I examine what happens in the brain when patients experience chronic pain and when subjects are addicted to alcohol. We can find important parallels between these two cases, and these parallels can perhaps point us toward new ways of treating (or at least understanding) both issues. Interestingly, we can understand both cases as our pleasure system gone awry. In brief, I argue that chronic pain and alcohol addiction both stem from a dysregulation in our brain’s reward structure. This dysregulation in what should be our pleasure circuitry pushes individuals to behave in ways counterproductive to their needs and to feel unpleasant things. In other words, there is likely both something quite right and perhaps quite wrong about how some philosophers are thinking about pain as an evaluative state. I shall be arguing that pain is both hedonic and evaluative, though perhaps not in the ways they are imagining.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association 2013. Diagnostic and Statistical Manual for Mental Disorders V.
Apkarian, A.V. 2012. Chronic pain and addiction pathways. New Orleans: Society of Neuroscience Annual Meeting.
Aydede, M. (ed.). 2006. Pain: New essays on its nature and the methodology of its study. Cambridge: MIT Press.
Bain, D. 2011. The imperative view of pain. Journal of Consciousness Studies 18: 164–185.
Bain, D. 2014. Pains that don’t hurt. Australasian Journal of Philosophy.
Baliki, M.N., D.R. Chialvo, P.Y. Geha, R.M. Levy, R.N. Harden, T.B. Parrish, and A.V. Apkarian. 2006. Chronic pain and the emotional brain: Specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. Journal of Neuroscience 26: 12165–12173.
Baliki, M.N., P.Y. Geha, and A.V. Apkarian. 2009. Parsing pain perception between nociceptive representation and magnitude estimation. Journal of Neurophysiology 101: 875–887.
Baliki, M.N., P.Y. Geha, H.L. Fields, and A.V. Apkarian. 2010. Predicting value of pain and analgesia: Nucleus accumbens response to noxious stimuli changes in the presence of chronic pain. Neuron 66: 149–160.
Bechara, A., and N.H. Naqvi. 2009. The somatovisceral components of emotions and their role in decision making: Specific attention to the ventromedial prefrontal cortex. In Handbook of neuroscience for the behavioral sciences, vol. 2, ed. G. Berntson and J. Caccioppo, 745–761. Hoboken: Wiley.
Brennan, P.L., K.K. Schutte, and R.H. Moos. 2005. Pain and use of alcohol to manage pain: Prevalence and 3-year outcomes among older problem and non-problem drinkers. Addiction 100: 777–786.
Brooks, J., and I. Tracey. 2005. From nociception to pain perception: Imaging the spinal and supraspinal pathways. Journal of Anatomy 207: 19–33.
Brown, R.A., and H.S.G. Cutter. 1977. Alcohol, customary drinking behavior and pain. Journal of Abnormal Psychology 86: 179–188.
Castillo, R.C., E.A. MacKenzie, S.T. Wegner, and M.J. Bosse. 2006. Prevalence of chronic pain seven years following limb threatening lower extremity trauma. Pain 124: 21–329.
Catalano, E.M. 1987. Chronic pain control workbook. Oakland: New Harbinger Publications, Inc.
Cauda, F., A.E. Cavanna, F. D’agata, K. Sacco, S. Duca, and G.C. Geminiani. 2011. Functional connectivity and coactivation of the nucleus accumbens: A combined functional connectivity and structure-based meta-analysis. Journal of Cognitive Neuroscience 18: 2864–2877.
Churchland, P.S. 1986. Neurophilosophy: Toward a unified science of the mind-brain. Cambridge: The MIT Press.
Clark, L., A. Bechara, H. Damasio, M.R. Aitken, B.J. Sahakian, and T.W. Robbins. 2008. Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making. Brain 131: 1311–1322.
Committee on Advancing Pain Research, Care, and Education, Institute of Medicine. 2011. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press.
Edwards, S., and G.F. Koob. 2010. Neurobiology of dysregulated motivational systems in drug addiction. Future Neurology 5: 393–401.
Edwards, S., L.F. Vendruscolo, J.E. Schlosburg, K.K. Misra, S. Wee, P.E. Park, G. Schulteis, and G.F. Koob. 2012. Development of mechanical hypersensitivity in rats during heroin and ethanol dependence: Alleviation by CRF(1) receptor antagonism. Neuropharmacology 62: 1142–1151.
Egli, M., G.F. Koob, and S. Edwards. 2012. Alcohol dependence as a chronic pain disorder. Neuroscience and Biobehavioral Reviews 36: 2179–2192.
Ewan, E.E., and T.J. Martin. 2011. Opioid facilitation of rewarding electrical brain stimulation is suppressed in rats with neuropathic pain. Anesthesiology 114: 624–632.
Feder, A., E.J. Nestler, and D.S. Charney. 2009. Psychobiology and the molecular genetics of resilience. Nature Reviews Neuroscience 10: 446–457.
Gatch, M.B. 2009. Ethanol withdrawal and hyperalgesia. Current Drug Abuse Reviews 2: 41–50.
Gianoulakis, C. 2009. Endogenous opioids and addiction to alcohol and other drugs of abuse. Current Topics in Medicinal Chemistry 9: 999–1015.
Giesler Jr., G.J., R.P. Yezierski, K.D. Gerhart, and W.D. Willis. 1981. Spinothalamic tract neurons that project to medial and/or lateral thalamic nuclei: Evidence for a physiologically novel population of spinal cord neurons. Journal of Neurophysiology 46: 1285–1308.
Gilpin, N.W., and G.F. Koob. 2008. Overview: Neurobiology of alcohol dependence with a focus on motivational mechanisms. Alcohol Research and Health 31: 185–195.
Goldberg, R.T., W.N. Pachas, and D. Keith. 1999. Relationship between traumatic events in childhood and chronic pain. Disability and Rehabilitation 2: 23–30.
Grant, B.F., D.A. Dawson, F.S. Stinson, S.P. Chou, M.C. Dufour, and R.P. Pickering. 2004. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence 74: 223–234.
Head, H., and G. Holmes. 1911. Sensory disturbances from cerebral lesions. Brain 34: 102–254.
Helm, B. 2002. Felt evaluations: A theory of pleasure and pain. American Philosophical Quarterly 39: 13–30.
Holmes, A., O. Williamson, M. Hogg, C. Arnold, A. Prosser, J. Clements, A. Konstantatos, and M. O’Donnell. 2010. Predictors of pain severity 3 months after serious injury. Pain Medicine 11: 990–1000.
Iannetti, G,D., M.C. Lee, and A. Mouraux. 2010. A multisensory investigation of the functional significance of the “pain matrix.” 13th World Congress on Pain, Montreal, Canada.
Iannetti, G.D., and A. Mouraux. 2010. From the neuromatrix to the pain matrix (and back). Experimental Brain Research 205: 1–12.
Ingvar, M. 1999. Pain and functional imagining. Philosophical Transactions of the Royal Society London B Biological Science 354: 1347–1358.
Insel, T. 2013. Transforming diagnoses. Director’s Blog. http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
Jensen, M. and P. Karoly 1987. Multimethod assessment of chronic pain. Pergamon Books, Inc.
Jochum, T., M.K. Boettger, C. Burkhardt, G. Juckel, and K.J. Bär. 2010. Increased pain sensitivity in alcohol withdrawal syndrome. European Journal of Pain 14: 713–718.
Jucker, M., and L.C. Walker. 2011. Pathogenic protein seeding in Alzheimer disease and other neurodegenerative disorders. Annals of Neurology 70: 532–540.
Katon, W., K. Egan, and D. Miller. 1985. Chronic pain: Lifetime psychiatric diagnoses and family history. American Journal of Psychiatry 142: 1156–1160.
Koob, G.F., and M. Le Moal. 2001. Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology 24: 97–129.
Malinen, S., N. Vartiainen, Y. Hlushchuk, M. Koskinen, P. Ramkumar, N. Forss, E. Kalso, and R. Hari. 2010. Aberrant temporal and spatial brain activity during rest in patients with chronic pain. Proceedings of the National Academy of Science, U.S.A. 107: 6493–6497.
Marr, D.C. 1982. Vision. Cambridge: The MIT Press.
Melzack, R. 1989. Phantom limbs, the self and the brain. Canadian Psychology 30: 1–16.
Modesto-Lowe, V., and E.M. Fritz. 2005. The opioidergic-alcohol link: Implications for treatment. CNS Drugs 19: 693–707.
Naqvi, N., D. Rudrauf, H. Damasio, and A. Bechara. 2007. Damage to the insula disrupts addiction to cigarette smoking. Science 315: 531–534.
Ploghaus, A., I. Tracey, J.S. Gari, S. Clare, R.S. Menon, P.M. Matthews, and J.N. Rawlines. 1999. Dissociating pain from its anticipation in the human brain. Science 284: 1979–1981.
Polymenidou, M., and D.W. Cleveland. 2012. Prion-like spread of protein aggregates in neurodegeneration. Journal of Experimental Medicine 5: 889–893.
Riley III, J.L., and C. King. 2009. Self-report of alcohol use for pain in a multi-ethnic community sample. Journal of Pain 10: 944–952.
Sherrington, C.S. 1906. The integrative action of the nervous system. New Haven: Yale University Press.
Stewart, S., P.R. Finn, and R.O. Pihl. 1995. A dose–response study of the effects of alcohol on the perception of pain and discomfort due to electric shock in men at high familial-genetic risk for alcoholism. Psychopharmacology 119: 261–267.
Tamminga, C.A. 2013. The role of the hippocampus in schizophrenia. Grand Rounds: Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati.
Walker, L.C., and M. Jucker 2013. The seeds of dementia, Scientific American 53–57.
Weissman, D.E., and J.D. Haddox. 1989. Opioid pseudoaddiction – an iatrogenic syndrome. Pain 36: 363–366.
Yang, M. (2013) Pain pathway. Music Therapy for Pain Management. http://www.macalester.edu/academics/psychology/whathap/ubnrp/audition/site/pain%20pathway.htm.
About this article
Cite this article
Hardcastle, V.G. Pleasure Gone Awry? A New Conceptualization of Chronic Pain and Addiction. Rev.Phil.Psych. 5, 71–85 (2014). https://doi.org/10.1007/s13164-013-0170-3
- Chronic Pain
- Amyotrophic Lateral Sclerosis
- Alcohol Dependence
- Acute Pain
- Limbic System