Perspectives on Pain

Abstract

The publication by Melzack & Wall (1965) of a novel concept of the anatomy and physiology of pain marked the advent of a renaissance in the study of this major cause of human suffering. The physiological, anatomical, pharmacological and psychological substrates of pain have become the subjects of a wide range of basic and clinical research projects. A conceptual framework to integrate information on pain will be given. It is of concern that each scientist tends to see only those aspects of the ‘Puzzle of Pain’ which are explicable within the conceptual framework of their own scientific discipline; yet, the problems encountered by the clinician suggest that the biomedical model which forms the cornerstone of modern scientific endeavour does not offer rational solutions to the readily apparent issues. It has been stated by Engel (1977) that: ‘… all medicine is in crisis and, further, that medicine’s crisis derives from the same basic fault as psychiatry’s, namely, adherence to a model of disease no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry. The importance of how physicians conceptualize disease derives from how such concepts determine what are considered the proper boundaries of professional responsibility and how they influence attitudes toward and behavior with patients.’