Some time ago, I wrote this paper, at the request of the journal Physical Therapy Reviews, on reconceptualising pain. It is a little old now but it has come to be a bit of a position paper. The position has four fundamentals, none of which will be very surprising to anyone I imagine:
(i) pain does not provide a measure of the state of the tissues;
(ii) pain is modulated by many factors from across somatic (things happening in the body below the foramen magnum – the hole at the bottom of your skull, through which your spinal cord transcends to the glory above), psychological (things that happen above the foramen magnum, and social (things that happen outside of the body);
(iii) the relationship between pain and the state of the tissues becomes less predictable as pain persists, and
(iv) pain can be conceptualised as a conscious correlate of the implicit perception that tissues are in danger.
The paper spends a little time justifying each of these points by drawing on basic and clinical science findings and then applies this framework to the understanding and management of complex regional pain syndrome. I must confess that since writing it, I have become more reluctant to group CRPS with other chronic pain states – there does seem to be a good number of unusual pathophysiologies going on with CRPS that are not immediately apparent with other states. Nonetheless, it is not meant to be a ‘how to treat chronic pain’ guide, but a descriptive account of one way to think about it all. I hope it is helpful. We are allowed to put the whole paper up on our website, which we have, but it is a bit long for a blog post. So, if you want it, click here: Reconceptualising pain
Reference
Moseley, G. (2007). Reconceptualising pain according to modern pain science Physical Therapy Reviews, 12 (3), 169-178 DOI: 10.1179/108331907X223010