An Introduction to Pain The history of our understanding of pain The early theories of pain can be traced back to the Ancient Greek era, when Aristotle and Hippocrates, as well as many others, had competing theories around the root cause of pain. However, in 1664, René Descartes theorised that tissue damage was directly proportional to pain. He also expressed a concept of Dualism; an idea of a material body that interacts with an immaterial mind. These concepts have stood the test of time. Many health professionals still use the underpinnings of his theories within their beliefs around what pain actually is. It’s a very mechanical concept, whereby pain is always related to damage; and then if we can’t find any damage, pain must be in the mind. Jumping forward to the 20th century… There have been many other proposed theories of pain. Most of these continued to provide a mechanical rationale, but slowly start to acknowledge the key role that the brain plays in the pain experience. Beforehand, if no obvious or clear “damage” was found, people that suffered with persistent pain would simply be labelled as psychologically disturbed.
The biopsychosocial model In 1977, the American Psychiatrist George Engel proposed the biopsychosocial model. It started to look at the biological, psychological and social aspects of health. Importantly, this model acknowledges the complex relationship between all three components. We must avoid separating them and attempt to understand the dynamic relationship between them. Pain cannot simply be either biological, psychological or social – it’s an individualised experience based on a complex affiliation between all three components.
Biological
Psychological Fear of movement
Illness/disease Injury
Expectations
Sleep
Pain beliefs
Physical stress
Self-efficacy
Genetic variables
Anxiety Depression Stress Drugs
Coping skills
Social Family circumstances Work stress/issues Social isolation Financial
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