Maldynia: chronic pain as illness, and the need for complementarity in pain care.

An expanding epistemology has generated enhanced understanding of the mechanistic basis and existential impact of pain as a complexity-based systems event, and compels the need to develop diagnostic and therapeutic approaches that reflect this progressive knowledge. The basic and clinical sciences, humanities and the experiential narratives of patients all contribute essential lenses through which we can examine and de-mystify the enigma of persistent pain. It is only through the combination of distinct domains of knowledge that we can both comprehend pain as a dysfunction of the dynamical, non-linear adaptability of the nervous system, and at the same time apprehend the manifestations of these changes within the networked-hierarchy of interacting systems that is the patient as person. These are concepts that are inherent to, and derived from complexity theory, and the use of a complexity-based model of pain may be important to fully reconcile the notions of disease and illness, and fit these within a more encompassing framework. Thus, the study of pain conjoins neuroscience to the burgeoning discourse of neurophilosophy, and in so doing, may allow a more thorough dialectical approach to addressing concepts of disease-illness, brain-mind, and ethical dimensions of care. 2008 S. Karger AG, Basel