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Purves D, Augustine GJ, Fitzpatrick D, et al., editors. Neuroscience. 2nd edition. Sunderland (MA): Sinauer Associates; 2001.
Neuroscience. 2nd edition.
Show detailsWith respect to the interpretation of pain, observers have long commented on the difference between the objective reality of a painful stimulus and the subjective response to it. Modern studies of this discrepancy have provided considerable insight into how circumstances affect pain perception and, ultimately, into the anatomy and pharmacology of the pain system.
During World War II, Henry Beecher and his colleagues at Harvard Medical School made a fundamental observation. In the first systematic study of its kind, they found that soldiers suffering from severe battle wounds often experienced little or no pain. Indeed, many of the wounded expressed surprise at this odd dissociation. Beecher, an anesthesiologist, concluded that the perception of pain depends on its context. For instance, the pain of an injured soldier on the battlefield would presumably be mitigated by the imagined benefits of being removed from danger, whereas a similar injury in a domestic setting would present quite a different set of circumstances that could exacerbate the pain (loss of work, financial liability, and so on). Such observations, together with the well-known placebo effect (discussed in the next section), make clear that the perception of pain is subject to central modulation (although all sensations are subject to at least some degree of this kind of modification). This statement, incidentally, should not be taken as a vague acknowledgment about the importance of psychological or “top-down” influences on sensory experience. On the contrary, there has been a gradual realization among neuroscientists and neurologists that such “psychological” effects are as real and important as any other neural phenomenon. This appreciation has provided a much more rational view of psychosomatic problems in general, and pain in particular.
- Central Regulation of Pain Perception - NeuroscienceCentral Regulation of Pain Perception - Neuroscience
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