Opening the Swedish Pain Society Congress: Challenging Some of Pain Science's Deepest Assumptions

Standing before an audience of internationally respected pain scientists, clinicians, educators, and researchers was both exciting and intimidating. Among those attending was Dr Andrew Rice, Professor of Pain Research at Imperial College London and current President of the International Association for the Study of Pain (IASP). The IASP is widely regarded as the world's leading multidisciplinary organisation for pain research, education, and clinical care, helping shape international agendas in pain science, policy, and practice. Knowing that the person currently occupying one of the most influential leadership positions in global pain science was in the audience certainly sharpened the mind. 

The lecture began with a deceptively simple question:

Why, despite decades of research, innovation, and increasingly sophisticated theories, does persistent pain remain such a stubborn problem?

My argument was that we may be constrained by some of the very assumptions that have driven the remarkable success of modern pain science. As a pain scientist, I am unmistakably a product of a WEIRD worldview: Westernised, Educated, Industrialised, Rich, and Democratic. This worldview has delivered extraordinary advances in scientific understanding, healthcare, and human wellbeing. Yet it also encourages particular habits of thought, emphasising individualism, rational analysis, material explanations, and a medicalised, tissue-centred understanding of health and pain.

While pain science has moved far beyond a narrow biomedical model, I suggested that many contemporary approaches remain fundamentally mechanistic. Whether we are discussing tissue pathology, central sensitisation, neuroplasticity, or even biopsychosocial factors, our instinct is often to search for mechanisms that explain pain and determine treatment effectiveness.

But what if something important is being overlooked?

Using TENS as a case study, I explored how interventions can acquire significance that extends beyond their physiological mechanisms of action. People do not encounter treatments simply as biological organisms. They engage with them as meaning-making human beings embedded within families, cultures, relationships, communities, histories, and healthcare systems.

The lecture therefore challenged not only mechanistic-dominant thinking but also some of the assumptions underpinning the biopsychosocial model itself. Rather than asking whether pain is biological, psychological, or social, I proposed that the next stage of pain scholarship may require a broader framework capable of integrating mechanism and meaning, explanation and experience, measurement and interpretation.

In many ways, the talk was also about my own WEIRDness.

Not just the intellectual kind. Delegates were treated to an explanation of why a professor of pain research was standing on stage wearing a Pinky and the Brain beanie hat and a Foghorn Leghorn T-shirt. The humour served a purpose. Progress often begins when someone is prepared to look at familiar problems from an unfamiliar angle. Science advances not only through better instruments and better methods, but sometimes through questioning assumptions that have become so familiar that they are almost invisible.

Challenging long-established traditions from within one's own discipline is not always comfortable, particularly in front of an audience containing many of the field's leading figures. Yet the enthusiastic discussion that followed suggested a genuine appetite for conversations about meaning, culture, worldview, and the future direction of pain research and practice.

The lecture also provided an opportunity to place a marker down for ideas developed more fully in my forthcoming book, A New Orientation to the Reality of Pain. The central proposition is simple but potentially far-reaching: if pain is more than a biological event, and perhaps more than a biopsychosocial phenomenon, then understanding pain may require a new orientation altogether. One that embraces mechanism without being confined by it. One that takes meaning as seriously as measurement. One that recognises that the reality of pain is larger, richer, and more complex than any single disciplinary lens can fully capture.

If the talk achieved anything, I hope it encouraged curiosity. Not because I offered definitive answers, but because I challenged some comfortable assumptions. The history of pain research shows that progress rarely comes from accumulating more of the same explanations. It comes from seeing familiar problems differently.

What we may be missing is not simply another mechanism, another theory, or another estimate of efficacy. What we may be missing is a richer way of seeing the human being with pain. The challenge is not simply to relieve pain, but to help people unstick their lives from pain.

As a WEIRD pain scientist, I suspect that some of our greatest blind spots arise not from what we do not know, but from assumptions we rarely think to question. Perhaps the next advance in pain science will begin not with a new mechanism, but with a new way of seeing. Perhaps it will begin by recognising that what matters most is not pain itself, but the person whose life has become organised around it.