From symptom to disease: a Fleckian comparative epistemology of the conceptualization of chronic pain

Although pain is considered a central object of medicine, it remains poorly under-stood. This is especially true for chronic pain conditions, in which an underlying cause often cannot or can no longer be found. Over the past decades, new scien-tific, technological, and social developments have led to the reconceptualization of chronic pain. In the latest edition of the International Classification of Diseases (ICD-11), chronic pain conditions are ascribed to a separate nosological category. Importantly, cases of chronic primary pain are now defined as a 'disease in its own right'. This is in stark contrast to how pain has traditionally been understood in medicine: as a symptom/sign of tissue damage. While this conceptual shift is con-sidered an important landmark in pain medicine, the reconceptualization of chronic pain has also been criticized. This is especially so because the conceptual shift was primarily explained by its practical benefits, while the etiology and patho-physiological mechanism remain unclear. Hence, the disease status of chronic pain remains unclear. In this paper, we argue that the understanding of chronic pain as a disease can be defended from a philosophical pragmatist perspective. By looking through the lens of philosopher of science Ludwik Fleck, we demonstrate that (1) the problematic status of chronic pain is historically contingent upon the mecha-nistic 'Cartesian' conceptualization of pain, but not problematic in itself; and (2), the view of chronic (primary) pain as a disease in its own right can be justified on pragmatist grounds