Chronic pain from the perspective of health: A view based on systems theory

Envisaging the phenomenon of pain within the concept of systems theory, different, mutually coherent system levels can be noted of interest, namely the existential person level, the psychological behavioural level and the organismal neurophysiological level. Viewed from this angle, and considering pain to be a signal indicating the whole system's integrity being threatened, the experience of pain can be seen as associated with an intrinsic system function: the pain function. This function is initiated in painful conditions with respect to the system as a whole, rather than being a symptomatic phenomenon lodged--in terms of cause and effect--in distinct system levels. The syndrome of chronic pain may therefore be regarded as a specific state resulting from a pathological derangement in the course of that function. In respect of the different ways in which the system, by way of this function, can cope with a painful event, various possible correlations may be pointed out with regard to the conditions of the system levels in concern. As to the specific course of the pain function--the system's 'answer' to the threatening condition--the pre-existing state of system's integrity can be proposed to be of major importance; the integrity being in clinical terms consonant with a given state of 'health'. Thus chronic pain may be considered as a pathological state resulting from the reaction to painful conditions of an already unhealthy individual. In view of this concept on (chronic) pain several implications can be pointed out with regard to the leading notions on chronic pain, as well as to the general therapeutic approach to be considered.