Pain

"The pain that you create now is always some form of non acceptance, some form of unconscious resistance to what is. On the level of thought, the resistance is some form of judgment. On the emotional level, it is some form of negativity. The intensity of the pain depends on the degree of resistance to the present moment, and this in turn depends on how strongly you are identified with your mind. The mind always seeks to deny the Now and to escape from it. In other words, the more you are identified with your mind, the more you suffer. Or you may put it like this: the more you are able to honor and accept the Now, the more you are free of pain, of suffering - and free of the egoic mind."

"When you create a problem, you create pain. All it takes is a simple choice, a simple decision: no matter what happens, I will create no more pain for myself. I will create no more problems. Although it is a simple choice, it is also very radical. You won' t make that choice unless you are truly fed up with suffering, unless you have truly had enough. And you won't be able to go through with it unless you access the power of the Now. If you create no more pain for yourself, then you create no more pain for others. You also no longer contaminate the beautiful Earth, your inner space, and the collective human psyche with the negativity of problem-making. If you have ever been in a life-or-death emergency situation, you will know that it wasn't a problem. The mind didn't have time to fool around and make it into a problem. In a true emergency, the mind stops; you become totally present in the Now, and something infinitely more powerful takes over. This is why there are many reports of ordinary people suddenly becoming capable of incredibly courageous deeds. In any emergency, either you survive or you don't. Either way, it is not a problem."

"Your unhappiness is polluting not only your own inner being and those around you but also the collective human psyche of which you are an inseparable part. The pollution of the planet is only an outward reflection of an inner psychic pollution: millions of unconscious individuals not taking responsibility for their inner space. Either stop doing what you are doing, speak to the person concerned and express fully what you feel, or drop the negativity that your mind has created around the situation and that serves no purpose whatsoever except to strengthen a false sense of self. Recognizing its futility is important. Negativity is never the optimum way of dealing with any situation. In fact, in most cases it keeps you stuck in it, blocking real change. Anything that is done with negative energy will become contaminated by it and in time give rise to more pain, more unhappiness. Furthermore, any negative inner state is contagious: Unhappiness spreads more easily than a physical disease. Through the law of resonance, it triggers and feeds latent negativity in others, unless they are immune - that is, highly conscious. Are you polluting the world or cleaning up the mess? You are responsible for your inner space; nobody else is..."

"Deep unconsciousness, such as the pain-body, or other deep pain, such as the loss of a loved one, usually needs to be transmuted through acceptance combined with the light of your presence - your sustained attention. Many patterns in ordinary unconsciousness, on the other hand, can simply be dropped once you know that you don't want them and don't need them anymore, once you realize that you have a choice, that you are not just a bundle of conditioned reflexes. All this implies that you are able to access the power of Now. Without it, you have no choice."

"Apart from her personal pain-body, every woman has her share in what could be described as the collective female pain-body - unless she is fully conscious. This consists of accumulated pain suffered by women partly through male subjugation of the female, through slavery, exploitation, rape, childbirth, child loss, and so on, over thousands of years. The emotional or physical pain that for many women precedes and coincides with the menstrual flow is the pain-body in its collective aspect that awakens from its dormancy at that time, although it can be triggered at other times too. It restricts the free flow of life energy through the body, of which menstruation is a physical expression... Often a woman is "taken over" by the pain-body at that time. It has an extremely powerful energetic charge that can easily pull you into unconscious identification with it. You are then actively possessed by an energy field that occupies your inner space and pretends to be you - but, of course, is not you at all. It speaks through you, acts through you, thinks through you. It will create negative situations in your life so that it can feed on the energy. It wants more pain, in whatever form... It is pure pain, past pain - and it is not you... The number of women who are now approaching the fully conscious state already exceeds that of men and will be growing even faster in the years to come. p. 106"

"The greater part of human pain is unnecessary. It is self created as long as the unobserved mind runs your life."

"The beginning of freedom from the painbody lies first of all in the realization that you have a painbody. Then, more important, in your ability to stay present enough, alert enough, to notice the painbody in yourself as a heavy influx of negative emotion when it becomes active. When it is recognized, it can no longer pretend to be you and live and renew itself through you."

"It is your conscious Presence that breaks the identification with the painbody. When you don't identify with it, the painbody can no longer control your thinking and so cannot renew itself anymore by feeding on your thoughts. The painbody in most cases does not dissolve immediately, but once you have severed the link between it and your thinking, the painbody begins to lose energy. Your thinking ceases to be clouded by emotion; your present perceptions are no longer distorted by the past. The energy that was trapped in the painbody then changes into vibrational frequency and is transmuted into Presence. In this way, the painbody becomes fuel for consciousness. This is why many of the wisest, most enlightened men and women on our planet once had a heavy painbody."

"Children are not fooled by parents who try to hide their painbody from them, who say to each other, “We mustn't fight in front of the children.” This usually means while the parents make polite conversation, the home is pervaded with negative energy. Suppressed painbodies are extremely toxic, even more so than openly active ones, and that psychic toxicity is absorbed by the children and contributes to the development of their own painbody."

"Many people live with a tormentor in their head that continuously attacks and punishes them and drains them of vital energy. It is the cause of untold misery and unhappiness, as well as of disease. The good news is that you can free yourself from your mind. This is the only true liberation. You can take the first step right now. Start listening to the voice in your head as often as you can. Pay particular attention to any repetitive thought patterns, those old gramophone records that have been playing in your head perhaps for many years. This is what I mean by "watching the thinker," which is another way of saying: listen to the voice in your head, be there as the witnessing presence. When you listen to that voice, listen to it impartially. That is to say, do not judge. Do not judge or condemn what you hear, for doing so would mean that the same voice has come in again through the back door. You'll soon realize: there is the voice, and here I am listening to it, watching it. This I am realization, this sense of your own presence, is not a thought. It arises from beyond the mind."

"That last moment belongs to us — that agony is our triumph."

"Interesting problem, pain. So helpful, so obnoxious."

"At first blush, the Unborn Child Pain Awareness Act would seem to be anathema to abortion rights groups. It requires abortion providers to tell a woman whose pregnacy is 20 weeks past fertilization "there is substantial evidence" that the fetus will feel pain during the procedure -- a point hotly debated among physicians and pain specialists. The woman would then have to sign a form accepting or declining anesthesia for her fetus. Some medical groups interpret the language to mean that the fetus would have to have an application of anesthesia separate from the mother's, a procedure that many abortion clinics are not capable of providing."

"It may seem to be a long way from Blake's innocent talk of love and copulation to De Sade's need to inflict pain. And yet both are the outcome of a sexual mysticism that strives to transcend the everyday world. Simone de Beauvoir said penetratingly of De Sade's work that 'he is trying to communicate an experience whose distinguishing characteristic is, nevertheless its will to remain incommunicable'. De Sade's perversion may have sprung from his dislike of his mother or of other women, but its basis is a kind of distorted religious emotion."

"It’s a big disappointment for the pro-life movement, which has embraced 20-week bans as a way of taking advantage of public discomfort over later abortion. Based on the disputed medical claim that a fetus can feel pain after 20 weeks, thirteen states have banned abortions after that point, and Republicans in Congress have introduced similar federal legislation. Had the Albuquerque referendum passed, it would have opened up new avenues for anti-abortion groups to pursue restrictions at the local level—an attractive prospect in blue states like New Mexico, where the Democratic-controlled legislature has repeatedly buried new abortion laws."

"World's use is cold, world's love is vain, World's cruelty is bitter bane; But pain is not the fruit of pain."

"Nature knows best, and she says, roar!"

"Pain is good, I'd say, when it's incidental to Love. In 'I give up my life for my friend' it is my friend, not my death, that matters. And sometimes I needn't give up my life for him, I can live for him, and with him, and the power of the spirit is then equally manifested, I should think."

"There is purpose in pain, Otherwise it were devilish."

"You purchase pain with all that joy can give, And die of nothing but a rage to live."

"Pain is no longer pain when it is past."

"Ah, to think how thin the veil that lies Between the pain of hell and Paradise."

"To have pain is to have certainty; to hear about pain is to have doubt."

"Why, all delights are vain; but that most vain, Which, with pain purchas'd, doth inherit pain."

"One fire burns out another's burning, One pain is lessen'd by another's anguish."

"The scourge of life, and death's extreme disgrace, The smoke of hell,—that monster callèd Paine."

"Your pain comes upon the individual, one by one, to each man alone and no other, but my soul groans for the city, for me and you together."

"There's a pang in all rejoicing, And a joy in the heart of pain; And the wind that saddens, the sea that gladdens, Are singing the selfsame strain."

"Nothing begins, and nothing ends, That is not paid with moan; For we are born in others' pain, And perish in our own."

"The mark of rank in nature is capacity for pain, And the anguish of the singer marks the sweetness of the strain."

"A man of pleasure is a man of pains."

"When pain can't bless, heaven quits us in despair."

"Evidence Synthesis Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing. Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks’ gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks. For fetal surgery, women may receive general anesthesia and/or analgesics intended for placental transfer, and parenteral opioids may be administered to the fetus under direct or sonographic visualization. In these circumstances, administration of anesthesia and analgesia serves purposes unrelated to reduction of fetal pain, including inhibition of fetal movement, prevention of fetal hormonal stress responses, and induction of uterine atony. Conclusions Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester. Little or no evidence addresses the effectiveness of direct fetal anesthetic or analgesic techniques. Similarly, limited or no data exist on the safety of such techniques for pregnant women in the context of abortion. Anesthetic techniques currently used during fetal surgery are not directly applicable to abortion procedures."

"Pain is a subjective sensory and emotional experience that requires the presence of consciousness to permit recognition of a stimulus as unpleasant. Although pain is commonly associated with physical noxious stimuli, such as when one suffers a wound, pain is fundamentally a psychological construct that may exist even in the absence of physical stimuli, as seen in phantom limb pain. The psychological nature of pain also distinguishes it from nociception, which involves physical activation of nociceptive pathways without the subjective emotional experience of pain. For example, nociception without pain exists below the level of a spinal cord lesion, where reflex withdrawal from a noxious stimulus occurs without conscious perception of pain. Because pain is a psychological construct with emotional content, the experience of pain is modulated by changing emotional input and may need to be learned through life experience. Regardless of whether the emotional content of pain is acquired, the psychological nature of pain presupposes the presence of functional thalamocortical circuitry required for conscious perception, as discussed below."

"Nociception may be characterized by reflex movement in response to a noxious stimulus, without cortical involvement or conscious pain perception. Nociception involves peripheral sensory receptors whose afferent fibers synapse in the spinal cord on interneurons, which synapse on motor neurons that also reside in the spinal cord. These motor neurons trigger muscle contraction, causing limb flexion away from a stimulus. In contrast, pain perception requires cortical recognition of the stimulus as unpleasant. Peripheral sensory receptor afferents synapse on spinal cord neurons, the axons of which project to the thalamus, which sends afferents to the cerebral cortex, activating any number of cortical regions. Sensory receptors and spinal cord synapses required for nociception develop earlier than the thalamocortical pathways required for conscious perception of pain. No human studies have directly examined the development of thalamocortical circuits associated with pain perception. The developmental age at which thalamic pain fibers reach the cortex has been inferred from studies of other thalamocortical circuits, which may or may not develop at the same time as thalamic fibers mediating cortical perception of pain."

"Another histological study of 12 specimens found that afferents from unspecified thalamic regions reached the developing prefrontal cortex in 1 preterm neonate of 27 weeks’ developmental age, concluding that thalamic fibers begin entering the cortex between 26 and 28 weeks’ developmental age (28 and 30 weeks’ gestational age). A different study found that thalamic afferents had not reached the somatosensory cortical plate by 22 weeks’ developmental age (24 weeks’ gestational age). By 24 weeks’ developmental age (26 weeks’ gestational age), the density of cortical plate synapses increased, although these were not necessarily from thalamic afferents. Based on these studies, direct thalamocortical fibers that are not specific for pain begin to emerge between 21 and 28 weeks’ developmental age (23 and 30 weeks’ gestational age)."

"Despite this developmental role, no human study has shown that synapses between subplate and cortical plate neurons convey information about pain perception from the thalamus to the developing cortex."

"The histological presence of thalamocortical fibers is insufficient to establish capacity for pain perception. These anatomical structures must also be functional. Although no electroencephalographic “pain pattern” exists, electroencephalography may be one way of assessing general cortical function because electroencephalograms (EEGs) measure summated synaptic potentials from cortical neurons."

"Somatosensory evoked potentials (SEPs) may also provide evidence of pain processing in the somatosensory cortex, although they are not used clinically to test pain pathways. SEPs test the dorsal column tract of the spinal cord, which transmits visceral pain sensation to the somatosensory cortex via the thalamus. SEPs with distinct and constant N1 components of normal peak latency are present at 29 weeks’ PCA, indicating that thalamic connections with the somatosensory cortex are functional at that time."

"Although widely used to assess pain in neonates, withdrawal reflexes and facial movements do not necessarily represent conscious perception of pain. Full-term neonates exhibit a “cutaneous withdrawal reflex” that is activated at a threshold much lower than that which would produce discomfort in a child or adult. This threshold increases with PCA, suggesting that the capacity of the neonate to distinguish between noxious and nonnoxious stimuli is maturing. Furthermore, flexion withdrawal from tactile stimuli is a noncortical spinal reflex exhibited by infants with anencephaly and by individuals in a persistent vegetative state who lack cortical function. Behavioral studies have also identified a distinct set of neonatal facial movements present during invasive procedures such as heel lancing but absent during noninvasive procedures. These facial movements, which are similar to those of adults experiencing pain, were evident in neonates at 28 to 30 weeks’ PCA but not at 25 to 27 weeks’ PCA. Facial movements may not necessarily be cortically controlled. One study found no difference in facial activity during heel lancing of neonates with and without significant cortical injury, suggesting that facial activity even around 32 weeks’ PCA may not represent conscious perception of pain."

"Hemodynamic and neuroendocrine changes in fetuses undergoing stressful procedures have also been used to infer pain perception. As early as 16 weeks’ gestational age, fetal cerebral blood flow increases during venipuncture and transfusions that access the fetal hepatic vein through the innervated fetal abdominal wall but not during venipuncture and transfusions involving the noninnervated umbilical cord. Increased cerebral blood flow is not necessarily indicative of pain, as this response is thought to constitute a “brain sparing” mechanism associated with hypoxia and intrauterine growth restriction."

"Other investigators measured increases in fetal plasma concentrations of cortisol, β-endorphin, and noradrenaline associated with intrauterine needling procedures, finding that increases during blood sampling from the hepatic vein were greater than those during sampling from the umbilical cord. However, these neuroendocrine responses do not constitute evidence of fetal pain, because the autonomic nervous system and hypothalamic-pituitary-adrenal axis mediate them without conscious cortical processing. Additionally, these responses are not specific for painful stimuli. Plasma noradrenaline concentrations may increase after umbilical cord transfusion, and plasma β-endorphin concentrations may increase after repeated cordocenteses. Plasma cortisol and β-endorphin concentrations increase during innocuous activities such as exercise. Moreover, in adults, neuroendocrine stress responses may persist despite well-controlled postoperative pain. Vital signs also have been used to assess neonatal pain."

"Anesthetics and analgesics are commonly used to alleviate pain and discomfort. Despite ongoing debate regarding fetal capacity for pain, fetal anesthesia and analgesia are still warranted for surgical procedures undertaken to promote fetal health. When long-term fetal well-being is a central consideration, evidence of fetal pain is unnecessary to justify fetal anesthesia and analgesia because they serve other purposes unrelated to pain reduction, including (1) inhibiting fetal movement during a procedure; (2) achieving uterine atony to improve surgical access to the fetus and to prevent contractions and placental separation; (3) preventing hormonal stress responses associated with poor surgical outcomes in neonates; and (4) preventing possible adverse effects on long-term neurodevelopment and behavioral responses to pain. These objectives are not applicable to abortions. Instead, beneficence toward the fetus represents the chief justification for using fetal anesthesia or analgesia during abortion—to relieve suffering if fetal pain exists."

"In contrast to fetal surgery requiring regional or general anesthesia, minimally invasive fetal procedures do not involve maternal laparotomy or hysterotomy and instead use needles or endoscopy to access the fetus. For the sake of reducing pain, the increased risks of general anesthesia are unjustified for these procedures; adults typically undergo similar procedures with no analgesia or only local analgesia."

"Pain is an emotional and psychological experience that requires conscious recognition of a noxious stimulus. Consequently, the capacity for conscious perception of pain can arise only after thalamocortical pathways begin to function, which may occur in the third trimester around 29 to 30 weeks’ gestational age, based on the limited data available. Small-scale histological studies of human fetuses have found that thalamocortical fibers begin to form between 23 and 30 weeks’ gestational age, but these studies did not specifically examine thalamocortical pathways active in pain perception. While the presence of thalamocortical fibers is necessary for pain perception, their mere presence is insufficient—this pathway must also be functional. It has been proposed that transient, functional thalamocortical circuits may form via subplate neurons around midgestation, but no human study has demonstrated this early functionality. Instead, constant SEPs appear at 29 weeks’ PCA, and EEG patterns denoting wakefulness appear around 30 weeks’ PCA. Both of these tests of cortical function suggest that conscious perception of pain does not begin before the third trimester. Cutaneous withdrawal reflexes and hormonal stress responses present earlier in development are not explicit or sufficient evidence of pain perception because they are not specific to noxious stimuli and are not cortically mediated."

"In the context of abortion, fetal analgesia would be used solely for beneficence toward the fetus, assuming fetal pain exists. This interest must be considered in concert with maternal safety and fetal effectiveness of any proposed anesthetic or analgesic technique. For instance, general anesthesia increases abortion morbidity and mortality for women and substantially increases the cost of abortion. Although placental transfer of many opioids and sedative-hypnotics has been determined, the maternal dose required for fetal analgesia is unknown, as is the safety for women at such doses. Furthermore, no established protocols exist for administering anesthesia or analgesia directly to the fetus for minimally invasive fetal procedures or abortions. Experimental techniques, such as administration of fentanyl directly to the fetus and intra-amniotic injection of sufentanil in pregnant ewes, have not been shown to decrease fetal pain and are of unknown safety in humans."

"Because pain perception probably does not function before the third trimester, discussions of fetal pain for abortions performed before the end of the second trimester should be noncompulsory. Fetal anesthesia or analgesia should not be recommended or routinely offered for abortion because current experimental techniques provide unknown fetal benefit and may increase risks for the woman. Instead, further research should focus on when pain-related thalamocortical pathways become functional in humans. If the fetus can feel pain, additional research may lead to effective fetal anesthesia or analgesia techniques that are also safe for women."

"Merker’s much-discussed article was accompanied by more than two dozen commentaries by prominent researchers. Many noted that if Merker is correct, it could alter our understanding of how normal brains work and could change our treatment of those who are now believed to be insensible to pain because of an absent or damaged cortex. For example, the decision to end the life of a patient in a persistent vegetative state might be carried out with a fast-acting drug, suggested Marshall Devor, a biologist at the Center for Research on Pain at Hebrew University in Jerusalem. Devor wrote that such a course would be more humane than the weeks of potentially painful starvation that follows the disconnection of a feeding tube (though as a form of active euthanasia it would be illegal in the United States and most other countries). The possibility of consciousness without a cortex may also influence our opinion of what a fetus can feel. Like the subplate zone, the brain stem is active in the fetus far earlier than the cerebral cortex is, and if it can support consciousness, it can support the experience of pain. While Mark Rosen is skeptical, Anand praises Merker’s work as a “missing link” that could complete the case for fetal pain."

"Our understanding of when the fetus can experience pain has been largely shaped by neuroanatomy. However, completion of the cortical nociceptive connections just after mid-gestation is only one part of the story. In addition to critically reviewing evidence for whether the fetus is ever awake or aware, and thus able to truly experience pain, we examine the role of endogenous neuro-inhibitors, such as adenosine and pregnanolone, produced within the feto-placental unit that contribute to fetal sleep states, and thus mediate suppression of fetal awareness. The uncritical view that the nature of presumed fetal pain perception can be assessed by reference to the prematurely born infant is challenged. Rigorously controlled studies of invasive procedures and analgesia in the fetus are required to clarify the impact of fetal nociception on postnatal pain sensitivity and neural development, and the potential benefits or harm of using analgesia in this unique setting."

"Whether the fetus can truly experience pain, at least in some way analogous to how adults emotionally understand pain, has been debated extensively over recent years and is of importance given continuing advances in fetal surgical and diagnostic procedures. This question has considerable implications for the management of invasive fetal procedures, particularly as fetal analgesic and anaesthetic treatment is complex and not without risk for the fetus. Prevention and treatment of pain are basic human rights, regardless of age, and if fetal interventions are to progress, then a greater understanding of nociception and stress responses is required. The timing of the neuroanatomical maturation of the nociceptive system is now well understood, and the final critical cortico-thalamic connections appear to be present by 24–28 weeks of gestation. This suggests that the fetus could potentially be able to feel pain by the third trimester, at least in a rudimentary fashion. This concept is said to be supported by studies which show that nociceptive stimuli elicit physiological stress-like responses in the human fetus in utero. However, physiological processing of a nociceptive stimulus and perceiving a nociceptive stimulus as painful are not the same. There are both a physiological and an emotional or cognitive aspect to pain perception, and indeed a significant element of learning [56]. Certainly, processing can be independent of perception, as is demonstrated during surgery under general anesthesia, for example, where nociceptive stimuli can still elicit subcortically mediated physiological stress responses despite unconsciousness. Thus, to emotionally experience pain, we must be cognitively aware of the stimulus (a cortical process), and this in turn requires that we must be conscious. The key question then is not about the anatomic completion or functionality of nociceptive pathways in utero, but whether the fetus is ever conscious and thus aware. In general, discussion of fetal pain perception tends to treat the fetus as an unborn newborn; i.e., that responses of the newborn represent an adequate surrogate for the fetus. The assumption is thus made that if the newborn (including the preterm newborn) can experience wakefulness (and therefore consciousness), and apparently feels pain, then so too must the age-equivalent fetus. Furthermore, evidence for fetal wakefulness (and again therefore consciousness) has been based on how certain fetal responses “resemble” newborn sleep–wake behaviors, rather than a true determination of fetal wakefulness per se. Given the complexities of studying the fetus, extrapolation from or to the newborn state is understandable. Systematic studies of fetal neurological function suggest, however, that there are major differences in the in utero environment and fetal neural state that make it likely that this assumption is substantially incorrect. This has important implications for our understanding of fetal pain perception. The current review critically evaluates the hypothesis that unlike the newborn, the fetus is actively maintained asleep (and unconscious) throughout gestation and cannot be woken by nociceptive stimuli. The evidence is examined with reference to fetal sleep–wake states, the role of cortico-thalamic gating in cortical arousal during sleep, and the unique contribution that certain inhibitory neuromodulators make in utero to cortical suppression. Finally, we briefly discuss the validity of the hypothesis that suggests that the nociceptive input may have long-lasting deleterious effects regardless of whether the fetus is asleep or not."