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Finally, we know that cultural
variation in pain expression is widespread. The accepted display behaviours associated
with pain are dictated by social, not biological rules. And if differences occur between
cultures, then they must also occur within cultures. Men are expected to tolerate pain
more than women. This raises interesting questions. For example, does someone who
complains more loudly and emotionally actual experience more pain as a result? Do men and
women experience different levels of pain (women report more pain than do men) or just
complain differently? Because of these different rules for pain expression are women ‘s
pain complaints treated as more “trivial” by staff, receiving less attention than
men’s complaints? (Women, it seems are no less likely to receive analgesia than men, but
nurses under estimate both men and women’s pain levels), (Fielding, 1994). These and
other features are powerful arguments for considering pain to be as much an emergent
property of (social) perception than simply a feature of neuronal activity. However,
perhaps the most convincing argument for considering pain as a perceptual phenomenon is
the concept of desynchrony. This refers to circumstances when the four
components of the pain experience (sensation, emotion/motivational/behavioural/social) are
not synchronized. This may be seen when a medical condition stabilizes or improves , yet
patients continue to report increasing pain, or when serious injury occurs, but little
pain is experienced (as Beecher reported in his wartime patients). Physiological models
implicate descending cortical neuronal inhibitory or excitatory influences on the
spino-thalamic tract (the so-called “Gate theory of pain”). But all this tells us is
that sensation input is modulated, hardly surprising given that most other sensory inputs
to the CNS are also under some form of higher control. |