Do we need an updated definition of pain?

Do we need an updated definition of pain? In 1996 Anand and Craig [1] asked for “a new perspective on the definition of pain”, criticizing the IASP-definition from 1979 [2]. In 2008 the IASP council, however, “after a spirited discussion”, saw no need to alter the definition because it “has proven very useful and is an appropriate one” [3]. Nevertheless, Williams and Craig [4] quite recently reiterated that an updating of the definition is necessitated by recent advances in the understanding of pain. No one would disagree that pain research and therapy have made progress during the past years and that we need a better understanding of persistent pain in particular. Yet, the strive for a more comprehensive and precise definition of pain is in my view misguided and will not lead to a deeper understanding of pain as a phenomenon, nor will it be helpful clinically.Firstly – like many other everyday words - pain does not lend itself to a precise definition, and clear thinking is not encouraged by forcing complex phenomena into definitional straightjackets. Merskey [5] in a letter commenting on the Anand And Craig paper [1] expressed this point succinctly: “It is a misdirection of energy to attempt to change the meaning of a word that, so far as I can tell, has been used everywhere - or perhaps almost everywhere - in a particular way for thousands of years. Efforts should rather be directed to a steady improvement in the recognition of probable pain patterns and their predictive value in relation to treatment”. Indeed, we all know what pain is without knowing the definition, and the least problem is to know when we feel pain and for others to understand what we mean when we say, “my knee hurts”, or “I have a splitting headache”. Even though persons may describe their pain experience in many ways, we easily understand that the person feels pain. At a practical level, it is hard to see how a more comprehensive definition of pain would help researchers in designing experiments and selecting patients for clinical studies.Secondly, and more seriously, the updating proposed by W and C [4] confuses rather than clarifies, because they fail to distinguish pain as a feeling from its causes and mechanistic explanations [6]. For example, by introducing “cognitive” and “social” in the definition they confuse the feeling of pain with its multitude of causes and modifying factors. The comment by Whitburn et al. [7] illustrates the futility of trying to find a precise, yet complete definition, by pointing out that the new definition would not include labour pain. Many other examples might be found. Alcock [8] and Wright and Ayede [9] identify a further problem: by removing the phrase “.. .or described in terms of such damage” patients who experience pain without any evidence of tissue damage are excluded from the new definition (e.g. pain induced by hypnotic suggestion). Rather than promoting a deeper understanding of clinical pain, well-intended updates may perpetuate conceptual confusion.In conclusion, a definition of pain cannot be more than an imperfect means of capturing salient aspects of a complex phenomenon, and the current IASP definition suffices for such a purpose. Notably, it avoids confusing pain as a feeling with its multifarious mechanisms and causes.conflict of interest: No conflict of interest.References[1]Anand KJS, Craig KD. New perspectives on the definition of pain. Pain 1996;67:3–6.8895225Anand KJS Craig KD New perspectives on the definition of pain Pain 19966736[2]Merskey H, Albe-Fessard D, Bonica JJ, Carmon A, Dubner R, Kerr FWL, Lindblom U, Mumford JM, Nathan PW, Noordenbos W, Pagni CA, Renaer MJ, Sternbach RA, Sunderland S. Pain terms: a list with definitions and notes on usage. Recommended bythe IASP subcommittee on taxonomy.Pain 1979;6:249–52.Merskey H Albe-Fessard D Bonica JJ Carmon A Dubner R Kerr FWL Lindblom U Mumford JM Nathan PW Noordenbos W Pagni CA Renaer MJ Sternbach RA Sunderland S Pain terms: a list with definitions and notes on usage Recommended bythe IASP subcommittee on taxonomy.Pain 1979624952[3]Loeser JD, Treede R-D. The Kyoto protocol of IASP basic pain terminology. Pain 2008;137:473–7.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000258359500005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f31858304810.1016/j.pain.2008.04.025Loeser JD Treede R-D The Kyoto protocol of IASP basic pain terminology Pain 20081374737[4]Williams ACde C, Craig KD. Updating the definition of pain. Pain 2016;157:2420–3.10.1097/j.pain.000000000000061327200490http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000386016400006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Williams ACde C Craig KD Updating the definition of pain Pain 201615724203[5]Merskey H. Response to Editorial: New perspectives on the definition of pain. Pain 1996;66:209.Merskey H Response to Editorial: New perspectives on the definition of pain Pain 199666209[6]Brodal P. A neurobiologist’s attempt to understand persistent pain. Scand J Pain 2017;15:140–7.28850339http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000405971800030&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Brodal P A neurobiologist’s attempt to understand persistent pain Scand J Pain 2017151407[7]Whitburn LY, Jones LE, Davey M-A, Small R. Supporting the updated definition of pain. But what about labour pain? Pain 2017;158:990–1.Whitburn LY Jones LE Davey M-A Small R Supporting the updated definition of pain But what about labour pain? Pain 20171589901[8]Alcock MM. Defining pain: past, present and future. Pain 2017;158:760–1.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000400440200024&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Alcock MM Defining pain: past, present and future Pain 20171587601[9]Wright A, Ayede M. Critical comments on Williams and Craig’s recent proposal for revising the definition of pain. Pain 2017;158:362–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000397015500022&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f32809232810.1097/j.pain.0000000000000765Wright A Ayede M Critical comments on Williams and Craig’s recent proposal for revising the definition of pain Pain 20171583623 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Do we need an updated definition of pain?

Free
1 page

Loading next page...
1 Page
 
/lp/degruyter/do-we-need-an-updated-definition-of-pain-JEjfymbjMB
Publisher
De Gruyter
Copyright
© 2017 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2017.08.012
Publisher site
See Article on Publisher Site

Abstract

In 1996 Anand and Craig [1] asked for “a new perspective on the definition of pain”, criticizing the IASP-definition from 1979 [2]. In 2008 the IASP council, however, “after a spirited discussion”, saw no need to alter the definition because it “has proven very useful and is an appropriate one” [3]. Nevertheless, Williams and Craig [4] quite recently reiterated that an updating of the definition is necessitated by recent advances in the understanding of pain. No one would disagree that pain research and therapy have made progress during the past years and that we need a better understanding of persistent pain in particular. Yet, the strive for a more comprehensive and precise definition of pain is in my view misguided and will not lead to a deeper understanding of pain as a phenomenon, nor will it be helpful clinically.Firstly – like many other everyday words - pain does not lend itself to a precise definition, and clear thinking is not encouraged by forcing complex phenomena into definitional straightjackets. Merskey [5] in a letter commenting on the Anand And Craig paper [1] expressed this point succinctly: “It is a misdirection of energy to attempt to change the meaning of a word that, so far as I can tell, has been used everywhere - or perhaps almost everywhere - in a particular way for thousands of years. Efforts should rather be directed to a steady improvement in the recognition of probable pain patterns and their predictive value in relation to treatment”. Indeed, we all know what pain is without knowing the definition, and the least problem is to know when we feel pain and for others to understand what we mean when we say, “my knee hurts”, or “I have a splitting headache”. Even though persons may describe their pain experience in many ways, we easily understand that the person feels pain. At a practical level, it is hard to see how a more comprehensive definition of pain would help researchers in designing experiments and selecting patients for clinical studies.Secondly, and more seriously, the updating proposed by W and C [4] confuses rather than clarifies, because they fail to distinguish pain as a feeling from its causes and mechanistic explanations [6]. For example, by introducing “cognitive” and “social” in the definition they confuse the feeling of pain with its multitude of causes and modifying factors. The comment by Whitburn et al. [7] illustrates the futility of trying to find a precise, yet complete definition, by pointing out that the new definition would not include labour pain. Many other examples might be found. Alcock [8] and Wright and Ayede [9] identify a further problem: by removing the phrase “.. .or described in terms of such damage” patients who experience pain without any evidence of tissue damage are excluded from the new definition (e.g. pain induced by hypnotic suggestion). Rather than promoting a deeper understanding of clinical pain, well-intended updates may perpetuate conceptual confusion.In conclusion, a definition of pain cannot be more than an imperfect means of capturing salient aspects of a complex phenomenon, and the current IASP definition suffices for such a purpose. Notably, it avoids confusing pain as a feeling with its multifarious mechanisms and causes.conflict of interest: No conflict of interest.References[1]Anand KJS, Craig KD. New perspectives on the definition of pain. Pain 1996;67:3–6.8895225Anand KJS Craig KD New perspectives on the definition of pain Pain 19966736[2]Merskey H, Albe-Fessard D, Bonica JJ, Carmon A, Dubner R, Kerr FWL, Lindblom U, Mumford JM, Nathan PW, Noordenbos W, Pagni CA, Renaer MJ, Sternbach RA, Sunderland S. Pain terms: a list with definitions and notes on usage. Recommended bythe IASP subcommittee on taxonomy.Pain 1979;6:249–52.Merskey H Albe-Fessard D Bonica JJ Carmon A Dubner R Kerr FWL Lindblom U Mumford JM Nathan PW Noordenbos W Pagni CA Renaer MJ Sternbach RA Sunderland S Pain terms: a list with definitions and notes on usage Recommended bythe IASP subcommittee on taxonomy.Pain 1979624952[3]Loeser JD, Treede R-D. The Kyoto protocol of IASP basic pain terminology. Pain 2008;137:473–7.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000258359500005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f31858304810.1016/j.pain.2008.04.025Loeser JD Treede R-D The Kyoto protocol of IASP basic pain terminology Pain 20081374737[4]Williams ACde C, Craig KD. Updating the definition of pain. Pain 2016;157:2420–3.10.1097/j.pain.000000000000061327200490http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000386016400006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Williams ACde C Craig KD Updating the definition of pain Pain 201615724203[5]Merskey H. Response to Editorial: New perspectives on the definition of pain. Pain 1996;66:209.Merskey H Response to Editorial: New perspectives on the definition of pain Pain 199666209[6]Brodal P. A neurobiologist’s attempt to understand persistent pain. Scand J Pain 2017;15:140–7.28850339http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000405971800030&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Brodal P A neurobiologist’s attempt to understand persistent pain Scand J Pain 2017151407[7]Whitburn LY, Jones LE, Davey M-A, Small R. Supporting the updated definition of pain. But what about labour pain? Pain 2017;158:990–1.Whitburn LY Jones LE Davey M-A Small R Supporting the updated definition of pain But what about labour pain? Pain 20171589901[8]Alcock MM. Defining pain: past, present and future. Pain 2017;158:760–1.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000400440200024&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Alcock MM Defining pain: past, present and future Pain 20171587601[9]Wright A, Ayede M. Critical comments on Williams and Craig’s recent proposal for revising the definition of pain. Pain 2017;158:362–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000397015500022&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f32809232810.1097/j.pain.0000000000000765Wright A Ayede M Critical comments on Williams and Craig’s recent proposal for revising the definition of pain Pain 20171583623

Journal

Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial