• James Giordano and John R Shook.
• Departments of Neurology and Biochemistry and Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington DC; Department of Defense Medical Ethics Center, Uniformed Services University of Health Sciences, Bethesda, MD.
• Pain Physician. 2024 Sep 1; 27 (7): 447451447-451.

AbstractPain is an objective, natural reality among sentient creatures that possess cognition and mobility sufficient for apprehending and acting upon its full significance. Defining pain mostly in mental terms makes sense for self-conscious psychology and vocabulary. Pain as a natural capacity among animals did not evolve merely to be aligned with human semantics and intuitions. Much about pain operates beneath the level of accessible and explicit consciousness, and pain as a sensory feeling probably arose before mammalian cognition. Pain should not be viewed as just a simple sensation of utter subjectivity. It displays qualitative variance, degrees of intensity, fluctuating durations, and deflects and/or captures attention. These features of pain situate it prominently within awareness amidst the myriad physical feelings and emotions that influence behavior. The significance of pain cannot omit felt painfulness, and pain wouldn't be painful without its urgent significance for redirecting bodily activity. Most pain shares characteristics of being hurtful, engaging, emotive, and directive (i.e.,- HEED). So delineated, pain evolved to be HEED-ed. Our proposed operational delimitation at first glance appears to be physiological, but its reliance upon the bio-psychosocial actuality of the painient organism renders it inter-theoretically reducible and expandable. This delineation of pain necessitates its being HEED-ed by the organism in which it occurs; and hence ethically heeded by those who profess to study and treat it.

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