In the research literature on pain and online forums devoted to pain research and treatment, questions about the relationship between mind and body are often raised.  Universities offer degrees in cognitive neurosciences and courses in psychophysiology, underlining our increasing understanding of the mind body connection. Despite this, pain medicine still seems stuck in the notion that the mind and body are two different things no matter how one might influence the other.

Terms like biopsychosocial or psychophysiology speak to our inability to conceptualize the workings of human beings without referring to mind and body as somehow separate. But where does “psych” end and “physio” begin anyway?

What if we stopped using the terms body and mind, and assumed that cognition and awareness are simply functions of another biological system among the many systems that make up a human being. The “cognitive system”, like the endocrine, cardiovascular, and musculoskeletal systems, receives input from the environment and other systems, and creates output to them. In doing so the system can regulate and be regulated to maintain optimal function.

In this view, the mind is simply another part of the whole, another system that is inseparable from other biological systems. No need to argue about whether pain is “in” the mind or body. Trauma, stress and perceived threats to survival may precipitate reactions that lead to the activation of these systems to differing degrees with varying consequences depending on the magnitude of the noxious stimulation, the severity of the trauma, previous exposure and other factors.

If what I’m saying has any validity, then it follows (to me at least) that in treating pain, the use of psychotherapy, drugs, surgery and physical therapy might all be valuable to varying degrees by having effects on the different systems involved in the experience of pain.  Speculating even further, it may be that no one modality of treatment can treat all pain if it fails to address all the systems involved in maintaining chronic pain in an individual patient. The successes that occur may represent the ability of the systems treated to influence the others, but do not prove that those systems were solely responsible for pain in the first place.

Of course the above is quite simplistic, but I think this kind of view might do away with conceptual constructs such as id, ego and the unconscious that are functionally autonomous, things somehow apart from biological processes. It might offer relief from such flowery Freudian notions of repression and suppression in which the pressure of past trauma breaks through defenses to manifest as pain or other somatoform disorders.

Our current way(s) of conceptualizing pain has yielded lots of knowledge but not enough wisdom. Pain care remains in a dismal state. As others have said before me, it’s time for a new paradigm to help us make better sense of what we see.