‘The Observer is the Observed: Towards Integrating Pain Phenomenology with Third-Person Scientific Methods in the Study of Pain’

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Information about ‘The Observer is the Observed: Towards Integrating Pain Phenomenology...
Health & Medicine

Published on March 5, 2014

Author: simonvanrysewyk

Source: slideshare.net

Description

Explaining pain partly relies on recognizing its first-person phenomenology. This implies using a first-person phenomenological method in addition to third-person experimental approaches in the scientific study of pain. I describe what the former approach is and how it can be integrated with the latter. I begin by briefly examining some philosophical issues concerning the use of introspection. I argue that such a first-person method in the study of pain is essential by showing that it has been consistently used together with standard third-person methods. Next, I describe two uses of introspective methods in scientific experiments: subject introspective reports (investigators have intersubjective access), and investigator introspective reports (investigator is subject). I offer examples of both approaches that include studies of second pain summation and its relationship to neural activities, and neuroimaging-psychophysical studies where sensory and emotional qualities of pain are correlated with cortical activity. Integrating phenomenological and experimental approaches in the scientific study of pain will lead to a more thorough explanation of pain.

The Observer is the Observed: Towards Integrating Pain Phenomenology and Third-Person Methods in the Scientific Study of Pain Simon van Rysewyk Taiwan National Science Council Postdoctoral Fellow Taipei Medical University

my focus today a puzzle for pain science about introspection pain studies in which researcher-subjects use introspection experiential method that integrates first and third-person methods to study pain Simon van Rysewyk 2

a seeming puzzle for pain science 1 experiences seem knowable via introspection 2 introspection is subjective 3 science is intersubjective ∴ experiences cannot be a scientific object (experiential science is not objective) Simon van Rysewyk 3

a seeming puzzle for pain science like vision, pain has an object of perception (tissue damage) unlike vision, pain itself is an experience only knowable by introspection ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (IASP) Simon van Rysewyk 4

a seeming puzzle for pain science 1 pain seems knowable via introspection 2 introspection is subjective 3 science is intersubjective ∴ pain cannot be a scientific object (pain science is not objective) Simon van Rysewyk 5

the puzzle’s impact on pain science conclusion false – pain science studies the brain pain experience and brain activity must be distinct (cartesian dualism) pain science studies brain correlates of pain, not pain itself Simon van Rysewyk 6

dualism is true of pain science cartesian dualism implies that the subject matter of pain is brain activity related to pain pain science is committed to introspection pain-neuroimaging was established by robust correlation of neuroimages with pain self-report cartesian dualism and pain science are historically consistent Simon van Rysewyk 7

dualism is true of pain science metaphysical dualism is not convincing pain science can assert epistemological dualism and mind-brain identity theory identity is advantageous: brain activity is identical to pain without revealing complex physical features of the brain Simon van Rysewyk 8

two scientific uses of introspection researcher-subject verbal/written report non-researcher-subject verbal/written report intuitive notion of introspection: inner perception yielding knowledge of immediate personal states intersubjectively available to researchers taken to indicate sensory qualities Simon van Rysewyk 9

researcher-subjects: double pain first and second pain results from a sudden noxious stimulus to a distal part of the body 0.5 to 1.5 second delay between the two pains impulses in thinly myelinated A axons (6–30 meters/sec) travel much faster than those in C axons (0.5–1.5 meters/sec) Simon van Rysewyk 10

researcher-subjects: double pain Simon van Rysewyk 11

researcher-subjects: double pain Lewis & Pochin 1938 independently mapped body regions wherein they introspected double pain near the elbow but not the lower trunk although both sites are about the same distance from the brain C fibers that supply the trunk have a short conduction distance to the spinal cord Simon van Rysewyk 12

Lewis & Pochin 1938 C fibers that supply the skin near the elbow have a long conduction distance once these C fibers enter the spinal cord, they synapse on A neurons differences in peripheral conduction distance and time mean that double pain can be discriminated at the elbow but not the trunk Simon van Rysewyk 13

researcher-subjects: double pain Landau & Bishop 1953 first pain sharp or stinging, well localized, and brief (A fibers) second pain diffuse, less well localized, dull, aching, throbbing, burning (C fibers) second pain longer lasting than first pain, vague unpleasantness Simon van Rysewyk 14

researcher-subjects: double pain 1. the results were obtained through researchers introspecting their own pain 2. observations about specific pain experiences 3. the observations have been integrated into our knowledge of pain 4. the observations have been replicated in studies using standard experimental designs and methods Simon van Rysewyk 15

relating introspection and brain activity to pain sensation and emotion Rainville et al. 1997 subjects rated pain sensation intensity and pain unpleasantness of immersion of the left hand in a 47° C water bath for 60 s condition hypnotic suggestion 1 ↑ pain unpleasantness 2 ↓ pain unpleasantness Simon van Rysewyk sensation no change 16

Rainville et al. 1997 ↑ unpleasantness increased magnitudes of pain-unpleasantness ratings and neural activity in ACC (area 24) no change in ACC for ↓ unpleasantness no change in S1 activity and magnitude ratings of pain sensation intensity in both conditions Simon van Rysewyk 17

Rainville et al. 1997 Simon van Rysewyk 18

Hofbauer et al. 2001 subjects rated pain sensation intensity and pain unpleasantness of immersion of the left hand in a 47° C water bath for 60 s condition hypnotic suggestion unpleasantness 1 ↑ sensation intensity no change 2 ↓ sensation intensity Simon van Rysewyk 19

Hofbauer et al. 2001 ↑ intensity increased magnitudes of painintensity ratings and neural activity in S1 no change in S1 for ↓ intensity no change in ACC activity and magnitude ratings of pain unpleasantness in both conditions Simon van Rysewyk 20

the significance of brain-pain phenomenology parallels changes in experience and brain activity cannot be predicted only by stimulus properties changes in experience and brain activity can be explained by analysis of experience and brain activity the neural activity sufficient for a given pain quality of pain does not prove it exists within one brain region Simon van Rysewyk 21

an experiential approach to pain Barrell & Barrell 1975, Price & Barrell 1980 experimental tasks identify common factors within pain experiences identify common factor interrelationships identify common factorbrain relationships phase horizontal (first-person) ‘phenomenal structure’ vertical (third-person) ‘brain structure’ Simon van Rysewyk 22

horizontal phase horizontal phase stages experimental subjects 1 question and observe 2 describe from a first-person perspective researcher-subjects 3 find common factors and their interrelationships 4 use psychophysical methods to test generality and functional relationships between common factors Simon van Rysewyk non-researcher-subjects 23

horizontal phase 1. questioning and observing ‘What is it like to experience the unpleasantness of laboratory pain, such as immersion of the hand in a heated water bath?’ how of pain (sensations, thoughts, feelings) not why pain occurs (stimulus conditions) ‘passive attention’, ‘being with pain’, immediate retrospective attention Simon van Rysewyk 24

horizontal phase 2. describing pain from the first-person verbal/written reports of immediate pain: ‘My hand was immersed in a 47° C water bath when intense burning and throbbing occurred in my hand. Feel bothered by this and distressed. Is it going to get stronger? Concern. Hope my hand isn't going to be scalded’ Simon van Rysewyk 25

horizontal phase 3. finding common factors and interrelationships ‘phenomenological reduction’ ‘Is it going to get stronger? Concern. I hope my hand isn't going to be scalded” can reduce to ‘I think and feel concern for future consequences related to this pain’ Simon van Rysewyk 26

horizontal phase ‘Feel bothered by this and distressed’ can reduce to ‘I have a feeling of intrusion related to this pain’ Simon van Rysewyk 27

horizontal phase definitional hypotheses: experiential factors commonly present during a pain-type functional hypotheses: common factor interrelationships Simon van Rysewyk 28

horizontal phase sample definitional hypotheses: 1. an intense burning throbbing sensation in the hand 2. an experienced intrusion or threat associated with this sensation 3. a feeling of unpleasantness associated with this felt intrusion or threat Simon van Rysewyk 29

horizontal phase when the factors of intrusion or threat are present, there is a felt sense of pain felt sense of pain is pain-aversion pain-aversion seems about felt bodily integrity Simon van Rysewyk 30

horizontal phase sample functional hypotheses: 1. felt unpleasantness should increase as a function of experienced intrusion or threat 2. experienced intrusion should increase as a function of the intensity of burning, throbbing sensation Simon van Rysewyk 31

horizontal phase 4. applying psychophysical methods controlled observation of ratings of experiential factors (pain aversion) or sub-factors (concern) rating scale methods (ratio scales) subjects are not researchers Simon van Rysewyk 32

vertical phase correlate horizontal results with brain activity to establish possible causal relationships patterns of cerebral cortical activity that co-vary with different factors of pain could be identified Simon van Rysewyk 33

future questions can less well-known introspective methods be used in the study of pain? are there experiential and neural similarities and differences between sub-types of acute and chronic pain? can there be a ‘neural signature’ of pain? Simon van Rysewyk 34

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