Here’s a flashback to 10 years ago with an article by Quintner et al. In this article the authors are examining the prevalent models in healthcare for discussing the topic of pain.
Ultimately the authors conclude, although the BioPsychoSocial model has done an excellent job at shifting us away from the Biomedical model – the movement has stalled and needs revising.
There are a lot of golden nuggets in this one such as this comment at the end: “The epistemological and ontological constraints of the aporia that is pain are underpinned by our inability to access the secrets of the self referential brain and by our difficulty in using our languaging systems to express such complex phenomena.”
Give this one a read to see the models of pain throughout history and what is necessary to keep moving the needle forward on the discussion of pain.
“What would it be like if human beings shewed no outward signs of pain (did not groan, grimace, etc.)? Then it would be impossible to to teach a child the use of the world ‘tooth-ache’.”—Well, let’s assume the child is a genius and itself invents a name for the sensation!—But then, of course, he couldn’t make himself understood when he used the word.—So does he understand the name, without being able to explain its meaning to anyone?—But what does it mean to say that he has ‘named his pain’?—How has he done this naming of pain?! And whatever he did, what was its purpose?
More seriously, there’s a criticism the authors repeatedly make in the article that I don’t really understand. For example here:
However, when discussing the phenomenon of pain unrelated to trauma, Flor and Hermann [16] expand their view of pain from being a behavioral response (as a symptom) into an experience that may cause profound reorganizational changes within the nervous system, thus increasing an indi- vidual’s susceptibility to all somatosensory input. Here, pain itself is conceptualized as an agent of change. In some way, this emergent aversive response is capable of changing the very structure of the nervous system. Thus, the learned memory of pain perpetuates the reorganizational basis of its own genesis. This proposal accommodates all possibilities and thus not only constitutes a tautology but enshrines a circular argument.
However, to then state “persistent pain does give rise to its own secondary pathology” is unacceptable as it elevates pain to the status of a causative “thing” and thus constitutes a circular argument.
Do you understand this? If so, can you explain what the ‘circular argument’ is meant to be here? They repeatedly associate it with ‘mind–body dualism’, which they also refer to as ‘circular’. But they never really explain what they mean. It seems like a lot of hand-waving—as does the more positive material towards the end. But maybe it just reads that way to me because I don’t know the literature.
I would agree with their statements that the biopsychosocial model in the context of pain has done wonders for this field and allowed us to understand a multi-variate approach to someone’s experiences with pain.