UCSF

Throughout much of clinical history, those working within the arena of pain medicine have conceptualized pain as a musculoskeletal problem. Clinicians adhered to biomechanical explanatory models of pain, seeking out an underlying corporeal source and targeting the body as a site of intervention. Recently, however, some pain specialists have begun to promote the notion that pain is an output of the brain, rather than an input of the tissue. This shift is occurring in relation to both an opioid-related overdose crisis, in which the biomedical community is searching for new solutions to chronic pain, and a neurocognitive turn, in which neuroscientific explanatory models of pathology are gaining popular and clinical authority. In this dissertation, I trace the ways in which pain is being newly biomedicalized, or neuroscientized, alongside these trends. I follow neuroscientific understandings of pain as they travel through the overlapping biomedical domains of production, dissemination, and uptake, arguing that a neuroscientization of pain repositions patient agency and responsibility.

Drawing upon interviews with pain neuroscientists and clinicians, as well as ethnographic observations conducted in a neuroimaging pain laboratory, two medical schools, and three clinical pain groups, I trace the policies, discourses, and subjects that both constitute and are constituted by these transformations occurring in pain medicine. I first explore the domain of production, demonstrating the means by which pain is produced as a neuroscientific object. Here, I argue that the structures of the scientific process of inquiry necessarily limit and restrict the various subjectivities inherent in pain by describing how pain scientists go about disciplining complexity. Next, I examine the domain of dissemination, drawing on descriptions of the opioid crisis and its proposed solutions in order to characterize them as thoroughly biopolitical in nature, attending to its focus on risk and production of specific subjectivities, the surrounding politics of knowledge production, and the flattening of complexity as policies and clinical discourses simplify both opiates and pain patients. Lastly, I attend to the domain of uptake, examining the ways in which neural and plasticity discourses are taken up in clinical settings, shaping notions of patienthood by invoking a simultaneous opportunity for optimization and obligation for self-regulation. Taken together, this dissertation asserts that a biopolitical transformations in pain medicine are producing new understandings of what pain is, how it should be managed, and who stands to benefit from these new configurations.