Pain and emotional assessment

Independence and connections of pain and suffering

S. Benjamin Fink

Journal of Consciousness Studies, 18, No. 9-10, 2011, pp. 45-66

As part of his discussion of pain and consciousness, Fink mentions the condition known as ‘pain asymbola’. With this condition, patients are aware of the pain, but not of its unpleasant aspect. It should be stressed that this is distinct from the condition of analgesic patients that have no awareness of pain. Those with asymbola can differentiate between different types of pain, something which analagesics cannot do. The asymbola patients can also withdraw from a source of pain, but this is seen to be the result of a rational evaluation of the potential for damage from a pain source, rather than a direct experience of unpleasantness. Fink points out that meditators and those under hypnosis sometimes exhibit a similar condition of not experiencing the unpleasantness of pain sensations.

Fink suggests that the asymbola patients have a deficit in their emotional evaluation of the pain sensation. He puts the initial pain sensation in the same class as visual and other sensory perceptions that do not necessarily by themselves produce a response. He does not pursue the neuroscience of the matter further than that, but the distinction he points out looks to be similar to that demonstrated elsewhere in the step from the sensory cortex to the prefrontal and also the limbic areas.

Thus visual perceptions in the inferior temporal region and tactile sensations in the somatosensory cortex are value neutral until they are projected to areas such the amygdala and the orbitofrontal cortex. Similarly studies have shown that subjects involved in meditation or even an engrossing film, have activity focused in the sensory areas, with reduced activity in the prefrontal. This study looks to emphasise the important role of subjective emotional experience in areas such as the orbitofrontal in evaluating sensory input. P. Fink also emphasises that rational assessment can override even the emotional assessment. Pain may be tolerated in pursuit of a longer term goal, although of course this longer term goal may be at least in part selected by emotional assessment.


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