Leeds Beckett University - City Campus,
Woodhouse Lane,
LS1 3HE
Flippin', Unmasking and Rethinking Johns Hopkins' view of Pain
In general, pain medicine is anchored to a mechanistic explanatory model whereby pain arises from actual or potential tissue damage generating activity in neural pathways belonging to a pain system [sic]. This model is overly simplistic and in parts illogical. In recent years I have been turning my attention away from a neuromechanistic perspective of pain to curiously explore pain from broader perspectives. For example, one perspective is through the lens of linguistic relativity, revealing how pain language may be shaping pain experience in a negative way (see here). Another lens is evolutionary-mismatch, how our Paleolithic physiology is maladapted for modern living, from which I introduced the notion of painogenicity, the tendency of modern living to make pain sticky (see here).
I have published a series of articles exploring the possibility of modern environments being painogenic but have been hesitant to talk about this at conferences. Last year, I raised the issue of painogenicity in a talk I delivered at a symposium organised by the Royal College of General Practitioners, and it seemed to go down well. This gave me the courage to pitch my ideas at The Blaustein Pain Grand Rounds conference, Johns Hopkins Medicine, Baltimore, US. The audience was mostly neurosurgeons who live in a mechanistic paradigm of cutting and destroying tissue. I felt like I was walking into a neuromechanistic lion’s den.
In my talk, which I titled “From Mechanism to Metaphor: Unmasking and Rethinking the Persistence of Pain”, I argued that the neuromechanistic view of pain maybe constraining how we understand pain as an experience and, importantly, that this may hinder recovery. In other words, a mechanistic tissue-centric view of pain may be making pain sticky. I invited delegates to embark on a journey of curious exploration of fallacies, errors in logic and gaps in knowledge and to seek-out solutions from non-biomedical disciplines. I revealed a ‘big picture’ view of pain experience, including socio-ecological factors that hinder and facilitate recovery, using wisdom I have gained from involvement with Flippin’ Pain (pain science education), Unmasking Pain (Artist-led activities) and Rethinking Pain (community-based services).
My scholarship sits at the intersection of tissue and the outside world, where the realm of subjective experience exists. This is the mystical juncture between the complex network of neurons symbolizing the physical brain and the abstract representation of mental experiences – sometimes called the ‘explanatory gap of consciousness’. It is here where I explore an ecology of pain to open new avenues of exploration, such as socio-ecological approaches to assist recovery. I am yet to meet anyone who is not curious about how conscious experience arises, and the neurosurgeons at The Blaustein Pain Grand Rounds conference were no different. By making the strange familiar and the familiar strange I ignited the curiosity of the audience enabling me to escape the neuromechanistic lion’s den relatively unscathed.
