Nonconscious Pain, Suffering, and Moral Status

Aguilera, Bernardo

doi:10.1007/s12152-020-09430-y

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…The ultimate goal of ‘personalised pain management’ requires a thorough understanding of the neuronal mechanisms that contribute to persistent pain in a given patient 37 , 38 . Temporal summation (TS), quantitative sensory testing (QST) and conditioned pain modulation (CPM) paradigms are three examples of tests that are psychophysical in nature as they assess the perception of pain via salience circuitry 39 , as opposed to the subconscious processing of stimuli, which may or may not reach conscious perception 40 . As such, psychological factors such as anxiety 41 , depression 42 and cognitive factors including attention and anticipation 43 can influence pain perception during psychophysical testing.…”

Section: Experimental Assessment Of Painmentioning

confidence: 99%

Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

Bannister

Smith

Wilkins

et al. 2021

npj Parkinsons Dis.

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People with Parkinson’s disease (PD) may live for multiple decades after diagnosis. Ensuring that effective healthcare provision is received across the range of symptoms experienced is vital to the individual’s wellbeing and quality of life. As well as the hallmark motor symptoms, PD patients may also suffer from non-motor symptoms including persistent pain. This type of pain (lasting more than 3 months) is inconsistently described and poorly understood, resulting in limited treatment options. Evidence-based pain remedies are coming to the fore but therapeutic strategies that offer an improved analgesic profile remain an unmet clinical need. Since the ability to establish a link between the neurodegenerative changes that underlie PD and those that underlie maladaptive pain processing leading to persistent pain could illuminate mechanisms or risk factors of disease initiation, progression and maintenance, we evaluated the latest research literature seeking to identify causal factors underlying persistent pain in PD through experimental quantification. The majority of previous studies aimed to identify neurobiological alterations that could provide a biomarker for pain/pain phenotype, in PD cohorts. However heterogeneity of patient cohorts, result outcomes and methodology between human psychophysics studies overwhelmingly leads to inconclusive and equivocal evidence. Here we discuss refinement of pain-PD paradigms in order that future studies may enhance confidence in the validity of observed effect sizes while also aiding comparability through standardisation. Encouragingly, as the field moves towards cross-study comparison of data in order to more reliably reveal mechanisms underlying dysfunctional pain processing, the potential for better-targeted treatment and management is high.

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Section: Experimental Assessment Of Painmentioning

confidence: 99%

Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

Bannister

Smith

Wilkins

et al. 2021

npj Parkinsons Dis.

View full text Add to dashboard Cite

show abstract

“…This finding is common to medical care more broadly, particularly end-of-life care, as suffering is often seen as denying dignity and autonomy 28. The profound effects suffering can have on one’s welfare are why some have argued that suffering (which requires consciousness and active experience), rather than pain (which may exist in non-conscious states), is a sufficient criterion for moral status 29…”

Section: Pain Not Necessary For Moral Statusmentioning

confidence: 99%

Clinicians’ criteria for fetal moral status: viability and relationality, not sentience

Campo‐Engelstein

Andaya

2022

J Med Ethics

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The antiabortion movement is increasingly using ostensibly scientific measurements such as ‘fetal heartbeat’ and ‘fetal pain’ to provide ‘objective’ evidence of the moral status of fetuses. However, there is little knowledge on how clinicians conceptualise and operationalise the moral status of fetuses. We interviewed obstetrician/gynaecologists and neonatologists on this topic since their practice regularly includes clinical management of entities of the same gestational age. Contrary to our expectations, there was consensus among clinicians about conceptions of moral status regardless of specialty. First, clinicians tended to take a gradualist approach to moral status during pregnancy as they developed and viewed viability, the ability to live outside of the uterus, as morally significant. Second, in contrast to ‘fetal pain’ laws and philosophical discussions about the ethical salience of sentience, the clinicians in our study did not consider the ability to feel pain as a morally relevant factor in moral status determinations. Third, during previability and perviability, clinicians viewed moral status as a personal value decision, which should be made by pregnant people and parents of neonates.

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Defining suffering in pain. A systematic review on pain-related suffering using natural language processing

Noe-Steinmüller,

Scherbakov,

Zhuravlyova

et al. 2024

PAIN

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Understanding, measuring, and mitigating pain-related suffering is a key challenge for both clinical care and pain research. However, there is no consensus on what exactly the concept of pain-related suffering includes, and it is often not precisely operationalized in empirical studies. Here, we (1) systematically review the conceptualization of pain-related suffering in the existing literature, (2) develop a definition and a conceptual framework, and (3) use machine learning to cross-validate the results. We identified 111 articles in a systematic search of Web of Science, PubMed, PsychINFO, and PhilPapers for peer-reviewed articles containing conceptual contributions about the experience of pain-related suffering. We developed a new procedure for extracting and synthesizing study information based on the cross-validation of qualitative analysis with an artificial intelligence–based approach grounded in large language models and topic modeling. We derived a definition from the literature that is representative of current theoretical views and describes pain-related suffering as a severely negative, complex, and dynamic experience in response to a perceived threat to an individual's integrity as a self and identity as a person. We also offer a conceptual framework of pain-related suffering distinguishing 8 dimensions: social, physical, personal, spiritual, existential, cultural, cognitive, and affective. Our data show that pain-related suffering is a multidimensional phenomenon that is closely related to but distinct from pain itself. The present analysis provides a roadmap for further theoretical and empirical development.

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Nonconscious Pain, Suffering, and Moral Status

Cited by 3 publications

References 31 publications

Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

Towards optimising experimental quantification of persistent pain in Parkinson’s disease using psychophysical testing

Clinicians’ criteria for fetal moral status: viability and relationality, not sentience

Defining suffering in pain. A systematic review on pain-related suffering using natural language processing

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