Given the frustration we feel when attempting to explain our pain experience to others, it’s not surprising that a very popular article on this blog is Libby Parfitt’s ‘Why is it so hard to describe your pain?’. Now, the International Association for the Study of Pain (IASP) propose to change the very definition of ‘pain’ itself – and you are invited to contribute.
In 1979, IASP published their definition of pain, which was derived from a version already in use by many since 1964:
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
Accompanying that definition were notes, which expand upon and seek to further define and explain that definition.
In a number of ways, having that definition was groundbreaking. At the time, it was a major advance to describe pain as an “experience” as opposed to a disease, condition or pathology. Further, at long last there was a sensory and emotional dimension and an accepted link not just to actual, but also to potential tissue damage – the apprehension of tissue damage or the fear that tissue damage might be occurring.
Seeking to define such an emotive term is fraught with risk and even when IASP published that definition 40 years ago, it was not universally accepted. Also, time moves on and what may have been acceptable to many in 1979 has over the years become eroded by our evolving understanding of the processes involved. It’s clearly important that the definition keeps pace with current understanding.
There are a number of criticisms of the existing definition, major ones being:
- It is seen to link pain to tissue damage.
- The accompanying notes state “Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons.” So, although the definition says the emotional dimension is important, it also suggests that if tissue damage cannot be found it must be psychological.
- That pain should not be confused with nociception (the sensory nervous system’s response to certain harmful or potentially harmful stimuli). One of the reasons is that pain is always defined as a subjective experience that arguably exists only in the person that feels it (a first-person perspective). On the other hand, nociception is defined as observable activity in the nervous system in response to an adequate stimulus (a third-person perspective). There is therefore a significant tension between these definitions.
Proposed new definition
Taking all of this on board, the IASP task force have now published their proposed new definition of pain:
“An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.”
As with the existing definition, there are also accompanying notes. Before the new definition is finalised, IASP have invited comments from the wider pain community. Those comments can be submitted via this link and must be received by 11th September 2019.
Over to you!