AAP 2026 CONFERENCE

Pain asymbolia is a rare condition in which patients report the experience of pain but do not exhibit characteristic motivational/behavioral and emotional responses to a noxious stimulus. Such cases pose a challenge to a characterisation of pain derived from typical episodes in which pain sensation is intimately associated with aversive response and negatively-valenced affect. Pain asymbolia is thus test case for neuroscientific and philosophical theories of the nature of pain experience. Those theories can be described as disconnection, depersonalisation and eliminativist (pain asymbolia is not real pain) accounts. None entirely preserve the phenomena, satisfactorily account for the role of neural correlates.

We argue that pain asymbolia represents a failure of emotional transcription of a nociceptive signal. This explanation depends on the idea that the insula cortex anchors distributed processing that subtends a form of interoceptive active inference. As well as explaining pain asymbolia this account also explains the enigmatic and cognitively ubiquitous role of insula processing. We discuss a recent case in which the patient was subject to a full battery of modern investigative techniques. This is helpful since philosophical discussion often relies on classic neuropsychological reports, especially the original 1931 study.