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What we communicate when reporting pain

9 May 2023
Imagine someone approaches you and says, “I have a pain in my arm.” When you hear this, you cannot help but automatically make all sorts of conclusions about what the person tries to tell you. Usually, we have a good idea of what someone means when they talk about their pain. However, for many philosophers and scientists, this is a more complicated issue: there is a lot of disagreement about what pain is and what people mean when they talk about it. So, what does the word ‘pain’ really mean?

VU-philosopher Sabrina Coninx and her colleagues Pascale Willemsen and Kevin Reuter from the University of Zurich argue that when people say “I have a pain in my arm”, they are talking about both an unpleasant feeling and a damaged body part. In the past, most studies only looked at one of these two aspects. In contrast, this new research shows that both aspects are important to understand what people mean when they talk about pain. The findings were recently published in The Philosophical Quarterly.

Why should we care about pain language?
One might wonder why we should worry about the meaning of the word ‘pain’. The complexities about pain language make it hard for researchers and scientists to study pain, but they also make it hard for people in everyday life to understand each other. Ambiguities in the meaning of pain are a potential source of miscommunication. This is especially important in medical settings. For example, when someone reports pain, it could mean that their body is hurt or that they are feeling bad, or both. It is vital for doctors and caregivers to understand what the person means so they can provide the right treatment and make the person feel heard and understood.

Coninx and colleagues: “Our investigation aims to better understand the folk concept of pain using a novel methodological approach based on pain linguistics. We conducted different linguistic tests which indicate that feeling and bodily content are both part of the meaning of first-person pain reports. These results allow us to identify pluralist accounts of the folk concept of pain as being most promising."

What is pain?  
Philosophers have investigated the concept of pain for a long time. The dominant view has been that feeling pain and having pain are the same thing. This idea also prevails in medicine. Prominently, the International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience. However, in real life, people might have different intuitions and employ different conceptions about what pain is. Other philosophers have argued for an alternative understanding of the folk concept of pain. According to this alternative view, people do not treat pain as an unpleasant feeling, but as an objective and publicly accessible bodily state, widely identified as physical damage, disruption, or disturbance. Interestingly, both positions seem to tell only part of the story: the folk concept of pain is far less uniform than most common definitions suggest.

What can we learn from pain linguistics?  
Coninx and colleagues employ a new methodological approach to complement existing accounts. Participants are asked to imagine a speaker who utters a first-person pain report, such as “I have a pain in my arm”, and to state what they infer from this statement. Such conversational settings are assumed to be quite familiar to participants and thus reliably trigger attempts to make sense of this statement, similar to social interactions in everyday life. The linguistic tests they use allow Coninx and colleagues to explore the literal, dictionary meaning of pain reports (so-called ‘semantic meaning’).

Coninx and colleagues: “Our results suggest that only a pluralistic view can do justice to the way we talk about pain: the content of first-person pain reports consists of information about both an unpleasant feeling and a disruptive bodily state. Pain linguistics thus provides new insights into ordinary pain language and poses an interesting challenge to the dominant views of pain.”