[The brain today is yesterday's psyche].

Abstract

Despite scientific advances, chronic pain remains difficult to diagnose and treat. For a long time, a dualistic understanding prevailed: pain without an identifiable organic cause was considered psychological in origin, leading to stigmatization and conflict-laden doctor-patient relationships. Imaging techniques often reveal abnormalities even in pain-free individuals, and surgical interventions are frequently unnecessary. Modern pain research understands pain as a complex interplay of biological, psychological, and social factors-not as a simple stimulus-response mechanism. Pain is learned, shaped by experience, and constructed by the brain, influenced by context and expectation. Pain is not the same as nociception; it is not a direct indicator of tissue damage, but rather a perception of potential threat. The new diagnosis of primary pain in ICD-11 integrates biological, psychological, and social factors and expands our treatment framework.