Asymbolia for Pain

Abstract

CLINICAL neurologists have observed patients who do not react to painful stimuli and yet have no anesthesia. Some of these patients, instead of withdrawing, will sometimes actually proffer their limbs for the pinprick. In such a case an inexperienced examiner when carrying out a routine sensory examination might note that pain sensation was normal, inasmuch as the patient could distinguish between sharp and dull equally throughout the body. Or, on the contrary, he might report that there was generalized hypesthesia when the patient stated that the pinprick did not hurt.Asymbolia for pain denotes the inability to recognize the unpleasant or disagreeable component of a painful or threatening stimulus, with the result that little or no defense reaction is produced, although the noxious stimulus itself is perceived. Although related to apraxia, it is characterized by the fact that it is a type of apraxia only in this distinctive sphere of reaction to pain and danger. Schilder noted that the apraxia usually became evident only in actions directed against the patient's own body. He then added : "It is not alone the expres¬ sion of a deficiency. There is also a particular attitude toward pain which lacks the integration into a higher propositional act." Pain asymbolia must be distinguished from other conditions which bear a superficial resemblance to it, such as generalized analgesia due to lesions in the nervous system, hysterical anesthesia and congenital insensitivity.1 Another type of decreased or absent reaction to pain which may be psychologically related but which is clinically distinct from pain asymbolia is that found in psychotic persons, particularly those with catatonic schizophrenia. These patients often hurt or mutilate themselves without showing the slightest apparent sign of From the

Psychological and Neural Mechanisms of the Affective Dimension of Pain

“…S-1 and S-2 somatosensory cortical areas would be involved at this level. However, higher levels of processing also occur within posterior parietal and insular regions that integrate somatosensory nociceptive input with other contextual inputs to provide an overall sense of intrusion and threat to the physical body and self (2,3,14,(20)(21)(22). Studies showing that sensory and unpleasantness dimensions of pain are in series are consistent with this mechanism (4, 6).…”

Disconnexion Syndromes in Animals and Man: Part I

“…One of these is the syndrome first described by Schilder and Stengel and called by them "asymbolia for pain" (Rubins and Friedman 1948). In this condition the patient correctly distinguishes sharp from dull but shows no response to pain or even to threatening gestures.…”

Some Foundational Problems in the Scientific Study of Pain

“…There are, however, important differences among the phenomena afflicting these patients, which are manifested in patients' reports and behavior. For instance, pain asymbolia also typically produces a kind of disassociation -a rather strong kind -similar to cingulotomy patients' but interestingly different from lobotomy patients' (Rubins and Friedman 1948;Weinstein et al 1995;Hurt and Ballantyne 1974;Devinsky et al 1995).…”