Chronic Pain and the Redistribution of Epistemic Power: From Technological Reductionism to Clinical Generalism

Abstract

Chronic pain is a highly prevalent condition with major impact on disability, quality of life, and healthcare system sustainability. The reductionist biomedical paradigm, focused on tissue injury and pharmacological suppression of symptoms, has revealed significant explanatory and therapeutic limitations, contributing to clinical, social, and cultural iatrogenesis. Through a genealogical analysis, this paper examines the historical evolution of pain from the premodern "domesticated pain" to the mechanistic modern "wild pain." The current crisis of chronic pain is argued to be fundamentally epistemic. Gate Control Theory and contemporary models of central sensitization support a more integrative paradigm in which pain is understood as a complex and modifiable experience. Within this framework, primary care-grounded in clinical generalism and longitudinal continuity-emerges as the structural setting best suited to redistribute epistemic power and reorient care toward functionality, autonomy, and quality of life rather than mere symptom suppression.