Pain 2016

Updating the definition of pain
Amanda C. Williams, PhD, Kenneth D. Craig, PhD

In this article Williams and Craig suggest modification of the current definition of pain as first defined almost 50 years ago. The current definition as per the International Association for the study of Pain states that “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

They propose the new definition as follows:

“Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components.”

With advances in research a biopsychosocial approach to pain warrants identifying non-tissue related conditions that may be contributing to the pain experience.
“Mounting evidence of neuroplastic changes in peripheral and central nervous systems and the brain during transition from acute to chronic pain supports the wisdom of this decision, acknowledging the reality of pain in the absence of pathophysiological basis.”

Williams & Craig propose 3 modifications to the existing definition. Firstly, the current definition excludes clinical characteristics such as social and cognitive components. Secondly, they mention that characterising pain as simply unpleasant falls short of what may be severe to some, and thirdly, that the current definition neglects nonverbal behaviours… “particularly those whose subjective experience cannot be communicated.” They go on further to describe the “explicit disregard for human cognitive abilities to influence both internal somatic environments… and the external physical and social environment.”

“Failure to acknowledge this feature of pain is a serious problem.”

They end off by saying that the current definition is partial rather than complete. It focuses on self report mostly, at the expense of nonverbal behaviours, which we know today play a major role in pain.

“The argument that reports of pain in the absence of tissue damage or any likely pathophysiological cause are probably psychological is outdated; neuroplasticity provides an explanation and supports the recommendations in the note to attend to subjective experience.”

Full article HERE