The Heterogeneity of Pain Memory and Pain Amnesia
Sabrina Coninx (Vrije Universiteit Amsterdam) Ying-Tung Ling (National Yang Ming Chiao Tung University) Christopher McCarroll (National Yang Ming Chiao Tung University)
Introduction
In contemporary philosophical discourse, pain is often treated as the paradigmatic case of an experience with a unique qualitative feeling to it – a distinct ‘what it is likeness’. This view is frequently paired with another claim: that we are strikingly bad at remembering this qualitative feeling. Labor pain is the stock example, commonly reported as an experience that seems entirely forgotten. Taking such reports seriously raises two foundational questions about the limits of pain memory and the nature of pain amnesia:
What does it mean to successfully remember pain?
Are we indeed uniquely deficient at remembering pain?
Pain Memory
What is it to successfully remember pain? Before we can answer this question, we first need to specify what is to be remembered, since different understandings of pain fix different targets of remembering. For example, philosophers disagree about whether pain characterizes a mental or bodily state. This disagreement matters for which aspects of the past should be captured for remembering to count as successful.
If pain is treated primarily as an experience or a conscious mental state (e.g., IASP: International Association for the Study of Pain), then memory success is evaluated by whether relevant aspects of the experiential episode can be reconstructed or recollected. If, by contrast, pain is construed primarily as a bodily state or disturbance (e.g., Reuter & Sytsma, 2020), then memory success is assessed the way we assess memory for external events or objects. And if pain is instead understood as a more complex phenomenon that integrates experiential and bodily dimensions, then the success criterion may be equally more complex.
For this post, we follow the IASP definition and treat pain primarily as an experience. Given this framing, the central question becomes how (and to what extent) pain memory should capture pain’s experiential aspect. This is also the framing adopted by much of the current literature on pain amnesia.
Even on this experiential framing, there is more than one way to remember pain. Starting from a standard taxonomy of memory, we can distinguish three corresponding ways in which remembering pain can succeed or fail:
Semantic memory allows us to encode, store, and retrieve factual information. To remember pain semantically is to retain propositional knowledge about a past experience, e.g., that it was moderately intense, that it was sharp rather than dull, or that it was unpleasant but not unbearable.
Episodic memory involves reconstructing personally experienced events, analogous to mentally travelling back in time and reliving such an episode. Although episodic memory typically concerns entire scenarios, it also includes recollection of the qualitative character of the experiences involved. Remembering pain episodically thus entails conjuring the feeling of what it is like to have such pain.
Various forms of non-declarative memory concern how past pain guides future behavior. A child who burns a hand on a hot plate and subsequently withdraws from similar situations has, in this sense, successfully remembered the earlier pain.
These three forms of pain memory can vary independently. One may be unable to accurately report whether past pain was intense or moderate, yet still learn to avoid related stimuli. Conversely, a person might accurately state that they experienced a sharp pain yesterday without being able to re-evoke what it felt like. While we treat these as different ways in which remembering pain can succeed or fail, Barbara Montero (2020) disagrees about which of these dimensions should count as central. The next section examines her proposal.
Pain Amnesia
The literature on pain amnesia—the inability to remember pain—largely concentrates on whether we can re-evoke what it felt like to be in pain, which we subsumed under the notion of episodic memory. Montero (2020) famously argues that we cannot retain the qualitative feeling of pain, drawing on a comparison with vision: although we can easily close our eyes and memorize the color red, thereby voluntarily reproducing what it is like to see red, we cannot similarly summon the feeling of a past pain.
Montero thinks that we have a form of memory –qualitative memory– for phenomenal properties (e.g., color) that is distinct from episodic memory. It is this qualitative memory that is present when we recall color and absent in the case of pain, according to her argument. Some authors think that for the recall of phenomenal properties, we don’t need to posit a new form of memory (qualitative), rather ‘our good-old episodic memory is just the kind of memory that we need’ (De Brigard, 2020, Coninx, 2020). However, even if we accept this, it remains unclear which aspect of a pain must be re-experienced for us to count as having episodically remembered what it feels like successfully.
This raises, once again, the question of what counts as a success criterion for remembering pain, given the complexity of pain experiences. They include sensory components, such as felt location (e.g., arm, head, or stomach), intensity (e.g., mild, moderate, or severe), and quality (e.g., pressing, wrenching, sharp, dull), as well as affective components, such as varying degrees of unpleasantness (e.g., annoying or unbearable). Is it necessary to recall several of these elements, or is one already sufficient?
Montero treats none of these sensory or affective components as central. What she claims must be remembered is a fundamental “ouch”, a primitive qualitative feel that supposedly unifies all pains, independent of their varying sensory and affective properties. This sets a demanding standard. Practically, it means that vividly recalling partial sensory or affective aspects still counts as pain amnesia if the unique ‘ouch’ is missing. Conceptually, it is demanding as well, since there is ongoing debate about whether such a fundamental pain quality exists at all, and, if so, what its character might be (e.g., Corns, 2013; Coninx, 2025; Klein, 2020).
Heterogeneity of Pain Memory and Amnesia
Even if we accept Montero’s success criterion of a fundamental ‘ouch’ to be re-experienced, another question emerges: is it true that we are distinctively bad at remembering what pain feels like, especially in comparison to other modalities? This generalized claim of pain amnesia seems overly radical.
Conjuring the feeling of an experience without a strong external trigger or a specific past event, such as recalling the smell of fish or the taste of cheesecake, can be difficult in relation to various modalities. The challenge of recalling pain, therefore, does not show that it is uniquely forgettable. Rather, it seems to share the same limits as other modalities when memory is decoupled from specific events or cues. Conversely, some studies suggest that vivid recall of pain is possible when it is linked to specific cues, for example, when women view recordings of their own labor (e.g., Niven & Murphy-Black, 2000).
At the same time, it is plausible to assume that the ability to remember pain varies across individuals. Just as mental imagery ranges from aphantasia - the inability to voluntarily form mental images - to hyperphantasia – the unusually vivid ability to generate mental images, similar differences may exist in people’s capacity to re-evoke pain. This may also show that some people are better at recalling sensory aspects, while others may more readily remember affective ones. It also remains an open question whether there are systematic differences in how we remember somatic pain – which arises from the skin, bones, muscles, or joints - versus visceral pain - which arises from the inner organs, or single acute pain episodes versus long-lasting chronic ones.
Finally, some philosophers defend a contextualist approach to memory, according to which success conditions vary with the aims and constraints of the remembering situation (Copenhaver, 2024; Dings et al., 2023). On this view, what counts as remembering pain successfully depends, among other things, on situational demands and cultural norms, such as those fostered in socio-clinical interactions. For example, for acute, injury-related pain, success may involve accurately recalling event-level features such as onset, peak intensity, and triggers. For chronic pain, by contrast, success may consist in capturing patterns over time rather than reproducing a single episode.
Rather than treating success in pain memory as a binary phenomenon that is enforced by focusing on a singular fundamental ‘ouch’, where we either fully re-experience a past pain or fail to recall it altogether, we should adopt a gradual account. There is unlikely to be a strict dichotomy between experiences of modalities that we can remember and those that we cannot. Instead, there are gradations in how easily we can evoke certain feelings, and in how rich the remembered experience is in terms of the involved experiential components. Moreover, these gradations do not depend solely on the modality: a range of additional factors shape how pain is remembered and whether this is considered successful. Ignoring these would overlook the considerable heterogeneity of pain memory and pain amnesia.
