Reconfiguring the Biomedical Dominance of Pain

We lay out an argument that the subjective nature of pain does not sit comfortably with the objective nature of medical practice and therefore broader perspectives are needed to explore pain in the context of painogenic environments.  We demonstrate that the biopsychosocial model of pain remains dominated by biomedical practices attempting to ‘cure’ and ‘remove’ pain based on an outdated belief that pain is solely driven by tissue damage. Biomedical treatments, such as drugs and surgery are very valuable in some, but not all, circumstances, and their overuse and misuse has been detrimental to the health and well-being of people living with persistent pain.

In our paper, we describe how bodily pain emerges from brain activity signalling potential bodily threat, not definite tissue damage, and this is influenced by an array of socio-ecological (contextual) inputs. With this knowledge we argue that salutogenic orientations are needed. In other words, a shift of emphasis from factors that cause disease (pathogenesis) to factors that support human health and well-being (salutogenesis).

In doing so, we will gain a fuller understanding of how people living with persistent pain can flourish and function with good health. This, we argue, will support a need for more ‘upstream’ solutions using community-based approaches to address cultural, environmental, economic, and social determinants of health, guided by principles of equity, civil society, and social justice.