Centre for Pain Research, School of Health, Leeds Beckett University, Portland Way, Leeds, West Yorkshire, LS1 3HE, UK.
School of Health and Sports Sciences, University of Suffolk, Neptune Quay, Ipswich, Suffolk, IP4 1QJ, UK.
Health Promot Int. 2022 Aug 1;37(4). doi: 10.1093/heapro/daac128.
Strategies to reduce the burden of persistent pain in society are rooted in a biomedical paradigm. These strategies are located downstream, managing persistent pain once it has become a problem. Upstream activities that create social conditions to promote health and well-being are likely to help, yet health promotion discourse and research are lacking in pain literature. In this article, we argue that the subjective nature of pain has not sat comfortably with the objective nature of medical practice. We argue that the dominance of the biomedical paradigm, with a simplistic 'bottom-up' model of pain being an inevitable consequence of tissue damage, has been detrimental to the health and well-being of people living with persistent pain. Evidence from neuroscience suggests that bodily pain emerges as a perceptual inference based on a wide variety of contextual inputs to the brain. We argue that this supports community, societal and environmental solutions to facilitate whole-person care. We call for more salutogenic orientations to understand how people living with persistent pain can continue to flourish and function with good health. We suggest a need for 'upstream' solutions using community-based approaches to address cultural, environmental, economic and social determinants of health, guided by principles of equity, civil society and social justice. As a starting point, we recommend appraising the ways human society appreciates the aetiology, actions and solutions towards alleviating persistent pain.
减轻社会持续性疼痛负担的策略根植于生物医学模式。这些策略位于下游，管理一旦成为问题的持续性疼痛。然而，在疼痛文献中缺乏促进健康和福祉的上游活动的论述和研究，这些活动创造了促进健康和福祉的社会条件。在本文中，我们认为疼痛的主观性与医学实践的客观性不太契合。我们认为，生物医学模式的主导地位，以及将疼痛的简单“自下而上”模型视为组织损伤的必然结果，已经对患有持续性疼痛的人的健康和福祉造成了损害。神经科学的证据表明，身体疼痛是基于大脑对各种情境输入的感知推断而出现的。我们认为，这支持社区、社会和环境解决方案，以促进全面关怀。我们呼吁采取更多的健康促进取向，以了解患有持续性疼痛的人如何继续保持健康和功能良好。我们建议需要采用基于社区的方法来解决健康的文化、环境、经济和社会决定因素，以公平、公民社会和社会正义原则为指导，以“上游”的方法来解决问题。作为一个起点，我们建议评估人类社会对缓解持续性疼痛的病因、行动和解决方案的认识方式。
