Pitfalls of the medical paradigm in chronic pelvic pain

This article reviews specific clinical and philosophical problems in the medical and psychiatric literature on chronic pelvic pain since 1993. The problem of the dichotomy of 'organic' and 'psychogenic' pain has been well established in previous literature. The aim here is to consider recent developments purporting to respond to the impasse presented by this dichotomy. An evaluation of emergent trends towards multi-disciplinarity, and the 'biopsychosocial model' is developed. The resulting pitfalls discussed include the failure to develop understandings of the 'subjective' aspects of pain, the tendency to reduce causal processes to 'mechanisms', and the tendency to consider the psychosocial as purely reactive to the biological, inevitably positioned as prior. It is argued that these trends are only partial solutions to the problems and do not fully address the issues at stake. A greater diversity of theoretical and empirical perspectives needs to be introduced into medical research on chronic pelvic pain.