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Reimagining pain as an allostatic imperative: perspectives from contemplative traditions.

Catherine Prueitt, Idil Sezer, Matthew D Sacchet

Neuroscience of consciousness January 1, 2025 Peer reviewed DOI: 10.1093/nc/niaf049 via PubMed

Summary

Pain serves as an allostatic imperative that prompts individuals to adapt their bodies. This paper combines empirical studies of pain reprocessing during advanced meditation with the philosophy of pain from Pratyabhijñā Śaivism, proposing that pain involves both homeostatic and heterostatic responses. Homeostatic responses correct errors to return to stability, while heterostatic responses prepare for future challenges. The successful adaptation to pain requires both types of responses, and the model may also extend to mental pain.

Study at a glance

Key finding Pain is theorized as an allostatic imperative requiring both homeostatic and heterostatic responses for effective adaptation.

Abstract

The motivational force of pain is undeniable. But what pain commands us to do, how we might satisfy this command, and if our experience of pain is inherently linked to suffering are far murkier topics. This paper brings together empirical studies of pain reprocessing during advanced meditation, the rise of allostatic paradigms to account for biological self-regulation, and the philosophy of pain in the classical Sanskrit philosophical tradition of Pratyabhijñā Śaivism to argue that pain is an allostatic imperative to adapt a part of one's body. We theorize two components of an allostatic response, heterostatic and homeostatic, that work in tandem to address pain as an allostatic command. Homeostatic responses are error-corrective in that they seek to protect an organism by returning to a previously stable steady state. Heterostatic responses are anticipatory in that they seek to better prepare an organism to meet future challenges by proactively shifting to a new steady state. We note that an organism's successful adaptation to its environment depends not just on error-correction, but also on anticipatory change. We theorize that a broad range of affect properly accompanies pain. We propose potential directions for empirically developing this model. We also note the possibility that this model could be extended to account for mental pain.

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