What constitutes pain?: Comment on “Facing the experience of pain: A neuropsychological perspective” by Franco Fabbro and Cristiano Crescentini

In their thought provoking perspective article, Fabbro and Crescentini [1] review the neuropsychological mechanisms of pain, encompassing physical and psychological pain. An underlying assumption of the article is that experiences, ranging from physical pain to the feelings that accompany thoughts of one’s own death, can all be subsumed under the banner of pain. While Fabbro and Crescentini are certainly not alone in amalgamating these diverse experiences, I would argue that it is not pain that binds them, but rather suffering. I don’t think anyone would argue that burning one’s arm and seeing a loved one burn their arm is different, and feel different, even though both experiences may roughly be categorized as painful. Similarly, being socially excluded or thinking of one’s own death can incite distressful unpleasant feelings. But should these feelings be considered pain? There are several reasons one might include these feelings under the domain of pain. Colloquially the word pain is used to refer to all sorts of disagreeable situations or feelings. Further, the actual definition used by the International Association for the Study of Pain suggests pain has both sensory and affective components and does not require a physical precipitating cause. Thus, one could conclude that the hurt of social exclusion is an instance of the affective component of pain. However, the definition also suggests, to be considered pain, a feeling must have both, a sensory and affective component. While there is potentially a physical sensation associated with exclusion, it bears no resemblance to physical pain. Another point of potential confusion is the affective component of pain itself and how much of that is considered specific to pain. Donald Price has proposed that along with the sensory dimension, physical pain has primary and secondary affective dimensions [2]. The primary affective dimension is stimulus-driven, bottom-up and that which signals alarm. The secondary affect is composed of various independent emotions such as fear that tend to be focused on long term implications of the event. I would argue that what physical pain shares with psychological pain is this secondary affect, making the two phenomena similar but ultimately different.