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Papers of the Week

Papers: 13 Aug 2022 - 19 Aug 2022

2022 Aug 15


Reconsidering Fordyce’s classic article, “Pain and Suffering: what is the unit?” to help make our model of chronic pain truly biopsychosocial.


The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 paper by Wilbert "Bill" Fordyce, "Pain and suffering: what is the unit?" In this paper, Fordyce suggested that pain-related disability and suffering should be viewed as "transdermal", as having causes both inside and outside the body. We consider Fordyce's paper theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience-from nociception to multisensory indicators of safety or danger-can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and non-medical providers to tackle chronic pain.