1 The Lived Experience of Pain : A Painful Journey for Medicine

Although understandings of pain phenomena have benefited from theoretical developments such as the biopsychosocial model of illness, the clinical path of the person in pain presenting to a health professional still leads to frustration for both. The biopsychosocial model generated an "official" definition, two major conceptual frameworks, and three putative explanatory models. However, in the absence of a theory that embraces pain as an emergent and unpredictable phenomenon, these progeny have been unable to displace biomedical reductionism or to transcend dualism. The observer-dependent stance of the clinician results in marginalisation of the "patient," compromises therapy and confronts both parties with a potential clinical nemesis. The lived experience of pain reflects an aporia, a puzzle that denies us access to its secrets. However application of principles underlying the self-referentiality of living systems opens a path to integrating the traditional somatic dimension of biomedical analysis with dimensions of beliefs, emotions, behaviour and environment. Clinically, pain may be grasped anew through the engagement of autonomous self-referential living systems, creating the intersubjective or “third space” with each influenced by similar sets of humanist factors and confronted with the same aporia. This reframing generates new possibilities in assessment, treatment and policy.