title: What does pain signify? A hypothesis concerning pain, the immune system and unconscious pain experience under general anesthesia.
abstract: In this paper, I present a case-study that initiates a discussion about the meaning of pain. The case-study concerns a person who was under deep sedation during colonoscopy. The person did not experience pain from a first-person perspective, although pain was evident to the medical team from a second-person perspective. The divergence of pain perspectives raises an interesting quandary. If the body communicates pain while pain consciousness is blocked by the sedation procedure, our conclusion should be that the intersubjective aspect of pain precedes the "subjective," first-person experience of pain. This conclusion is not consistent with the common representational conception of pain that places the intrasubjective point of view prior to the intersubjective point of view. The solution I offer to this quandary is the quasi-paradoxical idea that pain can be experienced unconsciously through the immune system. Following this suggestion, I hypothesize that post-traumatic stress disorders following general anesthesia may result from this unconscious pain experience. If this idea is scientifically grounded, then physicians should: (1) consider ways of blocking the unconscious pain experience produced by the immune system without interfering with the immune response, and (2) study pain as a complex cognitive and unconscious system by drawing an analogy with the immune system, which follows similar logic.
authors.affiliation: Ben-Gurion University of the Negev, Beer-Sheva, Israel. yneuman@bgumail.bgu.ac.il
authors.forename: Yair
authors.initials: Y
authors.lastname: Neuman
mesh_terms: D000768:Anesthesia, General; D000818:Animals; D001921:Brain / Q000276:immunology / Q000503:physiopathology*; D003071:Cognition; D006801:Humans; D007107:Immune System / Q000276:immunology / Q000503:physiopathology*; D018448:Models, Immunological; D008959:Models, Neurological; D010146:Pain / Q000276:immunology / Q000503:physiopathology*; D014474:Unconsciousness / Q000276:immunology / Q000503:physiopathology*