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Persistent pain is recognised as one of the most pervasive and challenging problems that the medical community is facing nowadays. Persistent pain is regarded more as a complex pathophysiological, diagnostic and therapeutic situation rather than a persistent symptom. Pain can have a highly destructive impact on the psychological and social wellbeing of individuals, who commonly experience high levels of stress and struggle to self-manage. Persistent pain is known to affect the individuals’ activity, social interactions and consequently their wellbeing. Furthermore, there is a high rate of comorbidity in the occurrence of persistent pain and mental health. The average percentage of patients living with persistent pain who also display symptoms of anxiety and depression is reported to be between 50% and 75%. There is evidence revealing that the burden of persistent pain and its prevalence are underestimated and in addition, treatment is not always adequate. Given the costs to the individuals and society, new research is needed to address the complex nature of persistent pain and its management.
For more than a century, the biomedical model has been dominant in Western medicine. This approach postulates that pain originates through the physiological mechanisms in the human body. By seeking to explain all disease in biological terms, this model is reductionist. This approach is currently the most commonly used in medical science, determining disease prevention, diagnosis and treatment. Physicians are typically treating disease by identifying a single abnormality in isolation, much like mechanics locate the faulty part of a broken car. While reductionism focuses on a treat-the-symptom process, holism takes into account cultural and existential dimensions and everything that affects health by focusing on finding and treating the causes, rather than the symptoms. One good example is idiopathic pain, which is under the label of medically unexplained symptoms (MUS). These symptoms or diseases cannot be explained in terms of organic pathology, which contributes to the patients being subject to stigma and marginalization. A holistic approach may be more appropriate in understanding and managing this type of illness.
This is closely related to the Biopsychosocial model proposed by Engel that provides a holistic view of the human being, by defining the different hierarchically organised systems that interdependently constitute an individual. For example, pain is regarded as an interactive psychophysiological phenomenon that cannot be separated into isolated, independent psychosocial and physical components. This model is phenomenological, as it recognizes that the lived experience is filled with meaning and values. Bendelow suggested that the biomedical approach to pain is simplistic and unsophisticated, and it often results in physicians being frustrated due to the intractable nature of pain which then leads to doubting patients’ reports of pain and labelling them as ‘frequent fliers” or “heart sink” patients. Not only does the biopsychosocial model provide a better account of the underlying dynamics of persistent pain, but it also provides healthcare professionals a set of alternative tools to address not only the biological but also the psychosocial variables associated with this condition. Pain cannot be evaluated without an understanding of the person who perceives it.
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