Embodied pain—negotiating the boundaries of possible action

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Pain is a protective strategy, which emerges from on-going interaction between body and world. However, pain is often thought of as a unitary output—an end product experienced as an intrusion upon an often unsuspecting perceiver.55 We know a lot about how nociception relates to pain, informed by both biological and psychological influences,30,68,96 how pain intrudes into awareness,5,26,29,34 and how it relates to clinical variables, such as suffering and disability.35 However, despite significant advances, the mechanisms of pain intrusion remain elusive.62 In this article, we stress a functional view of pain as more than experience, as defensive action operating in the context of uncertain threat.
Although traditional characterisations of perception as a product of sensory information have been critiqued,19,41,52 including in pain,87,94 there is now a well-advanced contemporary view that all perception is embodied and embedded.41,46,65,77,84,86 Here, embodied is defined by action, the premise that cognition extends beyond the brain so that an ever-changing body is at the core of how our experiences are shaped; this may be the unconscious workings of our immune system or the collaborative efforts made to avoid movement. Embedded refers to the situated interaction between the embodied being and the external environment, in both place (current context) and time (evolutionary context).
From this view, all experience is inferential,78 dynamic,22,54 and related to action in the world.2,21,24 Thus, to describe the experience of pain, we must understand it within its evolved, learned, and ultimately threat-defined context.33,99 Theories of embodied experience are well advanced elsewhere, most notably in cybernetics,4,23,79 evolutionary biology,39,73,80 and consciousness.81,82 Its provenance can be traced to structural psychology,91 phenomenology,47,52,61 and perception.41,75 However, embodied domains have avoided pain, considering it either too simple32 or paradoxically too difficult.6
Our embodied view, in many ways, complements the existing literature,18,27,36,42,93,95 supporting the growing understanding of pain as an experience inferred from uncertain information.3,17,83,98 However, it critically looks to extend this work beyond a passive information processing model that has come to dominate.48 Here, we emphasise the body, not separate from the brain nor the world, but part of the facility that actively shapes our experience of pain. This perspective defines pain in terms of action: an experience that, as part of a protective strategy, attempts to defend one's self in the presence of inferred threat.
We start with a consideration of the core features of embodied pain. Next, we review the few studies that have been attempted on embodied perception and pain. Finally, we discuss how this approach can be applied usefully to pain, exploring both the research and clinical implications of embodied pain.
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