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Our understanding of pain has always been derived from reductionist and inaccurate thought processes.
Beginning with the Cartesian body-mind dualistic perspective and even transitioning into the biopsychosocial model, we try to reduce pain into a specific classification mainly focusing on pathoanatomical (biological) causes of pain while neglecting any other psychosocial influences.
In order to reconceptualize pain into a new framework, the enactive approach was proposed which aims to understand pain while avoiding any dichotomization or trichotomization classification, along with incorporating a first-person experience.
Stilwell and Harman have eloquently illustrated the enactive approach by discussing the 5 E’s of Pain:
👉Embodied - Recognizing that experiences [pain] are not only physical in nature but are shaped by the physical, cognitive, and social immersion depending on space, time, and ultimately future action
👉Embedded - Interpreting each situation based on the background contexts and surrounding environment
👉Enactive - A relational interaction between the body, brain, and environment that shapes a meaningful world that is determined by the goals, needs, and capacity of the former
👉Emotive - A way we engage with, interpret, and make sense of the world through 'desiderative feelings of affective framing'
👉Extended - A coupling of biological processes with external processes that shape and contribute towards our consciousness and cognition
“Saying that pain is in the brain is like saying flight is in a bird’s wings. A brain is needed to have pain and wings are needed to fly – but to understand pain or flight, one needs to consider the whole picture and the relational nature between things like a person (with a body/brain) and their social/environmental context; or the bird and the atmosphere. It follows that the experience of pain will not be found in the blood, brain, or other bodily tissues. The tissues in the body or the networks in the brain are not the key to pain – instead, they are pieces of a larger system that is adapting and striving to sustain into the future. This always involves the environment that we shape and that shapes us.”
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