Phenomenology and the Cognitive Sciences

, Volume 18, Issue 4, pp 637–665 | Cite as

An enactive approach to pain: beyond the biopsychosocial model

  • Peter StilwellEmail author
  • Katherine Harman


We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us.


Biopsychosocial Phenomenology Pain Cognition Embodied Enactivism 



We would like to acknowledge the two anonymous reviewers who worked with us to create a more coherent and rigorous argument. Thanks to the many who discussed these ideas with us, providing feedback and support. The Canadian Chiropractic Guideline Initiative (CCGI) funded clinical research that inspired this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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corrected publication 2019

Authors and Affiliations

  1. 1.Faculty of HealthDalhousie UniversityHalifaxCanada
  2. 2.School of Physiotherapy, Faculty of HealthDalhousie UniversityHalifaxCanada

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