Definition of pain - 3.1.1
Curriculum 3.1.1
Pain (IASP 2020): An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”
...And is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience as pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
Old definition:
Pain (IASP 1979): An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Issues with previous definition:
"Criticisms of the IASP definition include the explicit association of pain with tissue damage, perpetuation of dualistic body–mind thinking and unresolved tension between the primacy of self-report and the privileging of the perspective of the observer"
IASP stated reasons for the change:
- Inability to communicate verbally does not negate an individual experiencing pain
- Pain is always subjective - related to injury in early life.
- Biologists recognise that those stimuli which cause pain are liable to damage tissue
- Accordingly, pain is that experience we associate with actual or potential tissue damage
- It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience.
- Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain.
- Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. - Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons.
- There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report.
- If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain
- This definition avoids tying pain to the stimulus
- Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.
ICD-11 Taxonomy of pain 3.1.1 (Describe in detail the ICD-11 taxonomy of pain)
"The new list of diagnostic codes covers the most common painful clinical entities and divides them into subgroups defined by etiology or affected organ system. The classification further includes a subgroup of conditions primarily characterized by pain whose underlying cause is incompletely understood. "
In ICD 10, a large amount of chronic pain conditions were scattered across the codes - for example migraine was under episodic and paroxysmal disorders, and trigeminal neuralgia was under nerve, nerve root, and plexus disorders (PPM)
The new classification defines chronic pain as persistent or recurrent pain for at least 3 months. ICD-11 distinguishes the main categories of chronic primary pain and chronic secondary pain
Nocebo: Latin 'I will harm'. This is where negative expectations of a patient about a procedure create a more negative effect than it otherwise would have
Nociplastic
Nociceptive
Addiction
Substance use disorder
Dependence
Tolerance
Neuropathic pain
Somatic symptom disorder
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