From treating the body as a machine to the contemporary obsession with neuroscience, hidden philosophical assumptions are exposed when we think about pain and its treatment. A new conceptualisation called the enactive approach brings together advances in phenomenology and cognitive science and puts the patient and their future at the centre. Peter Stilwell and Sabrina Coninx make the case for a new medical paradigm for pain. 

Acute pains, such as the immediate unpleasant experience of stubbing a toe, last for a relatively short duration. In contrast, pains that recur or persist are labelled as chronic and are associated with enormous personal and economic impacts. Unfortunately, we are far from understanding why many pains persist and how they are best treated. Chronic pain often has no apparent injury or pathology to help explain its occurrence, leaving many patients asking: why does it still hurt?

Common responses to this question are viewed as unsatisfactory to patients. People with chronic pain are often left feeling confused, broken, and frustrated after receiving differing explanations and promises of cures or fixes that don’t materialize. Further, pain without a demonstrable objective problem in the body is viewed by many outsiders (e.g., clinicians, friends, family) as less real, and people are stigmatized as a result. Feelings of shame, invalidation, and suicidality among people with chronic pain are clear indicators that we need to do better.