• „Pain is a more terrible lord of mankind than even death itself”
Albert Schweitzer
• The puzzle of pain,
Ronald Melzack, (1973)
• The tragedy of needless
pain, Ronald Melzack,
(1990) Scientific
American, 262, 19-25.
The function of pain
Any stimulus that is intense enough to cause tissue damage is a stimulus for pain.
It may be pressure, temperature, electric shock, or irritant chemicals.
Apparently, the biological value of pain is to alert the body for tissue damage.
In a behavioral point of view, the function is
to cause an organism to remove itself from the dangerous stimulus
(protect the injured body part or seek shelter until healing occurs).
The function of pain: congenital absence of pain
• A young Canadian girl
• Attended at the McGill University, Montreal
• Congenital insensitivity to pain
• She was normal in every way except that she felt no pain.
• In childhood: bitten of the tip of her tongue, and suffered third-degree burns
after touching a hot radiator.
• Experiments: reported no pain for electric shock, hot water, long ice bath,
burning temperature etc.
• She showed no changes in blood pressure, heart rate, respiration when
exposed to painful conditions.
• Difficulty with the stimulation with gag reflex.
• Severe medical problems: pathological problems in her knees, hips, and
spine.
• She could not shift her weight and turn over in her slept.
• Died at the age of 29 of massive infections.
The physiology of pain perception: Three systems evoke pain
The main factors
Neurophysiological
Psychological Social
Cultural
The subjective nature of pain
The subjective nature of pain
1 2 3 4 5 6 7
No pain at all Unbearable
pain
The main factors of pain
• Pain perception and reactions on pain strongly depend on the
patient’s cultural and social background.
• Social and cultural factors can modify the verbal and non-
verbal reports of pain.
• Pain is always a personal experience that is influenced to varying
degrees by biological, psychological, and social factors.
• Pain and nociception are different phenomena. Pain cannot be inferred
solely from activity in sensory neurons.
• Through their life experiences, individuals learn the concept of pain.
• A person’s report of an experience as pain should be respected.
• Although pain usually serves an adaptive role, it may have adverse
effects on function and social and psychological well-being.
• Verbal description is only one of several behaviors to express pain;
inability to communicate does not negate the possibility that a human or
a nonhuman animal experiences pain.
Variations in the quality of pain
PAIN
Phasic Tonic
Often, immediately upon Often after the injury has
suffering an injury. Briefly occurred.
and rapidly rises and falls It’s often long and steady.
in intensity. („cramping” and „stinging”)
(„frightful” and „cruel”
Pain reactions
Pain reactions
Involuntary:
Voluntary
„unconscious”
Removing the
source Asking for help
of pain
Pain reactions
Pain reactions
Involuntary:
Voluntary
„unconscious”
Removing the
source Asking for help
of pain
The role of the cultural and social factors is the greatest regarding the voluntary reactions
Pain reactions
Private Pain Public Pain
The effects of culture on pain perception: Sun-dance ceremony
Hooks attached by ropes.
The celebrant hangs on hooks shoved
under his skin and muscles on his chest.
No evidence for pain. The celebrant
appears to be in a state of exaltation.
Pain reactions
The normality
or acceptance
of the actual
pain
Private Pain Public Pain
Pain reactions
• In any cultural group, pain reactions strongly depend on
whether the actual pain is considered a natural part of their life
or not.
Reactions on pain
Pain is a sign of Pain as a type of
disorders / penalty
sickness
Private Pain Public Pain
Pain reactions
Culture 1 Culture 2
Pain Pain
Pain
Witchcraft
God’s
Sickness Sickness penalty
Pain as a sign of sickness The pain is a penalty, it is a type of suffering
Pain reactions
Reaction type
Involuntary:
Voluntary
„unconscious”
Pain threshold Pain tolerance
(Intensity detection) (emotional content)
Cultural differences in pain perception
• Pain threshold hardly shows any cultural difference.
• In contrast, pain tolerance has been found to be variable across
cultural groups.
Chronic Pain - IASP - International Association for the Study of Pain
Chronic pain is pain that persists or recurs for longer than three months.
Such pain often becomes the sole or predominant clinical problem in some patients.
As such it may warrant specific diagnostic evaluation, therapy and rehabilitation.
Chronic pain is a frequent condition, affecting an estimated 20% of people worldwide.
Cultural differences in (chronic) pain perception
•Future oriented
anxiety
•They frequently reject
antinociception
„Average” .
population
•Stronger emotional Cultural •Weak emotional
reactions groups reaction
•They deal with pain •Maximal
as an actual cooperation
Opened „Conservative”
experience cultural groups cultural
•Effective background
antinociception
Zborowski’ inverstivation in an army hospital in New-York
Reaction on Pain
The relationship between an individual and the society regarding pain behaviour
Pain behaviour
Person Society
Response to the pain behaviour
Other’s pain: Pain Empathy
Other’s pain: Pain Empathy
Pain in self
Pain in other
„Life without pain has no meaning”
- Arthur Schopenhauer
1. Where (in which context) can we expect the strongest influence of socio-cultural
factors on pain?
2. What does the term of “phasic and tonic pain” refer to?
3. What is the difference between private and public pain?
4. What is the definition of chronic pain?
• PTE4115
