Forty-five years ago, Patrick Wall published his John J Bonica lecture "On the relation of injury to pain."90 In this lecture, he argued that pain is better classified as an awareness of a need-state than as a sensation. This need state, he argued, serves more to promote healing than to avoid injury. Here I reframe Wall's prescient proposal to pain in early life and propose a set of different need states that are triggered when injury occurs in infancy. This paper, and my own accompanying Bonica lecture, is dedicated to his memory and to his unique contribution to the neuroscience of pain. The IASP definition of pain includes a key statement, "through their life experiences, individuals learn the concept of pain."69 But the relation between injury and pain is not fixed from birth. In early life, the links between nociception (the sense) and pain (the need state) are very different from those of adults, although no less important. I propose that injury evokes three pain need states in infancy, all of which depend on the state of maturity of the central nervous system: (1) the need to attract maternal help; (2) the need to learn the concept of pain; and (3) the need to maintain healthy activity dependent brain development.

中文翻译：

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关于伤害与疼痛的关系 - 婴儿视角。


45 年前，帕特里克·沃尔 （Patrick Wall） 发表了他的约翰·博尼卡 （John J Bonica） 讲座“关于损伤与疼痛的关系”。90 在这次讲座中，他认为疼痛更适合归类为对需求状态的意识，而不是一种感觉。他认为，这种需求状态更多地是为了促进愈合，而不是避免受伤。在这里，我重新构建了 Wall 对早期生命痛苦的先见之明的建议，并提出了一组不同的需求状态，这些状态在婴儿期受伤时触发。这篇论文，以及我自己配套的 Bonica 讲座，都是为了纪念他和他对疼痛神经科学的独特贡献。IASP 对疼痛的定义包括一个关键陈述，“通过他们的生活经历，个人学习了疼痛的概念。69 但是，伤害和疼痛之间的关系并不是从出生开始就固定下来的。在早期生活中，伤害感受（感觉）和疼痛（需求状态）之间的联系与成年人的联系大不相同，但同样重要。我提出受伤会在婴儿期引起三种痛苦需求状态，所有这些都取决于中枢神经系统的成熟状态：（1） 需要吸引母亲的帮助;（2） 需要学习疼痛的概念;（3） 需要保持健康的活动依赖性大脑发育。