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Pain and Pleasure: Masters of Mankind

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Pain and Pleasure: Masters of Mankind Copying or circulation without permission are strictly prohibited. This chapter is included in Kringelbach ML and Berridge KC, "Pleasures of the Brain" (c) 2010. Oxford University Press: New York. 19 Pain and Pleasure: Masters of Mankind SIRI LEKNES AND IRENE TRACEY Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do. Jeremy Bentham, 1789 or Bentham, the study of pleasures and pains true that punishments feel unpleasant and generate Fwas the study of hedonic feelings. All good feel- negative aL ect (NA), whereas rewards cause pleasure ings were pleasures, and “pain” could describe all and positive aL ect (PA). This relationship is not always that humankind sought to avoid (Bentham, 1789). straightforward, however. Importantly, even primary Everyday expressions (“what a pain!”, “my plea- rewards or punishments are not always rewarding or sure” etc.) indicate that this type of categorization aversive, although some aL ective responses to them of positive and negative hedonic feelings is still in may be hardwired. For instance, sweet tastes and tissue use today. In modern-day science, however, the damage are associated with innate reQ exive reactions terms reward and punishment have largely replaced such as smiling and withdrawal; this holds true across Bentham’s pleasures and pains. For instance, a recent a range of species (Berridge, 2003). Nonetheless, hav- PubMed search of “reward and brain” yielded over ing already devoured six big chocolate bars, the sev- 20 times more entries than “pleasure and brain.” enth would not feel like much of a reward; satiation has Reward and punishment are deG ned as something made its taste aversive (Small et al., 2001). Conversely, an animal will work to achieve or avoid, thus eL ec- scratching an itchy bit of skin until it looks red and irri- tively circumventing the hedonic aspect inherent in tated can feel extremely pleasant despite causing tissue pleasures and pains. This has allowed for a Q our- damage (Craig, 2003). This scenario can also illustrate ishing behavioral neuroscience literature on pos- the complex relationship between hedonic feelings and itive and negative reinforcement. The probability positive aL ect and negative aL ect. For eczema suL er- that a previously rewarded (or punished) response ers, scratching often exacerbates the skin condition is emitted is considered an objective measure of the (Carroll et al., 2005). Thus the pleasure of scratching reinforcement value of that reward. In contrast, the may be diminished by fear and guilt, while resisting hedonic value of a reward or punishment is by def- the “irresistible” itch can cause positive aL ect (Leknes inition subjective. et al., 2007). Here, we will consider reward, punish- The hedonic quality of pleasures and pains is the ment, and positive aL ect/negative aL ect only in as subject matter of this chapter. Exploring the relation- much as these give rise to or aL ect hedonic feelings. ship between the brain and subjective hedonic feelings (qualia) is necessary to understand “what it is like” to be a sentient being (Nagel, 1974). Here, we shall Pain and Hedonic Feelings consider a simple continuum of hedonic feelings span- ning from the extremely unpleasant through to the “Pleasure and pain were the earliest forms of emotion extremely pleasant (Figure 19.1). In general, it holds to evolve” (Jaak Panksepp, as cited in Phillips, 2003). 320 MlKringelbach_BookPS.indb 320 4/27/2009 6:17:32 PM Copying or circulation without permission are strictly prohibited. This chapter is included in Kringelbach ML and Berridge KC, "Pleasures of the Brain" (c) 2010. Oxford University Press: New York. 321 Leknes and Tracey: Pain and Pleasure Unpleasant Pleasant Unpleasant Pleasant Figure 19.1 The inner state determines the pleasantness of a stimulus. While chocolate and other sweet foods are pleasurable under normal circumstances, the opposite may be true for someone with nausea. Unlike pleasure (but like reward), pain is the subject of electrical activity from peripheral neurons (Raja et al., a vast G eld of neuroscientiG c and medical research. The 1999). Some still argue for objective measures of pain, International Association for the Study of Pain (IASP) such as quantiG cation of reQ exes (Gerdelat-Mas et al., deG nes pain as “an unpleasant sensory and emotional 2007). With the advent of functional brain imaging, experience associated with actual or potential tissue many hope that a technique that will provide the elusive damage, or described in terms of such damage.” Note objective measurement of pain has been found. A num- that unlike for Bentham, pain no longer describes neg- ber of brain regions light up in neuroimaging studies ative hedonic feelings such as unhappiness, irritation, of pain. Some, notably the insula, thalamus, and dorsal and itch. Instead, pain research has mainly concerned anterior cingulate cortex (ACC), are reported with great itself with pain related to nociception. Pain is reliably consistency (Tracey, 2005). Rainville and colleagues induced by stimuli that activate nociceptive receptors (1997) used hypnotic suggestion to show that activity in the skin, muscle, gut, and others. Although sensory in the ACC varies with the aL ective component of pain pains vary qualitatively (consider a sharp pin-prick pain processing, leaving the thalamus and the insula as the vs. a dull muscle ache), these feelings are similar enough main candidate regions for an objective marker of noci- to be classiG ed as pain both in hedonic and physiological ceptive input. Direct electrical stimulation of insular terms. Chronic pain syndromes such as poststroke and cortex in epilepsy patients causes intense feelings of pain phantom pain are examples of painful conditions where (Ostrowsky et al., 2002). Interestingly, however, both the pain is not caused by stimulation of nociceptors the insula and the thalamus have recently been shown in the periphery. Nevertheless, the subjective hedonic to activate during hypnotic suggestion of pain in the feeling of these pain syndromes mimics sensory pains, absence of nociceptive stimulation (Raij et al., 2005). and central pain syndromes are thus encompassed by The role of subjective interpretation of pain as the the IASP deG nition of pain. Most of the pain studies determinant of the hedonic pain experience is becom- described in this chapter have used nociceptive stim- ing increasingly recognized within the pain G eld, ulation to induce pain. Numerous attempts have been especially in the study of the factors that increase pain made to G nd objective measures for pain. Animal pain unpleasantness (Fairhurst et al., 2007; Gracely et al., research largely relies on measures of avoidance behav- 2004; Wiech et al., 2006). However, little research iors such as tail Q ick latency, although some quantiG - focuses on the role of pleasure or positive emotion for cations of suL ering behavior have also been reported pain (but see Strand et al., 2006, 2007). Medical treat- (Dickinson and Dearing, 1979; Szechtman et al., 1981). m e n t f o r p a i n i s c o n c e r n e d w i t h r e d u c i n g n e g a t i ve e m o - Although many human pain studies use subjective pain tion (analgesia) more than increasing positive emotion. ratings to indicate the level of pain, others choose to Although opiate and other analgesics are frequently assess nociceptive signalling, for example, by measuring abused and are known to induce euphoria (Franklin, MlKringelbach_BookPS.indb 321 4/27/2009 6:17:32 PM Copying or circulation without permission are strictly prohibited. This chapter is included in Kringelbach ML and Berridge KC, "Pleasures of the Brain" (c) 2010. Oxford University Press: New York. 322 Pleasures of the Brain 1998), few studies have systematically assessed positive we perceive a stimulus. The seventh chocolate bar aL ect related to pain or pain relief. We believe that eaten in a row is aversive because the body is already the G eld of pain research may beneG t from looking to more than sated on cocoa, sugar, and fat. For Bentham Bentham’s wider deG nition of pain as well as his focus (1789), the key to pleasures and pains is subjective util- on subjective hedonic feelings. For instance, compar- ity. If overeating and skin damage are not useful to ing pain with unpleasant sensations such as itch and you, they should not be pleasant. These ideas are con- nausea, and also with pleasant sensations and emo- ceptualized in homeostatic theory. tions, could elucidate common emotional components All organisms strive to maintain optimal inter- of sensory hedonic feelings. Similarly, studying the nal equilibrium. The notion of homeostasis was G rst interactions between pain and other hedonic emotions introduced in relation to automatic regulatory pro- may further our understanding of both pains and plea- cesses such as thermoregulation (Cannon, 1929). Later sures. To our knowledge, neuroimaging studies of pain G ndings have highlighted the relationship between have not identiG ed a single brain region that has not homeostasis and emotion. Michel Cabanac showed also been implicated in aspects of reward processing. that the pleasantness of a stimulus increases the more The insula encodes taste and food cravings (Pelchat eL ective that stimulus is in restoring bodily homeo- et al., 2004; Small and Apkarian, 2006); the ACC rep- stasis (Cabanac, 1979). When someone’s core temper- resents reward size (Koyama et al., 2001; Rogers et al., ature is too low, stimuli that would normally feel too 2004); and the amygdala is involved in anticipation hot become pleasant (Cabanac, 1971). In other words, of pleasant taste (O’Doherty et al., 2002) and in the homeostatic utility determines the hedonic value of experience of intense pleasure when listening to music a stimulus.
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