher pain catastrophising scores (29.7±12.7 vs. 17.8±10.9, P=0.0007). Conclusion: Assessment and treatment for pain catastrophising should be considered in cancer patients still complaining of severe pain, despite high dose opioids.
Research Interests:
Pain is not a behaviour, but an experience. Yet, it reveals itself in behaviours that cannot fail to disclose, or to compromise, the person with pain. Pain-related behaviours range from verbal self-report, to nonverbal behaviours, which... more
Pain is not a behaviour, but an experience. Yet, it reveals itself in behaviours that cannot fail to disclose, or to compromise, the person with pain. Pain-related behaviours range from verbal self-report, to nonverbal behaviours, which include paralinguistic vocalisations, bodily activity, and facial expressions. Verbal self-report is mostly voluntary, and relies on reflection, whereas nonverbal expression tends to be involuntary. The specific and distinct facial expression of pain is consistent across the lifespan, stimuli, cultures, and recognisable as pain by observers. The activity revealed in the face is more meaningful to observers than in other body-parts, because body-parts do not have the individuating meaning of the face: a person may be perceived by his arm, but not in his arm. We feel that each person we encounter in the world is a unique perspective that is not the body, but the “self”, which is lodged in the face. The most meaningful features in facial displays of pain are the eyes, then brows, eyelids, mouth, head, forehead, and other body-parts. Voluntary control of pain through facial movements is normally judged by observers to be an insincere expression of pain. By contrast, involuntary facial changes show the person with pain "as he really is," because he does not fully control them, and observers are more obliged to offer help when facial movements are involuntary. Pain imposes a vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. The loss of voluntary control over my body during pain, and its dominion over me, create the compelling sense, for me and for others, of an "incarnate" person. Deception about pain is possible because we do not distinguish a human person from his or her face. There are deceiving faces, but not deceiving arms or legs.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Research Interests:
1st International Online Networking Event, INRePALC, 2021 Overview: Let’s discuss what it means to cope with chronic pain – this is not a data presentation. Instead, I attempt to create a sense of enquiry and self-reflection on how to... more
1st International Online Networking Event, INRePALC, 2021
Overview: Let’s discuss what it means to cope with chronic pain – this is not a data presentation. Instead, I attempt to create a sense of enquiry and self-reflection on how to take the meaning of coping with chronic pain and apply it in the clinic. Thinking about what we do, and what the doing represents in the clinic, can be rewarding.
Overview: Let’s discuss what it means to cope with chronic pain – this is not a data presentation. Instead, I attempt to create a sense of enquiry and self-reflection on how to take the meaning of coping with chronic pain and apply it in the clinic. Thinking about what we do, and what the doing represents in the clinic, can be rewarding.
Research Interests: Clinical Psychology, Coping Strategies, Chronic Pain, Meaning of Life, Clinical Decision-Making, and 13 moreClinical Health Psychology, Meaning Response/Placebo Effect, Construction of Meaning, Religious Coping, Meaning Making, Coping, Clinical Medicine, Stress and coping, Chronic Pain Management and Self-Care, Clinical Sciences, Spiritual/religious coping, Chronic Low Back Pain, and Coping With Change
Aim: to describe pain coping strategies used by patients with cancer pain attending chronic pain clinic at RNSH, 2014-2019.
Research Interests:
Full abstract Pain is not an action; yet it reveals itself in those gestures which cannot fail to disclose and to compromise the person with pain. During pain, body-parts are subject to massive involuntary transformations. But the... more
Full abstract Pain is not an action; yet it reveals itself in those gestures which cannot fail to disclose and to compromise the person with pain.
During pain, body-parts are subject to massive involuntary transformations. But the involuntary transformations revealed in the face are more meaningful than in other body-parts. This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. When I observe another’s pain facial expression, I am not perceiving a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face. A person may be perceived by his arm, but not in his arm. The most meaningful features in displays of pain are the eyes, followed by brows, eyelids, mouth, head, forehead, and then other body-parts. Intentional control of pain through facial movements is normally judged by observers to be an insincere expression of pain, and open to doubt. Thus, involuntary facial changes show the person with pain "as he really is" because he does not fully control them, and observers are more obliged to offer help when movements are most involuntary.
The loss of voluntary control over my body during pain, and its dominion over me, create the compelling sense, for me and for others, of an "incarnate" person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person with pain feel answerable for what he or she experiences. The expression on a face is an offering in the world of mutual responsibilities: it projects into our inter-personal relations a particular person’s "being there". As soon as I notice pain in another person's face, my responsibilities are engaged. Facial expressions of pain call on you to respond to me. The face has this meaning for us because it is the boundary at which the other appears, offering "this person" as one in need of help. This feature is perhaps at the heart of what it means to treat and monitor pain.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Simon van Rysewyk, adjunct researcher
Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart 7001, Australia
simon.vanrysewyk@utas.edu.au | +61 4 8899 7823
https://simonvanrysewyk.com/ | https://utas.academia.edu/SimonvanRysewyk
During pain, body-parts are subject to massive involuntary transformations. But the involuntary transformations revealed in the face are more meaningful than in other body-parts. This is because body-parts do not have the individuating meaning of the face: the meaning of revealing me, here, now. When I observe another’s pain facial expression, I am not perceiving a physical part of him, as I am when I notice his injured arm or leg. I am meeting him, a real person, who reveals himself in the face. A person may be perceived by his arm, but not in his arm. The most meaningful features in displays of pain are the eyes, followed by brows, eyelids, mouth, head, forehead, and then other body-parts. Intentional control of pain through facial movements is normally judged by observers to be an insincere expression of pain, and open to doubt. Thus, involuntary facial changes show the person with pain "as he really is" because he does not fully control them, and observers are more obliged to offer help when movements are most involuntary.
The loss of voluntary control over my body during pain, and its dominion over me, create the compelling sense, for me and for others, of an "incarnate" person. Pain imposes a significant vulnerability on persons: the vulnerability of a free person who is overwhelmed in his or her body by the presence of pain. This can make the person with pain feel answerable for what he or she experiences. The expression on a face is an offering in the world of mutual responsibilities: it projects into our inter-personal relations a particular person’s "being there". As soon as I notice pain in another person's face, my responsibilities are engaged. Facial expressions of pain call on you to respond to me. The face has this meaning for us because it is the boundary at which the other appears, offering "this person" as one in need of help. This feature is perhaps at the heart of what it means to treat and monitor pain.
Keywords: face; facial expression; pain; meaning; body; involuntary.
Simon van Rysewyk, adjunct researcher
Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart 7001, Australia
simon.vanrysewyk@utas.edu.au | +61 4 8899 7823
https://simonvanrysewyk.com/ | https://utas.academia.edu/SimonvanRysewyk
Research Interests:
Cancer-related pain is particularly sensitive to cognitive factors. This presentation describes some common cognitions that people with cancer-related pain have, and how they influence patient outcomes.
Research Interests:
Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes some common meanings and beliefs that people have about cancer, illness, and pain, and the consequences these... more
Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes some common meanings and beliefs that people have about cancer, illness, and pain, and the consequences these meanings have in relation to common help-seeking behaviours or coping strategies people choose to adopt. Suffering is a cognitive and emotional response to recurrent perceived losses experienced in some people with cancer. Megan Best presents on the challenges in assessing people with cancer-related suffering and the relationship of suffering to cancer-related pain. Melanie Lovell compares levels of suffering in people with cancer-related pain versus non-cancer chronic pain, highlighting differential meanings of existential or spiritual distress and mood dysfunction. Best and Lovell outline management approaches to cancer pain and suffering that are not responsive to analgesia, such as meaning-or peace-centred therapies.
Research Interests:
Introduction: The widely accepted definition of pain promulgated by the International Association for the Study of Pain (IASP), although useful in a clinical context, is written mainly from the perspective of the "observer". As such it... more
Introduction: The widely accepted definition of pain promulgated by the International Association for the Study of Pain (IASP), although useful in a clinical context, is written mainly from the perspective of the "observer". As such it fails sufficiently to capture the perspective of the "experiencer" of pain.
Methods: This presentation briefly analyses the historical development of the IASP definition, and some of the commentaries and suggested modifications to it over almost 40 years. Common factors of pain that patients experience are described, together with theoretical insights from philosophy and biology.
Results: Major problems with the IASP definition of pain include: (i) the stance of the observer is privileged over that of the experiencer of pain; (ii) the obligatory linking with "tissue damage" focuses attention on the body as distinct from the person; and (iii) the validity of the experience when there is no obvious "cause" is questioned. A revised definition of pain is offered: Pain is a mutually recognisable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.
Conclusion: This definition integrates the subjectivity or “first-person” level of experience of pain, and the challenge for the “second-person” of clinical evaluation (if not also intervention) towards objective “third-person” goals. This redefinition of pain is compatible with that of the IASP but more philosophically sound, biologically relevant, clinically applicable, and meaningful for people experiencing pain and for health care professionals who engage with them.
Methods: This presentation briefly analyses the historical development of the IASP definition, and some of the commentaries and suggested modifications to it over almost 40 years. Common factors of pain that patients experience are described, together with theoretical insights from philosophy and biology.
Results: Major problems with the IASP definition of pain include: (i) the stance of the observer is privileged over that of the experiencer of pain; (ii) the obligatory linking with "tissue damage" focuses attention on the body as distinct from the person; and (iii) the validity of the experience when there is no obvious "cause" is questioned. A revised definition of pain is offered: Pain is a mutually recognisable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity.
Conclusion: This definition integrates the subjectivity or “first-person” level of experience of pain, and the challenge for the “second-person” of clinical evaluation (if not also intervention) towards objective “third-person” goals. This redefinition of pain is compatible with that of the IASP but more philosophically sound, biologically relevant, clinically applicable, and meaningful for people experiencing pain and for health care professionals who engage with them.
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Pain due to cancer, a common effect of the disease and its treatment, makes the experience of cancer more distressing for patients and their families. The meaning of cancer-related pain has been referred to as the “feared consequence of... more
Pain due to cancer, a common effect of the disease and its treatment, makes the experience of cancer more distressing for patients and their families. The meaning of cancer-related pain has been referred to as the “feared consequence of cancer”, and associated with pathology and death. However, if cancer-related pain is related to (non-cancer) pain and its common factors, of which the meaningfulness of pain is one, and not the cancer disease, then the meaning of cancer-related pain is clinically relevant. The meanings of personal experiences are important to human beings, and influence how we respond to life’s changing circumstances. A neglected aspect of the clinical management of cancer is the patient’s ability to make the experience of cancer meaningful, despite the presence of disabling pain. This presentation provides an overview of the meanings of pain, and some pilot data based on Lipowski’s meanings of chronic illness, which suggests that cancer-related pain is qualitatively closer to chronic non-cancer pain than to cancer. Ideas are provided for health care professionals to make cancer and cancer-related pain more meaningful to patients and their families.
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"Meanings of Pain Volume 2: Common Types of Pain and Language is the second instalment of a three-part series from Simon van Rysewyk following the 2016 release of Meanings of Pain, the first book devoted to studying the meanings of pain.... more
"Meanings of Pain Volume 2: Common Types of Pain and Language is the second instalment of a three-part series from Simon van Rysewyk following the 2016 release of Meanings of Pain, the first book devoted to studying the meanings of pain. There is a prominent and consistent theme of using first-person experiences to fully describe the impact of chronic pain. The foreword from Marc Russo sets this theme right from the beginning, discussing how his own experiences as a pain clinician and
researcher have been influenced by a triple level spinal fracture and a C6 radiculopathy."
researcher have been influenced by a triple level spinal fracture and a C6 radiculopathy."
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El libro Meanings of Pain, editado por Simon van Rysewyk en 2016, constituye sin dudas un aporte fundamental a las investigaciones actuales sobre dolor. El libro se compone de veintitrés artículos que, desde las más variadas disciplinas y... more
El libro Meanings of Pain, editado por Simon van Rysewyk en 2016, constituye sin dudas un aporte fundamental a las investigaciones actuales sobre dolor. El libro se compone de veintitrés artículos que, desde las más variadas disciplinas y enfoques, cen-tran su atención en los significados que la experiencia del dolor suscita a quienes lo padecen y a quienes lo tratan (médicos, enfermeros, acompañantes). La riqueza interdisciplinar de los artículos reunidos en esta compilación, inaugura un campo de investigación que promete una compren-sión más profunda de la experiencia del dolor y de los significados y sentidos que acompañan tal experiencia. La temática se aborda desde la preocupación filosófica, neurocientífica, médica, filosófica y engloba el conjunto de intereses correspondientes a lo que el editor denomina enfoque biopsicosocial del dolor. El objetivo de este libro es mejorar la comprensión de la relación en-tre las experiencias del dolor y los significados percibidos por los actores involucrados, a partir del estudio de distintos aspectos que se ponen en juego en dicha relación: los significados del dolor asociados con las interacciones entre el paciente y el médico, las interacciones entre la actividad cerebral y los significados del dolor, entre otras. En esta compilación, los autores presentan enfoques que rompen con la perspectiva naturalista que domina las in-vestigaciones sobre el dolor y propone una revalorización de la experiencia subjetiva, no sólo del sujeto padeciente sino de los actores que acompañan, desde distintos roles, el sufrimiento. La estructura del libro se organiza en cinco ejes. El editor se encarga de definir estos ejes del siguiente modo: el primero está dedicado a las relaciones entre la ex-periencia del dolor, los significados y el ce-rebro; el segundo, a los métodos cualitativos para el estudio de los significados del dolor; el tercero, al dolor extendido (extended pain) y sus significados; el cuarto, a las relaciones entre los significados del dolor y la práctica clínica; y por último, el quinto, dedicado al dolor en animales no humanos.
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This episode has Sandy and Cory discussing a recently released book, tilted Meanings of Pain. Can we measure pain? What is the impact when we try? How do the roles we assume impact the care we provide and how it is received? Listen in as... more
This episode has Sandy and Cory discussing a recently released book, tilted Meanings of Pain. Can we measure pain? What is the impact when we try? How do the roles we assume impact the care we provide and how it is received? Listen in as our hosts consider these and other topics that have been raised by this very interesting and comprehensive book.
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"This text is edited by Simon van Rysewyk, a medical writer, author and University Associate at University of Tasmania. The text is supported by 36 international contributors, from diverse research perspectives, such as health psychology,... more
"This text is edited by Simon van Rysewyk, a medical writer, author and University Associate at University of Tasmania. The text is supported by 36 international contributors, from diverse research perspectives, such as health psychology, phenomenology, humanities, psychophysics, cognitive and behavioural neurobiology and psychiatry. It promises to be the first of its kind to provide an in-depth review of the research dedicated to the meaning of pain, especially in the real world context".
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I was delighted to be asked to present a chapter from the recent collection Meanings of Pain. Dr Smadar Bustan’s contribution- A Scientific and Philosophical Analysis of Meanings of Pain in Studies of Pain and Suffering, is a complex... more
I was delighted to be asked to present a chapter from the recent collection Meanings of Pain. Dr Smadar Bustan’s contribution- A Scientific and Philosophical Analysis of Meanings of Pain in Studies of Pain and Suffering, is a complex chapter with ideas deriving from a long philosophical tradition. The challenge for me was to do the chapter justice while offering readers of Body in Mind an easily graspable summary of the work.
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Pain is most certainly the holy grail of medical research, an elusive entity composed of ethereal components. The book " Meanings of pain " is a fresh and novel entity in the scientific realm of pain science. Leading researchers in the... more
Pain is most certainly the holy grail of medical research, an elusive entity composed of ethereal components. The book " Meanings of pain " is a fresh and novel entity in the scientific realm of pain science. Leading researchers in the field of pain science have gathered together to create the first book dedicated to the study of: The meanings of pain. The technological advances of the 21 st century have unfortunately shifted some of the focus of pain research to the realm of objectivity leaving some of the experiences of the patients behind.
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Should we allow our own experiences to guide our research? While ‘objectivity’ is being strived for in quantitative research, Rysewyk and Baeyer (2016) argue that researchers should focus more on their own personal experiences and... more
Should we allow our own experiences to guide our research? While ‘objectivity’ is being strived for in quantitative research, Rysewyk and Baeyer (2016) argue that researchers should focus more on their own personal experiences and metacognitive reflections (e.g. attention to what ‘I’ am thinking about) when they come up with new research ideas.
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Mimicry refers to the tendency to adopt the behavioral expressions of interaction partners. According to Wittgenstein, mimicry typically occurs outside of conscious awareness, and without any intent to mimic or imitate. Further, he... more
Mimicry refers to the tendency to adopt the behavioral expressions of interaction partners. According to Wittgenstein, mimicry typically occurs outside of conscious awareness, and without any intent to mimic or imitate. Further, he suggests a bi-directional relationship between mimicry on the one hand, and rapport, affiliation on the other. That is, the ability to imitate and mimic what one perceives in the expression of another person creates affiliation, and affiliation can be expressed through mimicry. We argue that mimicry plays an important part in our form of life. Mimicry increases affiliation, which serves to promote relationships with others.
The congenital absence of facial expression and the inability to imitate facially the expressions of other persons may result in profound changes in the way a person is perceived by others and in a subsequent loss of affiliation. These experiences reveal not merely the importance of perceiving feelings and the capacity for imitating others for the maintenance of human relationships, but also the extent to which adults with a condition such as Möbius Syndrome may have difficulty in engaging in a shared form of life with others. These limitations are partial rather than absolute, however, and people with Möbius may yet maintain social coordination through their other channels of expression; through prosody of voice, gesture, clothes, enriched vocabulary, and so on.
Keywords: Wittgenstein, mimicry, Möbius Syndrome, rapport, form of life
The congenital absence of facial expression and the inability to imitate facially the expressions of other persons may result in profound changes in the way a person is perceived by others and in a subsequent loss of affiliation. These experiences reveal not merely the importance of perceiving feelings and the capacity for imitating others for the maintenance of human relationships, but also the extent to which adults with a condition such as Möbius Syndrome may have difficulty in engaging in a shared form of life with others. These limitations are partial rather than absolute, however, and people with Möbius may yet maintain social coordination through their other channels of expression; through prosody of voice, gesture, clothes, enriched vocabulary, and so on.
Keywords: Wittgenstein, mimicry, Möbius Syndrome, rapport, form of life
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What our personal experiences mean are important to us, and influence how we respond to life’s changing circumstances. Due to personal experience, everyone “knows” what pain is. Yet, this knowledge fails us when we try to explain what... more
What our personal experiences mean are important to us, and influence how we respond to life’s changing circumstances. Due to personal experience, everyone “knows” what pain is. Yet, this knowledge fails us when we try to explain what pain means. What is the meaning of pain?
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Meaningful changes that we notice in others are often subtle, such as small changes in facial expressions. These subtle features when expressed by clinicians (e.g., through subtle facial expressions, gestures, or particular tones of... more
Meaningful changes that we notice in others are often subtle, such as small changes in facial expressions. These subtle features when expressed by clinicians (e.g., through subtle facial expressions, gestures, or particular tones of voice) convey significant meaning for patients that provide an impression of clinician enthusiasm, positive personality, or attentiveness (e.g., Gracely et al. 1985). Pain is a personal experience, not an action; yet it is frequently displayed through actions in which a person in pain is revealed to observation (Craig et al. 2010). While body parts are subject to involuntary changes during pain, such as reflexive withdrawal, in the social transaction of pain, the involuntary changes revealed in the face are vastly more meaningful than in other body parts (Prkachin et al. 1983; Craig, 2009). This is because body parts do not have the individuating meaning of the face: the meaning of revealing me, here and now.