Biopsychosocial Pain Research in America: The Veterans Health System Leads the Way

Abstract

The pleasure I experience in reading this special issue of Pain Medicine , co-edited so capably by Drs. Bob Kerns and Steve Dobscha, comes not just from the intellectual stimulation of the studies themselves. As a now senior professional in pain medicine, just by reading the table of contents I immediately appreciate the cross-disciplinary academic breadth and quality of the research herein, and the progress we have made over the years. The titles represent traditional domains of our exciting biomedical enterprise, such as modulation of molecular mechanisms, gene therapies, symptom and psychophysiologic measurement, and the epidemiology of disease and illness. However, there are also articles in domains of relevance to our national debate on the organization of health care services, for example, in the sociomedical sciences such as studies of provider and practice factors, barriers to care, and the culture of medicine. If I reflect on where we started several decades ago, we should gain satisfaction in how far our research enterprise has progressed. Pain medicine is really the first specialty to operationally fully embrace the biopsychosocial model in its scientific and clinical enterprise, as George Engel intended; not just brain–mind as in psychiatry and behavioral neuroscience, or body–brain as in neurology, but how the dynamic relationship of mind, brain, and body interacts longitudinally with the environment to influence the course and outcome of pain and pain disorders and diseases. Long before cardiology “discovered” the severe impact of depression on outcomes of cardiac disease and the impact of behaviors on cardiac disease, pain clinicians had translated pain science into clinical teams with a strong biobehavioral clinical enterprise. Pain medicine emerged as a specialty fundamentally …