First‐person neuroscience and the understanding of pain

Reflections — feature e were invited to reflect upon brain–mind– pain interactions and to opine on whether modern neuroscience adequately considers pain phenomena and experience. One might suggest that adequacy is not a particularly lofty goal in this respect. However, if we were to consider whether modern neuroscience thoroughly, or precisely, considers pain phenomena and experience, we would have to conclude in the negative. Classically, clinicians have been taught to ask patients a series of questions to extract the information required to establish a diagnosis. Although this is standard practice, it may mean that the individual patient's experiences are not heard. This is not always seen to be a bad thing — removing the patient's perspective might be considered to make the interview more objective. Contrast this view, however, with the common complaint from patients with longstanding pain that they feel they have never had a chance to fully explain what is going on with them, that no one has ever fully understood what is wrong and, moreover, that no one is listening. Dissatisfaction and disempowerment are not the only risks here — scientists show us that such feelings are likely to be associated with up-regulation of our protective systems, most notably the nociceptive pain system. 1 Aside from that, the folly of eliminating a patient's report from his or her pain assessment has been highlighted for decades. Patrick Wall, perhaps the forefather of modern pain science, repeatedly stated that pain research was a waste of time unless it directly answered questions that are of interest to patients as well as clinicians. 2 Brain neuroscience as it relates to our understanding of pain really only arrived a century ago. It was pioneered by such Cartesian dualists as Charles Sherrington and John Eccles, who separated the concept of the mind from the brain, and whose data paved the way for an alternative perspective — that the mind could be directly attributed to the brain. Quickly, aspects of the mind were attributed to specific areas of the brain, and the brain was considered to directly possess experiences. The brain was seen as able to reason, to perceive and to construct schemata. These abilities were, more and more, considered properties of specific anatomical centres within the brain. Philosophy offers a different viewpoint, classifying such conclusions as mereological fallacies — or the misattribution of a property of the whole being to a single part …