Reconceptualising Pain According to Modern Pain Science

At first glance, pain seems relatively straightforward – hitting one’s thumb with a hammer hurts one’s thumb. Such experiences are easily understood with a structural-pathology model, which supposes pain provides an accurate indication of the state of the tissues. However, on closer inspection, pain is less straightforward. Much of the pain we see clinically fits into this less straightforward category, where pain cannot be understood as a marker of the state of the tissues. This paper argues that the biology of pain is never really straightforward, even when it appears to be. There are four key points: (i) that pain does not provide a measure of the state of the tissues; (ii) that pain is modulated by many factors from across somatic, psychological and social domains; (iii) that the relationship between pain and the state of the tissues becomes less predictable as pain persists; and (iv) that pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger. These points will be discussed in light of their clinical implications and will form the basis of one approach to understanding complex regional pain syndrome.