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Should Chronic Pain be Redefined?

May 24, 2018
A proposed updated description may account for the intersubjective experience of an individual's pain.

A PPM Brief

Earlier this spring, PAIN Reports - a scholarly journal of the International Association for the Study of Pain (IASP) -  published a paper suggesting a revised definition of pain. Led by Milton Cohen, MD, the authors reviewed the history of the IASP definition for pain and its revisions over a period of 40 years. The definition put forth in 1979 was: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

In their review, the authors reported on common criticisms of the definition including the unsatisfactory nature of the term “unpleasant,” the perpetuation of outdated thinking (ie, implying that pain is either real/in the body or imagined/in the mind), that pain is a singular experience, reliance on self-report, and so forth.

The authors found that a greater scope should be applied to defining pain to include its phenomenology, social intersubjective space, and existing language limitations around the world. They ultimately proposed a new definition: “Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.” (Of note, the authors' proposal does not represent a formal IASP opinion or revision; the IASP definition has not changed.)

Concluded the authors: "Not everyone who experiences pain will wish to share that experience with others, including health professionals, or agree that their bodily and/or existential integrity are threatened. But, not everyone who experiences pain presents as a patient seeking assistance from those in the health professions. It is to the clinical situation that the proposed definition is intended to apply."
 

What’s your take? Email ppmeditorial@verticalhealth.com. See others' comments below.

Thank you for opening this up for opinion. I thought I’d offer some commentary on the idea of changing the 1979 definition of pain. I still think it is appropriate. Most patients find pain unpleasant, and the physical/somatic experience, as well as the psychological component of pain, play heavily into the patient’s pain experience. Plus, at this point in time, it’s their experience along with their individualized report of pain we try to manage. Thus, I prefer the current definition. It still fits well with the patients I see and the nurses I teach. Regards, -Michele Yurgil, MSN, RN, ACNS-BC, APN
Last updated on: June 15, 2018
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