Pain that is equally intense may be equally bad even in the absence of self-consciousness. It is not necessary to have the thought “I am in pain” in order for pain to be bad. As people who have experienced the more intense forms of pain are aware, pain can blot out self-consciousness altogether. Intense pain can dominate consciousness completely, filling it and crowding out all self-conscious thoughts.
Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life, New York, 2002, p. 229