Pain and Jean-Baptiste Carpeaux: Difference between pages

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[[Image:Jean-Baptiste Carpeaux's marble sculpture 'Ugolino and his Sons', Metropolitan Museum of Art.jpg|thumb|right|400px|Jean-Baptiste Carpeaux's marble sculpture 'Ugolino and his Sons', Metropolitan Museum of Art]]
{{Redirect|Painful|the [[Yo La Tengo]] album|Painful (album)}}
[[Image:Jean-Baptiste_Carpeaux_La_Danse.jpg|thumb|right|400px|La Danse (The Dance), Opera Garnier in Paris]]
{{Redirect|Hurting|the [[Tears for Fears]] album|The Hurting}}
{{Commonscat}}
{{otheruses|Pain (disambiguation)}}
'''Pain''' is an unpleasant sensation; '''nociception'''<ref>[http://www.iasp-pain.org/AM/Template.cfm?Section=General_Resource_Links&Template=/CM/HTMLDisplay.cfm&ContentID=3058 IASP Pain Terminology]</ref> or '''nociperception'''<ref>''The American Heritage Stedman's Medical Dictionary'', 2nd Edition, Houghton Mifflin, 2004. [http://medical-dictionary.thefreedictionary.com/nociperception Cited online at medical-dictionary.thefreedictionary.com].</ref> is a measurable [[physiology|physiological]] event of a type usually associated with pain and agony and suffering. The word "pain" comes from the {{lang-la|poena}} meaning punishment, a fine, a penalty. A sensation of pain can exist in the absence of nociception: it can occur in response to both external perceived events (for example, seeing something) or internal cognitive events (for example, the ''[[phantom limb]]'' pain of an amputee). Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” - [[International Association for the Study of Pain]] (IASP).
Scientifically, ''pain'' (a subjective experience) is separate and distinct from ''nociception'', the system which carries information, about [[inflammation]], damage or near-damage in [[biological tissue|tissue]], to the [[spinal cord]] and [[brain]]. Nociception frequently occurs without pain being felt and is below the level of consciousness. Despite it triggering pain and [[suffering]], nociception is a critical component of the [[body]]'s defense system. It is part of a rapid warning relay instructing the [[central nervous system]] to initiate [[motoneuron|motor neurons]] in order to minimize detected physical [[harm]]. Pain too is part of the body's defense system; it triggers mental problem solving strategies that seek to end the painful experience, and it promotes learning, making repetition of the painful situation less likely. The two most common forms of pain reported in the [[United States]] are [[headache]] and [[back pain]].


'''Jean-Baptiste Carpeaux''' ([[May 11]], [[1827]], [[Valenciennes]] –[[October 12]], [[1875]], [[Courbevoie]]) was a French sculptor and painter. His early studies were under [[François Rude]]. Carpeaux won the [[Prix de Rome]] in [[1854]], and moving to [[Rome]] to find inspiration, he there studied the works of [[Michelangelo Buonarroti|Michelangelo]], [[Donatello]] and [[Andrea del Verrocchio|Verrocchio]]. Staying in Rome from [[1854]] to [[1861]], he obtained a taste for movement and spontaneity, which he joined with the great principles of [[baroque art]]. In [[1861]] he made a bust of [[Mathilde Bonaparte|Princess Mathilde]], and this later brought him several commissions from [[Napoleon III]]. He worked at the pavilion of [[Flora (goddess)|Flora]], and the [[Opéra Garnier]]. His group La Danse (the Dance, [[1869]]), situated on the right side of the façade, was criticised as an offence to common decency.
== Description ==
=== Intensity ===


He never managed to finish his last work, the famous Fountain of the Four Parts of the Earth, on the Place Camille Jullian. He did finish the terrestrial globe, supported by the four figures of [[Asia]], [[Europe]], [[North America|America]] and [[Africa]], and it was [[Emmanuel Frémiet]] who completed the work by adding the eight leaping horses, the tortoises and the dolphins of the basin.
Pain may range in intensity from slight through severe to agonizing. It is experienced as having qualities such as sharp, throbbing, dull, nauseating, burning and shooting. It often has both an emotional quality and a sensed bodily location. Medical professionals will sometimes ask patients to rate their pain on a scale of zero through ten, where ten is consistent with screaming and thrashing about.


== Sculptures by Carpeaux ==
=== Localization ===


* Ugolin et ses fils - [[Ugolino della Gherardesca|Ugolino]] and his Sons (1861, in the permanent collection of the [[Metropolitan Museum of Art]])[[http://www.insecula.com/oeuvre/photo_ME0000009025.html]] with versions in other museums including the [[Musée d'Orsay]]
This subjective reality of the localization of pain to an area of the body is the basis for speaking of ''pain receptor, neck pain, referred pain, cutaneous pain,'' as well as ''pain in my foot'', ''[[kidney]] pain,'' or the ''painful [[uterine contraction]]s'' occurring during [[childbirth]]. This common usage of ''pain'' is not entirely consistent with the scientists' model of pain being a subjective experience.
* The Dance (commissioned for the [[Palais Garnier|Opera Garnier]])
* Jeune pêcheur à la coquille - [[Naples|Neapolitan]] Fisherboy - in the [[Louvre]], [[Paris]] [[http://www.insecula.com/oeuvre/photo_ME0000034255.html]]
* Girl with Shell
* [[Antoine Watteau]] monument, [[Valenciennes]]


==Neapolitan Fisherboy==
== Insensitivity to pain ==


Carpeaux submitted a plaster version of ''Pêcheur napolitain à la coquille'', the Neapolitan Fisherboy, to the [[French Academy]] while a student in [[Rome]]. He carved the marble version several years later, showing it in the Salon exhibition of 1863. It was purchased for [[Napoleon III]]'s empress, [[Eugénie de Montijo|Eugènie]]. The statue of the young smiling boy was very popular, and Carpeaux created a number of reproductions and variations in marble and bronze. There is a copy, for instance, in the Samuel H. Kress Collection in the [[National Gallery of Art]] in [[Washington D.C.]]
Inability to experience pain, as in the rare condition [[congenital insensitivity to pain]] or congenital analgesia, can cause various health problems.


Some years later, he carved the Girl with a Shell, a very similar study.
==Types of pain==
Pain can be classified as ''acute'' or ''chronic.'' The distinction between acute and chronic pain is not based on its duration of sensation, but rather the nature of the pain itself. In general, physicians are more comfortable treating acute pain, which has as its source soft tissue damage, infection and/or inflammation. It can be modulated and removed by treating its cause and through combined strategies using analgesics to treat the pain and antibiotics to treat the infection. In general, while it is uncomfortable to experience, it is easy to treat; is distinguished by having a specific cause and purpose, and generally produces no persistent psychological reaction. Physicians are more likely to prescribe medications to treat acute pain, particularly in those situations when they are satisfied that they understand the pain's origin and believe the pain will be short in duration. This is why a patient might leave the hospital with two weeks' worth of adequate pain medicine, but the same medications may not be readily prescribed if the patient's pain lasts beyond an expected period of time. It is not the pain itself that is short in duration: it is the diagnosis of "acute pain" and the expectation that it will be short in nature that continues to confuse both the medical establishment and those who experience pain.


Carpeaux sought real life subjects in the streets and broke with the classical tradition. The Neapolitan Fisherboy's body is carved in intimate detail and shows an intricately balanced pose. Carpeaux claimed that he based the Neapolitan Fisherboy on a boy he had seen during a trip to [[Naples]].
The primary distinction is this: acute pain serves to protect one after an injury. Chronic pain does not serve this or any other purpose. Acute pain is the symptom of pain. Chronic pain is the disease of pain.


===Chronic Pain===
==External links==
American pain associations estimate that 40-80 million Americans live with [[chronic pain]].{{Fact|date=June 2007}} At the same time, there are only 8,000 qualified pain management specialists. Many physicians faced with patients who live with chronic pain have had no professional training in pain management. It is not regularly taught in medical school, and even recent legislation in some states to ensure that physicians receive continuing education in pain medicine and end-of-life care do not guarantee proper training in pain. In many states, there remains no legislation ensuring that licensed physicians, even those who work in hospital [[emergency room]]s, have any [[pain management]] training whatsoever.


*[http://cartelfr.louvre.fr/cartelfr/visite?srv=rs_display_res&critere=jean+baptiste+carpeaux&operator=AND&nbToDisplay=5&langue=fr A page on the official Louvre site giving access to some of Carpeaux's works (French language only)]
Chronic pain has no time limit, often has no apparent cause and serves no apparent biological purpose. Chronic pain can trigger multiple psychological problems that confound both patient and health care provider, leading to feelings of helplessness and hopelessness. The most common causes of chronic pain include low-back pain, headache, recurrent facial pain, cancer pain, and arthritic pain. And sometimes chronic pain can have a [[Psychosomatic illness|psychosomatic]] or [[Psychogenic disease|psychogenic]] cause.<ref>Sarno, John E., MD, et. al., ''The Divided Mind: The Epidemic of Mindbody Disorders'' 2006 (ISBN 0-06-085178-3)</ref>.
*[http://www.insecula.com/contact/A005511_oeuvre_1.html A page from insecula.com listing more views of Carpeaux's works (also in French;] it may be necessary to close an advertising window to view this page)

*[http://www.studiolo.org/MMA-Ugolino/Ugolino.htm A page analysing Carpeaux's ''Ugolino'', with numerous illustrations]
Chronic pain was originally defined as pain that has lasted 6 months or longer. It is now defined as "the disease of pain." Its origin, duration, intensity, and specific symptoms vary. The one consistent fact of chronic pain is that, as a disease, it cannot be understood in the same terms as acute pain, and the failure to make this distinction (particularly in those who suffer chronic pain) has been and continues to be the cause of multi-dimensional suffering, depression, social isolation, and helplessness. The failure to recognize chronic pain as substantially different from acute pain cannot be blamed on the medical profession: it is a societal lapse.

Chronic pain, no matter how debilitating it is in one's life, continues to be considered by most insurance carriers as a 3-17% disability.

There have been some theories that not treating acute pain properly can lead to chronic pain.<ref>{{cite journal | author=Dahl JB, Moiniche S | title=Pre-emptive analgesia | journal=Br Med Bull | year=2004 | pages=13-27 | volume=71 | id=PMID 15596866}}</ref>

The experience of physiological pain can be grouped according to the source and related [[nociceptor]]s (pain detecting [[neuron]]s).

*'''Cutaneous pain''' is caused by injury to the [[skin]] or superficial tissues. [[Cutaneous]] nociceptors terminate just below the skin, and due to the high concentration of nerve endings, produce a well-defined, localized pain of short duration. Examples of injuries that produce cutaneous pain include paper cuts, minor cuts, minor (first degree) [[burn (injury)|burn]]s and [[laceration]]s.

*'''Somatic pain''' originates from [[ligament]]s, [[tendon]]s, bones, [[blood vessel]]s, and even [[nerve]]s themselves. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, poorly-localized pain of longer duration than cutaneous pain; examples include [[sprain]]s and broken bones. Myofascial pain usually is caused by [[trigger point]]s in muscles, tendons and fascia, and may be local or referred.

*'''Visceral pain''' originates from body's viscera, or [[organ (biology)|organ]]s. Visceral nociceptors are located within body organs and internal cavities. The even greater scarcity of nociceptors in these areas produces pain that is usually more aching and of a longer duration than somatic pain. Visceral pain is extremely difficult to localize, and several injuries to visceral tissue exhibit [[referred pain|"referred" pain]], where the sensation is localized to an area completely unrelated to the site of injury. [[Myocardial ischaemia]] (the loss of blood flow to a part of the [[heart]] muscle tissue) is possibly the best known example of referred pain; the sensation can occur in the upper chest as a restricted feeling, or as an ache in the left shoulder, arm or even hand. "The brain freeze" is another example of referred pain, in which the vagus nerve is cooled by cold inside the throat. Referred pain can be explained by the findings that pain receptors in the viscera also excite [[spinal cord]] neurons that are excited by cutaneous tissue. Since the brain normally associates firing of these spinal cord neurons with stimulation of somatic tissues in skin or muscle, pain signals arising from the viscera are interpreted by the brain as originating from the skin. The theory that visceral and somatic pain receptors converge and form [[synapse]]s on the same spinal cord pain-transmitting neurons is called "Ruch's Hypothesis".

*'''[[Phantom limb pain]]''', a type of referred pain, is the sensation of pain from a limb that has been lost or from which a person no longer receives physical signals. It is an experience almost universally reported by [[amputee]]s and [[quadriplegia|quadriplegic]]s.

*'''[[Neuropathic pain]]''', can occur as a result of injury or disease to the nerve tissue itself. This can disrupt the ability of the sensory nerves to transmit correct information to the [[thalamus]], and hence the brain interprets painful stimuli even though there is no obvious or known physiologic cause for the pain. Neuropathic pain is, as stated above, the disease of pain. It is not the sole definition for chronic pain, but does meet its criteria.

==Selected common and serious causes of pain by region==
'''It should be noted that visceral pain sensation is often referred by the CNS to a ''dermatome region'' which may be far away from the originating organ. These correlate to the position of the organ in the embryo.''' Examples of this include the heart which originates in the neck, thus producing the classical pain and arm pain experienced during acute cardiac pain.
{{expert}}
===Head and neck===
*[[Jaw pain|Jaw]] - [[Temporal arteritis]] (serious), [[Physical trauma|trauma]]
*[[Ear pain|Ear]] - [[otitis media]] (very common esp. in children), [[otitis externa]], [[Physical trauma|trauma]]
*[[Eye pain|Eye]] - [[glaucoma]], [[Physical trauma|trauma]]
*[[Headache|Head]] - [[migraine]], [[tension headache]], [[cluster headache]], [[cancer]], [[cerebral aneurysm]], [[sinusitis]], [[meningitis]]
*[[Neck pain]] - [[myocardial infarction|MI]] (atypical), [[Physical trauma|trauma]]

===Thorax===
*[[Back pain|Back]] - [[cancer]], also see ''joints'' section
*[[Breast pain|Breast]] - [[menses|perimenstrual]], [[cancer]], [[Physical trauma|trauma]]
*[[Chest pain|Chest]] - [[myocardial infarction|MI]] (common and sometimes fatal), [[Gastroesophageal reflux disease|GERD]] (very common), [[pancreatitis]], [[hiatal hernia]], [[aortic dissection]] (rare), [[pulmonary embolism]] (more frequently asymptomatic), [[Costochondritis]]
*[[Shoulder pain|Shoulder]] - [[cholecystitis]] (right side), [[Musculoskeletal|MSK]]

===Abdomen===
*[[Abdominal pain|Abdominal]]
**Left and right upper quadrant - [[peptic ulcer disease]], [[gastroenteritis]], [[hepatitis]], [[pancreatitis]], [[cholecystitis]], [[myocardial infarction|MI]] (atypical), [[abdominal aortic aneurysm]], [[gastric cancer]] (usually asymptomatic)
**Left and right lower quadrant - [[appendicitis]] (serious), [[ectopic pregnancy]] (serious/women only), [[endometriosis]] (women only), [[pelvic inflammatory disease]] (women only), [[diverticulitis]] (common in the elderly), [[urolithiasis]], [[pyelonephritis]], [[cancer]] ([[colorectal cancer]] most common)

===Back===
*[[Back pain|Back]] - [[Musculoskeletal|MSK]] ([[muscle strain]]), [[cancer]], [[spinal disc herniation]], [[degenerative disc disease]], [[coccyx]] ([[coccydynia]]), [[tension myositis syndrome]], also see ''joints'' section

===Limbs===
*Arm - [[myocardial infarction]] (classically the left arm, sometimes bilateral), [[musculoskeletal system|musculoskeletal]]
*Leg - [[deep vein thrombosis]], [[peripheral vascular disease]] ([[claudication]]), [[musculoskeletal system|musculoskeletal]], [[spinal disc herniation]], [[sciatica]]

===Joints===
*Classically small joints - [[osteoarthritis]] (common in old), [[rheumatoid arthritis]], [[systemic lupus erythematosis]], [[gout]], [[pseudogout]]
*Classically large joints (hip, knee) - [[osteoarthritis]] (common in the elderly), [[septic arthritis]], [[hemarthrosis]], [[osteonecrosis]], [[Physical trauma|trauma]]
*Classically back - [[ankylosing spondylitis]], [[inflammatory bowel disease]]
*Other - [[psoriatic arthritis]], [[Reiter's syndrome]]

==Physiology of nociception (commonly Physiology of pain)==
*This section, except in the paragraph on pain in consciousness, for historical reasons uses '''pain''' to refer to nociception. Where both a historical '''pain''' term and a modern '''nociception''' term are common, a bracketed '''pain''' term is included. e.g. Nociceptors (Pain receptors)
"Nociception is the term introduced almost 100 years ago by the great physiologist Sherrington (1906) to make clear the distinction between detection of a noxious event or a potentially harmful event and the psychological and other responses to it.<ref>[http://fermat.nap.edu/books/0309072913/html/23.html "Assessing Pain and Distress: A Veterinary Behaviorist's Perspective by Kathryn Bayne" in "Definition of Pain and Distress and Reporting Requirements for Laboratory Animals: Proceedings of the Workshop Held June 22, 2000 (2000)]</ref>"

Nociception is the system which carries information about noxious stimuli, usually but not always associated with tissue damage, to the spinal cord and brain<ref>[http://www.npcentral.net/ce/pain/section1.shtml Section B 2. from NP(Nurse Practitioner)Central]</ref>.

Nociception is also known as ''nociperception'' and ''physiological pain''. Nociception is separate to, and distinct from, [[psychological pain]].

===Nociceptors (Pain receptors)===
All nociceptors are [[free nerve ending]]s that have their cell bodies outside the [[spinal column]] in the [[dorsal root ganglion]] and are named based upon their appearance at their sensory ends. These sensory endings look like the branches of small bushes. There are mechanical, thermal, and chemical nociceptors. They are found in skin and on internal surfaces such as periosteum and joint surfaces. Deep internal surfaces are only weakly supplied with pain receptors and will propagate sensations of chronic, aching pain if tissue damage in these areas occurs.

Two main types of nociceptor fibres, [[Aδ fibre|Aδ]] and [[C fibre]]s, mediate fast and slow pain respectively. Thinly myelinated type Aδ fibres, which transmit signals at rates of between 6 to 30 meters per second mediate '''fast pain'''. This type of pain is felt within a tenth of a second of application of the pain stimulus. It can be described as sharp, acute, pricking pain and includes mechanical and thermal pain. '''Slow pain''', mediated by slower, unmyelinated ("bare") type C pain fibers that send signals at rates between 0.5 and 2 meters per second, is an aching, throbbing, burning pain. Chemical pain is an example of slow pain. Nociceptors do not adapt to stimulus. In some conditions, excitation of pain fibers becomes greater as the pain stimulus continues, leading to a condition called [[hyperalgesia]].

===Transmission of nociception (pain) signals in the central nervous system===
There are 2 pathways for transmission of nociception in the [[central nervous system]]. These are the neospinothalamic tract (for fast pain) and the paleospinothalamic tract (for slow pain).

*Fast pain travels via type Aδ fibers to terminate on lamina I (lamina marginalis) of the [[dorsal horn]] of the spinal cord. Second order neurons of the neospinothalamic tract then take off and give rise to long fibres which cross the midline through the anterior white commisure and pass upwards in the contralateral anterolateral columns. These fibres then terminate on the reticular formation,[[Ventrobasal Complex]] (VBC) of the thalamus. From here, third order neurons communicate with the somatosensory cortex. Fast pain can be localised easily if Aδ fibres are stimulated together with tactile receptors.

*Slow pain is transmitted via slower type C fibres to laminae II and III of the dorsal horns, together known as the [[substantia gelatinosa]]. Second order neurons take off and terminate in lamina V, also in the dorsal horn. Third order neurons then join fibers from the fast pathway, crossing to the opposite side via the anterior white commisure, and traveling upwards through the anterolateral pathway. These neurons terminate widely in the [[brain stem]], with one tenth of fibres stopping in the thalamus, and the rest stopping in the [[medulla]], [[pons]] and tectum of midbrain [[mesencephalon]], periaqueductal grey. Slow pain is poorly localized.

===Consequences of nociception===

When the nociceptors are stimulated they transmit signals through sensory neurons in the spinal cord. These neurons release [[glutamate]], a major exicitory [[neurotransmitter]] that relays signals from one neuron to another.

If the signals are sent to the [[reticular formation of brain stem]], [[thalamus]], then pain enters consciousness, but in a dull poorly localised manner. From the thalamus, the signal can travel to the [[somatosensory cortex]] in the [[telencephalon|cerebrum]], when the pain is experienced as localised and having more specific qualities.

Feinstein and colleagues found that nociception could also, "activate generalized autonomic responses independently of the relay of pain to conscious levels" causing "pallor, sweating, bradycardia, a drop in blood pressure, subjective "faintness," nausea and [[Fainting|syncope]]" <ref>cite seen at [http://findarticles.com/p/articles/mi_qa3987/is_200603/ai_n16117205/pg_1 Feinstein B, J Langton, R Jameson, F Schiller. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg 1954;36-A(5):981-97] retrieved 2007-01-06</ref>.

===Analgesia===
The [[gate control theory of pain]], proposed by Patrick Wall and Ron Melzack, postulates that nociception (pain) is "gated" by non-nociception stimuli such as vibration. Thus, rubbing a bumped knee seems to relieve pain by preventing its transmission to the brain. Pain is also "gated" by signals that descend from the brain to the spinal cord to suppress (and in other cases enhance) incoming nociception (pain) information.

The analgesia system is mediated by 3 major components : the [[periaquaductal grey matter]] (in the [[midbrain]]), the [[nucleus raphe magnus]] (in the medulla), and the nociception (pain) inhibitory neurons within the dorsal horns of the spinal cord, which act to inhibit nociception(pain)-transmitting neurons also located in the spinal dorsal horn.

The body has several different types of [[opioid receptor]]s that are activated in response to the binding of the body's [[endorphin]]s. These receptors, which exist in a variety of areas in the body, inhibit firing of neurons that would otherwise be stimulated to do so by nociceptors.

== Phenotype and pain ==
Pain may be experienced differently depending on phenotype. A study by Liem ''et al.'' suggests that redheads are more susceptible to thermal pain. <ref>Liem EB, Joiner TV, Tsueda K, Sessler DI. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15731586&dopt=Abstract Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.] ''Anesthesiology.'' 2005 Mar;102(3):509-14.</ref>

Gene [[SCN9A]] has been identified as a major factor in the development of the pain-perception systems within the body. A rare genetic mutation in this area causes non-functional development of certain [[sodium channel]]s in the nervous system, which prevents the brain from receiving messages of physical damage. People having this disorder are completely [[Congenital insensitivity to pain|ignorant to pain]], and can perform without pain any kinds of self mutilation or damage. In the families studied, this has ranged from biting of the person's own tongue leading to damage, through to street acts with knives, to death from injuries due to a failure to have learned limits on injury through experience of pain. The same gene also appears to mediate a form of ''hyper-sensitivity'' to pain, with other mutations seeming to be "at the root of paroxysmal extreme pain disorder" according to a 2006 report in ''Neurone''. Various other forms of somatic sensitivity are unaffected. [http://www.nature.com/news/2006/061211/full/061211-11.html]

==Pain and alternative medicine==
A recent [http://nccam.nih.gov/news/2004/052704.htm survey] by [[U.S. National Center for Complementary and Alternative Medicine|NCCAM]] (part of the [[NIH]]) found pain was the most common reason that people use [[alternative medicine]]. Among American adults who used CAM in 2002, 16.8% used CAM to treat [[back pain]]; 6.6% for [[neck pain]]; 4.9% for [[arthritis]]; 4.9% for joint pain; 3.1% for [[headache]]; and 2.4% used CAM to treat recurring pain. (Some survey respondents may have used CAM to treat more than one of these pain conditions.)

One such alternative, [[traditional Chinese medicine]], views pain as a [[qi]] "blockage" equivalent to [[electrical resistance]], or as "stagnation of blood" &ndash; theorized as [[dehydration]] inhibiting metabolism. Traditional Chinese treatments such as [[acupuncture]] are said to be more effective for nontraumatic pain than [[Physical trauma|traumatic]] pain. Although these claims have not found broad scientific acceptance, research into both the mechanism and clinical efficacy of [[acupuncture]] supports that it can have a role in pain reduction for both humans and animals. Although the mechanism is not fully understood, it is likely that acupuncture stimulates the release of large quantities of endogenous [[opioids]].<ref>[[Robert Sapolsky]], ''[[Why Zebras Don’t Get Ulcers|Why zebras don't get ulcers]]'', pp 196-197: "Scientists noted that Chinese veterinarians used acupuncture to do surgery on animals, thereby refuting the argument that the painkilling characteristics of acupuncture was one big placebo effect ascribable to cultural conditioning (no cow on earth will go along with unanaesthetized surgery just because it has a heavy investment in the cultural mores of the society in which it dwells. [...] Acupuncture stimulates the release of large quantities of endogenous opioids, for reasons no one really understands. The best demonstration of this is what is called a subtraction experiment: block the activity of endogenous opioids by using a drug that blocks the opiate receptor... acupuncture no longer effectively dulls the perception of pain."</ref> A 2004 NCCAM-funded study showed that acupuncture provides pain relief and improved function in patients with osteoarthritis of the knee, causing some managed care organizations to support acupuncture as adjunctive therapy for this purpose.<ref>Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. "Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial." ''Annals of Internal Medicine'' 2004 Dec 21; 141(12): 901-10.</ref> The [[NIH]]'s 1997 Consensus Statement on Acupunture notes that research has been mixed, partly due to difficulties with designing clinical studies with the proper controls.<ref>National Institutes of Health Consensus Panel. "Acupuncture: National Institutes of Health Consensus Development Statement." National Institutes of Health Web site. Accessed at consensus.nih.gov/1997/1997Acupuncture107html.htm on February 24, 2007.</ref>

Another common alternative treatment for chronic pain is use of nutritional supplements such as:
*[[Curcumin]], a [[polyphenol]] found in [[turmeric]] (Curcuma Longa) and said to be a natural [[cox-2 inhibitor]]<ref>Sharma S, Kulkarni SK, Agrewala JN, Chopra K. "Curcumin attenuates thermal hyperalgesia in a diabetic mouse model of neuropathic pain." Eur J Pharmacol. 2006 May 1; 536(3): 256-61</ref>
*Glucosamine
*Chondroitin
*Bromelain (a digestive enzyme from pineapple core)
*Omega-3 fatty acids.
The efficacy of Glucosamine and Chondroitin, popular supplements for patients with arthritis, were examinied in the GAIT study, a $12 million trial funded by the NIH which showed statistical evidence for the treatment's positive effect only amongst patients with moderate to severe pain, a small subsection of the study.<ref>Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. "Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis." ''New England Journal of Medicine''. 2006 Feb 23; 354(8): 795-808.</ref>

==Philosophy of pain==
{{main|Pain (philosophy)}}
The concept of pain has played an important part in the study of philosophy, particularly in the [[philosophy of mind]]. The question of what pain actually consists in is still open since any evaluation is dependent upon what subject one approaches the question from. [[Type physicalism|Identity theorists]] assert that the mental state of pain is completely identical with some physical state caused by various physiological causes. [[Functionalism (philosophy of mind)|Functionalists]] consider pain to be defined completely by its [[causal]] role (ie in the role it has in bringing about various effects) and nothing else. Some [[theologians]] and other [[spirituality|spiritual]] traditions have much to say about the nature of pain and its various spiritual consequences, especially its role in growth, understanding, compassion, and in providing an aspect of life to be overcome.

==Survival benefit==
Despite its unpleasantness, pain is an important part of the existence of humans and other animals; in fact, it is vital to survival. Pain encourages an organism to disengage from the noxious stimulus associated with the pain. Preliminary pain can serve to indicate that an injury is imminent, such as the ache from a soon-to-be-[[broken bone]]. Pain may also promote the healing process, since most organisms will protect an injured region in order to avoid further pain. People born with [[congenital insensitivity to pain]] usually have short life spans, and suffer numerous ailments such as broken bones, [[bed sore]]s, and chronic [[infection]].

The study of pain has in recent years diverged into many different fields from pharmacology to psychology and neurobiology. It was even proposed that fruit flies may be used as an animal model for pharmacological pain research [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15763072&query_hl=21]. Pain is also of interest in the search for the neural correlates of consciousness, as pain has many subjective psychological aspects besides the physiological nociception.

Interestingly, the brain itself is devoid of nociceptive tissue, and hence cannot experience pain. Thus, a [[headache]] is not due to stimulation of pain fibers in the brain itself. Rather, the membrane surrounding the brain and spinal cord, called the [[dura mater]], is innervated with pain receptors, and stimulation of these dural nociceptors (pain receptors) is thought to be involved to some extent in producing headache pain. Some [[evolution]]ary biologists have speculated that this lack of nociceptive tissue in the brain might be because any injury of sufficient magnitude to cause pain in the brain has a sufficiently high probability of being fatal that development of nociceptive tissue therein would have little to no survival benefit.

Chronic pain, in which the pain becomes pathological rather than beneficial, may be an exception to the idea that pain is helpful to survival, although some doctors believe that psychogenic chronic pain exists as a protective distraction to keep dangerous repressed emotions such as anger or rage unconscious.<ref>Sarno, John E., MD, et. al., ''The Divided Mind: The Epidemic of Mindbody Disorders'' 2006 (ISBN 0-06-085178-3) pp.61-65.</ref>. And it is not clear what the survival benefit of some extreme forms of pain (e.g. toothache) might be; and the intensity of some forms of pain (for example as a result of injury to fingernails or toenails) seem to be out of all proportion to any survival benefits.

==Pain and nociception in other species==
Pain is defined as a subjective conscious experience. The presence or absence of pain even in another human is only verifiable by their report; "Pain is whatever the experiencing person says it is, and exists whenever he says it does."<ref>cite sourced from [http://www.sign.ac.uk/guidelines/fulltext/44/references.html#3 McCaffery M. Nursing management of the patient in pain. Philadelphia, Pa: JB Lippincott 1972.]</ref> It is not scientifically possible to prove whether an animal is in pain or not.

To determine if an animal is likely to be able to experience pain, two tests are used.
*The first is; does the animal respond to noxious stimulus? "Most, if not all, invertebrates have the capacity to detect and respond to noxious or aversive stimuli. That is, like vertebrates, they are capable of nociception".<ref name=JaneASmith>[http://dels.nas.edu/ilar_n/ilarjournal/33_1_2/V33_1_2Question.shtml A Question of Pain in Invertebrates]ILAR Journal 33(1-2) 1991 retrieved 2007-01-06</ref> Both vertebrates and non-vertebrates respond to noxious stimuli and are capable of modifying their response to such stimuli. However noxious stimuli will cause complex, though automatic, responses in animals who have had the higher regions of their brains destroyed and are thus incapable of experiencing pain. Which leads to;
*the second question; does noxious stimulus have longer lasting effects that indicate that pain has been experienced. If pain was experienced, the animal would "guard" an injured part of his body and show aggression when approached. There would also be a decrease in movement, feeding or sexual activity. Also, the reasoning behind this question is that the likely evolutionary benefit of experiencing pain is that learning to withdraw from the noxious stimulus, and avoid similar situations in future, is enhanced and therefore the animal is more likely to survive and breed. From this line of reasoning, if no learning from noxious stimulus is seen, then pain was not experienced. In fact, as pain is useful to shape behaviour, it seems unlikely to occur in species whose behaviour is genetically programmed and inherited.

From these lines of questioning the following groups have been identified;
*Most invertebrates — including lobsters, crabs, worms, snails, slugs and clams- reaction to noxious stimulus does occur but no reports of longer term learning from pain — probably don't have the capacity to feel pain. <ref>cbsnews[http://www.cbsnews.com/stories/2005/02/14/tech/main673989.shtml Hot Debate: Do Lobsters Feel Pain? Feb. 14, 2005] retrieved 2007-01-06</ref>
*Insects; possibly don't experience pain. Sometimes no response to noxious stimulus. No sign of longer term avoidance. Possibly do not feel pain. <ref name=JaneASmith/>
*Cephalopods (octopus, squid); long term withdrawal from possibly painful stimuli observed - possibly do experience pain.<ref name=JaneASmith/>
*Fish; respond to noxious stimuli - reports of long term learning from noxious stimulus - possibly do experience pain.<ref>Report prepared for the RSPCA by S.C. Kestin 2004 36 p. Amended. NAL Call no: SH177.S75K47 [http://www.pisces.demon.co.uk/pain.html Pain and Stress in Fish. April 1994.] retrieved 2007-01-29</ref>
*Other non-human vertebrates (mammals, birds and reptiles); vocalizations and physiological responses (e.g. the release of stress hormones) are similar to our own when we are in pain, learned long term avoidance from noxious stimulus observed - suggesting these animals do experience pain.<ref>The Senate Standing Committee on Legal and Constitutional Affairs [http://www.parl.gc.ca/37/2/parlbus/commbus/senate/Com-e/lega-e/witn-e/shelly-e.htm Do Invertebrates Feel Pain?] retrieved 2007-01-06</ref>
In veterinary science this uncertainty is overcome by assuming that if something would be painful for a human then it would be painful for an animal.<ref>[http://www.acva.org/professional/Position/pain.htm American College of Veterinary Anesthesiologists' position paper on the treatment of pain in animals] retrieved 2007-01-06</ref> Where possible, analgesics are used preemptively if there is any likelihood of pain being caused to an animal.

==See also==
*[[Dolorimeter]]
*[[Chronic pain]]
*[[Pain disorder]]
*[[Pain management]]
*[[Pain scale]]
*[[Neuropathy]]
*[[Agony]]
*[[Nociceptor]]
*[[Allodynia]]
*[[hyperalgesia]]
*[[International Association for the Study of Pain]]

==References==
{{reflist}}

==External links==
*[http://www.ampainsoc.org/ American Pain Society]
*[http://www.painfoundation.org/ American Pain Foundation]
*[http://www.aapainmanage.org/ American Academy of Pain Management]
*[http://www.painmed.org/ American Academy of Pain Medicine]
*[http://www.sppm.org/ Society for Pain Practice Management]
*[http://www.fightingpain.co.il/en/default.asp/ The Society for Fighting Pain, Israel]
*[http://www.abpm.org/ American Board of Pain Medicine]
*[http://www.pain-management-info.com/ Pain Management Information: includes conventional & alternative treatments.]
*[http://www.institut-fuer-schmerzdiagnostik.de/englisch.html Institute for Pain Diagnostic]
*[http://www.helproberto.com Help Roberto: The website of a young boy who cannot feel any pain]
*[http://www.hop.man.ac.uk/painresearch Human Pain Research Group, University of Manchester]
*[http://www.nature.com/nrn/poster/pain/index.html Pain Map PDF from Nature.com]
* {{Cite web | Last = Murray | First = T.J. | url = http://www.wcb.ns.ca/chronicpain.pdf | title = Chronic Pain}}, prepared for the Workers' Compensation Board of [[Nova Scotia]]


[[Category:Pain]]
[[Category:French sculptors|Carpeaux, Jean-Baptiste]]
[[Category:1827 births|Carpeaux, Jean-Baptiste]]
[[Category:1875 deaths|Carpeaux, Jean-Baptiste]]


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Revision as of 01:07, 19 June 2007

Jean-Baptiste Carpeaux's marble sculpture 'Ugolino and his Sons', Metropolitan Museum of Art
La Danse (The Dance), Opera Garnier in Paris
Wikimedia Commons has media related to Jean-Baptiste Carpeaux.

Jean-Baptiste Carpeaux (May 11, 1827, Valenciennes –October 12, 1875, Courbevoie) was a French sculptor and painter. His early studies were under François Rude. Carpeaux won the Prix de Rome in 1854, and moving to Rome to find inspiration, he there studied the works of Michelangelo, Donatello and Verrocchio. Staying in Rome from 1854 to 1861, he obtained a taste for movement and spontaneity, which he joined with the great principles of baroque art. In 1861 he made a bust of Princess Mathilde, and this later brought him several commissions from Napoleon III. He worked at the pavilion of Flora, and the Opéra Garnier. His group La Danse (the Dance, 1869), situated on the right side of the façade, was criticised as an offence to common decency.

He never managed to finish his last work, the famous Fountain of the Four Parts of the Earth, on the Place Camille Jullian. He did finish the terrestrial globe, supported by the four figures of Asia, Europe, America and Africa, and it was Emmanuel Frémiet who completed the work by adding the eight leaping horses, the tortoises and the dolphins of the basin.

Sculptures by Carpeaux

Neapolitan Fisherboy

Carpeaux submitted a plaster version of Pêcheur napolitain à la coquille, the Neapolitan Fisherboy, to the French Academy while a student in Rome. He carved the marble version several years later, showing it in the Salon exhibition of 1863. It was purchased for Napoleon III's empress, Eugènie. The statue of the young smiling boy was very popular, and Carpeaux created a number of reproductions and variations in marble and bronze. There is a copy, for instance, in the Samuel H. Kress Collection in the National Gallery of Art in Washington D.C.

Some years later, he carved the Girl with a Shell, a very similar study.

Carpeaux sought real life subjects in the streets and broke with the classical tradition. The Neapolitan Fisherboy's body is carved in intimate detail and shows an intricately balanced pose. Carpeaux claimed that he based the Neapolitan Fisherboy on a boy he had seen during a trip to Naples.

External links

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