Updating the
definition of pain
Amanda C de C Williams
University College London and
Kenneth D Craig
University of British Columbia
IASP definition of pain: An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage (1979).
Strengths
:• Applies to acute and chronic pain
• Emphasises subjective experience
• Does not require evidence of tissue damage or pathology
• Gives weight to sensory and emotional aspects
• Applicable in scientific and clinical settings
IASP definition of pain: An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage.
Problems:
• Clinical pain is almost always more than
“unpleasant”
• Refers only to sensory and emotional qualities, neglecting important features
• The final phrase, “or described in terms of
such damage” is ambiguous
Problems:
• Clinical pain is almost always more than “unpleasant”
• The final phrase, “or described in terms of such damage” is ambiguous
• Refers only to sensory and emotional qualities, neglecting important features
[Pain is] An unpleasant sensory and emotional experience
Pain is a distressing experience
associated with actual or potential tissue damage, or described in terms of such damage.
with sensory, emotional, cognitive and social components.
Pain is a distressing experience associated with actual or potential tissue damage, with sensory, emotional, cognitive and social components.
Improvements:
• Adds cognitive and social components seen in human and nonhuman animals
– Cognitive neuroscience highlights attention, memory, appraisal, descending modulation
– Personal narratives highlight social contexts: family, work, participation
• Removes unnecessary reference to self-report in use of the word “describes”
We would also revise the Note that qualifies the definition:
• We would shorten it, and remove inconsistencies
• As before, the Note specifies assessment
methods for different circumstances and needs
Conclusion
Pain science and practice need an improved definition.
We hope to contribute to this through active discussion and debate of our proposal.
