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Clinical Bioethics

d2_Giordano_web.jpg (6193 bytes)Neurogenesis, Brain, Mind, and Pain
In the last issue of Practical Pain Management, I described the notion of resolution, both as prospective intention and a simplification or explanatory separation of something into its component parts.2 I opine that these definitions are not mutually exclusive. Rather I offer the suggestion that if we are to speculate upon, and effectively plan for what pain management could and should be in the future, we must attempt to recognize how pain, and its relief, somehow “fit” into what I consider to be a “big(ger) picture.” In this essay I examine how a neuroscience and neurophilosophy of pain arise from, are integrated within, and may be contributory to the natural understanding of the world we live in, the human condition, and the realities, role, and ethics of pain medicine.

Dr. Forest Tennant’s comments on the concept of neurogenesis—the capacity of neural systems to self-model in response to effects of internal and external environmental factors—has become focal to an understanding of pain and recognition of the capabilities of pain management.3 Indeed, neurogenesis is a likely mechanism by which the nervous system integrates its “past,” as established by genotypic predispositions, with a capacity to engage its “future” through potentiation of both local and system-wide network properties to evoke “mind.” As Hardcastle has stated, any discussion of pain cannot be extricated from an understanding of brain function.4 I agree with Hardcastle in that any meaningful discussion of the brain must also eventually consider the ‘hard question’ of consciousness. Approaching pain as a ‘simple question’ of neuroscience—that is, assuming a wholly reductionistic view of pain as merely sense-data produced by activation of discrete units within distinct neural pathways—fails on an important critical point. Namely, while explaining the effect(s), it does not sufficiently appreciate the relationship of the explanation to that which is being explained (i.e., the explanandum – in this case the “essence” of pain itself). Nor does it regard the actual nature of that which is being explained (i.e., pain as a phenomenal event). Such reductionistic descriptions fail to achieve what is philosophically known as “saving the phenomenon” and therefore cannot apprehend or regard the facts of pain as an experience.

Please refer to the March 2007 issue for the complete text. In the event you need to order a back issue, please click here.

Last updated on: February 22, 2011
First published on: March 1, 2007