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The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises
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The current International Association for the Study of Pain (IASP) definition of pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” was recommended by the Subcommittee on Taxonomy and adopted by the IASP Council in 1979. This definition has become accepted widely by health care professionals and researchers in the pain field and adopted by several professional, governmental, and nongovernmental organizations, including the World Health Organization. In recent years, some in the field have reasoned that advances in our understanding of pain warrant a reevaluation of the definition and have proposed modifications. Therefore, in 2018, the IASP formed a 14-member, multinational Presidential Task Force comprising individuals with broad expertise in clinical and basic science related to pain, to evaluate the current definition and accompanying note and recommend whether they should be retained or changed. This review provides a synopsis of the critical concepts, the analysis of comments from the IASP membership and public, and the committee's final recommendations for revisions to the definition and notes, which were discussed over a 2-year period. The task force ultimately recommended that the definition of pain be revised to “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and that the accompanying notes be updated to a bulleted list that included the etymology. The revised definition and notes were unanimously accepted by the IASP Council early this year.
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Pain is not only a physical sensation but also an emotional experience influenced by emotions such as anxiety or fear.
“The International Association for the Study of Pain also establishes a relationship between fear-painknowledge, as they state that pain not only represents the sensation of physical harm, but also an emotional experience that can be influenced by other emotions, such as anxiety or fear of the unknown [53].”
From Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis (2024) · cites this paper as [53]
The section on the initial recommendation to the IASP Council (page unavailable) defines pain as a sensory and emotional experience and says psychological factors can influence it. That supports the central point, but the cited passages do not specifically identify anxiety, fear, or fear of the unknown as influences on pain. (LLM, conf=0.85)
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“Pain arising from DPN is categorized as neuropathic pain that is a direct consequence of a lesion or disease in the somatosensory nervous system and may occur without tissue damage [20].”
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Zhu, H., Guan, A., Liu, J., Li, P., Zhang, Z., & Wang, S. (2023) · Journal of Neuroinflammation · doi:10.1186/s12974-023-02901-y · Cited by 91
“Physical, mental or emotional pain have expanded the definition of pain and recently all of these have been included in personal emotional experience [269].”
BackgroundGrassini, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19074071 · Cited by 87
Kovačević, I., Pavić, J., Filipović, B., Vulinec, Š. O., Ilić, B., & Petek, D. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21091135 · Cited by 121
“In 2020, the International Association for the Study of Pain (IASP) adopted a revised definition of pain: “an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage” [14].”
BackgroundSalimi, M., Mosca, S., Gardner, B., Palombo, F., Matousek, P., & Stone, N. (2022) · Nanomaterials · doi:10.3390/nano12060922 · Cited by 84
Vieira, W. F., Coelho, D. R. A., Litwiler, S. T., McEachern, K. M., Clancy, J. A., Morales-Quezada, L., & Cassano, P. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105673 · Cited by 91
Brain mechanisms of chronic pain: critical role of translational approach
Barroso, J., Branco, P., & Apkarian, A. V. (2021) · Translational research · doi:10.1016/j.trsl.2021.06.004 · Cited by 91
Li, Y., Yin, K., Diao, Y., Fang, M., Yang, J., Zhang, J., Cao, H., Liu, X., & Jiang, J. (2022) · Nanoscale · doi:10.1039/d1nr07896h · Cited by 80
What Do We Know about Nociplastic Pain?
Bułdyś, K., Górnicki, T., Kałka, D., Szuster, E., Biernikiewicz, M., Markuszewski, L., & Sobieszczańska, M. I. (2023) · Healthcare · doi:10.3390/healthcare11121794 · Cited by 101
“Another Cochrane review showed that, in the case of LBP, there are no significant differences between selective and non-selective NSAIDs [110].”
BackgroundInfluentialSensory Abilities of Horses and Their Importance for Equitation Science
Rørvang, M. V., Nielsen, B. L., & McLean, A. N. (2020) · Frontiers in Veterinary Science · doi:10.3389/fvets.2020.00633 · Cited by 80
Individual variability in brain representations of pain
Kohoutová, L., Atlas, L. Y., Büchel, C., Buhle, J. T., Geuter, S., Jepma, M., Koban, L., Krishnan, A., Lee, D. H., Lee, S., et al. (2022) · Nature Neuroscience · doi:10.1038/s41593-022-01081-x · Cited by 79
Jang, K., & Garraway, S. M. (2024) · Neurobiology of Pain · doi:10.1016/j.ynpai.2024.100151 · Cited by 83
“Pain can be broadly defined as adaptive or maladaptive and is composed of a perceptive, reflexive component as well as an affective and emotional component (Melzack & Casey, 1968; Raja et al., 2020).”
BackgroundChronic Visceral Pain: New Peripheral Mechanistic Insights and Resulting Treatments
Ford, A. C., Vanner, S. J., Kashyap, P., & Nasser, Y. (2024) · Gastroenterology · doi:10.1053/j.gastro.2024.01.045 · Cited by 87
Jayathilake, N. J., Phan, T. T., Kim, J., Lee, K. P., & Park, J. M. (2025) · Experimental & Molecular Medicine · doi:10.1038/s12276-025-01409-0 · Cited by 90
Broomé, S., Feighelstein, M., Zamansky, A., Lencioni, G. C., Andersen, P. H., Pessanha, F., Mahmoud, M., Kjellström, H., & Salah, A. A. (2022) · International Journal of Computer Vision · doi:10.1007/s11263-022-01716-3 · Cited by 92
Cracking the enigma of adenomyosis: an update on its pathogenesis and pathophysiology
Guo, S. (2022) · Reproduction · doi:10.1530/rep-22-0224 · Cited by 93
Chen, J., Wang, X., & Xu, Z. (2023) · Journal of Pain Research · doi:10.2147/jpr.s416253 · Cited by 81
“Pain is defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with or similar to actual or potential tissue damage.(7) Chronic pain, which lasts for three months or longer, affects over 30% of people worldwide and is prevalent in older popula…”
BackgroundHadland, S. E., Agarwal, R., Raman, S. R., Smith, M. J., Bryl, A. W., Michel, J. J., Kelley‐Quon, L. I., Raval, M. V., Renny, M. H., Larson-Steckler, B., et al. (2024) · PEDIATRICS · doi:10.1542/peds.2024-068752 · Cited by 77
Pain and the field of affordances: an enactive approach to acute and chronic pain
Coninx, S., & Stilwell, P. (2021) · Synthese · doi:10.1007/s11229-021-03142-3 · Cited by 81
Incorporation of “Artificial Intelligence” for Objective Pain Assessment: A Comprehensive Review
El-Tallawy, S. N., Pergolizzi, J. V., Vasiliu-Feltes, I., Ahmed, R. S., LeQuang, J. A., El-Tallawy, H. N., Varrassi, G., & Nagiub, M. S. (2024) · Pain and Therapy · doi:10.1007/s40122-024-00584-8 · Cited by 89
Prati, J. M., Pontes‐Silva, A., & Gianlorenço, A. C. (2024) · Behavioural Brain Research · doi:10.1016/j.bbr.2024.114933 · Cited by 79
Not All Pain is Created Equal: Basic Definitions and Diagnostic Work-Up
Bonezzi, C., Fornasari, D., Cricelli, C. A., Magni, A., & Ventriglia, G. (2020) · Pain and Therapy · doi:10.1007/s40122-020-00217-w · Cited by 80
What is pain: Are cognitive and social features core components?
Craig, K. D., & MacKenzie, N. E. (2021) · Paediatric and Neonatal Pain · doi:10.1002/pne2.12046 · Cited by 86
EEG Recordings as Biomarkers of Pain Perception: Where Do We Stand and Where to Go?
Zis, P., Liampas, A., Artemiadis, A., Tsalamandris, G., Neophytou, P., Unwin, Z., Kimiskidis, V. Κ., Hadjigeorgiou, G. M., Varrassi, G., Zhao, Y., et al. (2022) · Pain and Therapy · doi:10.1007/s40122-022-00372-2 · Cited by 71
Kimura, L. F., Novaes, L. S., Picolo, G., Munhoz, C. D., Cheung, C. W., & Camarini, R. (2021) · British Journal of Pharmacology · doi:10.1111/bph.15584 · Cited by 74
Representation and control of pain and itch by distinct prefrontal neural ensembles
Pan, Q., Guo, S.-S., Chen, M., Su, X., Gao, Z., Wang, Q., Xu, T., Liu, M., & Hu, J. (2023) · Neuron · doi:10.1016/j.neuron.2023.04.032 · Cited by 73
Sailer, U., & Leknes, S. (2022) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2021.101099 · Cited by 69
What Is It Like to Be a Bass? Red Herrings, Fish Pain and the Study of Animal Sentience
Mason, G. J., & Lavery, J. M. (2022) · Frontiers in Veterinary Science · doi:10.3389/fvets.2022.788289 · Cited by 80
Neuroplasticity in the transition from acute to chronic pain
Song, Q., Sihan, E., Zhang, Z., & Liang, Y. (2024) · Neurotherapeutics · doi:10.1016/j.neurot.2024.e00464 · Cited by 69
Mota‐Rojas, D., Marcet‐Rius, M., Ogi, A., Hernández-Ávalos, I., Mariti, C., Martı́nez-Burnes, J., Mora‐Medina, P., Casas-Alvarado, A., Domínguez-Oliva, A., Reyes-Sotelo, B., et al. (2021) · Animals · doi:10.3390/ani11113334 · Cited by 69
Cancer cachexia: Pathophysiology and association with cancer-related pain
Law, M. L. (2022) · Frontiers in Pain Research · doi:10.3389/fpain.2022.971295 · Cited by 71
Towards Machine Recognition of Facial Expressions of Pain in Horses
Andersen, P. H., Broomé, S., Rashid, M., Lundblad, J., Ask, K., Li, Z., Hernlund, E., Rhodin, M., & Kjellström, H. (2021) · Animals · doi:10.3390/ani11061643 · Cited by 68
The Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice
Marcianò, G., Vocca, C., Evangelista, M., Palleria, C., Muraca, L., Galati, C., Monea, F., Sportiello, L., Sarro, G. D., Capuano, A., et al. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15041165 · Cited by 80
“The International Association for the Study of Pain (IASP) describes chronic pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage [1].”
BackgroundAdult Cancer Pain, Version 2.2025, NCCN Clinical Practice Guidelines In Oncology
Swarm, R. A., Youngwerth, J. M., Agne, J. L., Anițescu, M., Are, M., Buga, S., Butler, T., Chwistek, M., Cleary, J. F., Copenhaver, D. J., et al. (2025) · Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2025.0032 · Cited by 79
Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement
Demoule, A., Decavèle, M., Antonelli, M. M., Camporota, L., Abroug, F., Adler, D., Azoulay, É., Başoğlu, M., Campbell, M., Grasselli, G., et al. (2024) · Intensive Care Medicine · doi:10.1007/s00134-023-07246-x · Cited by 71
“The inability to verbally or physically report a symptom does not mean that its source is not present and does not cause suffering, as clearly acknowledged about pain [11].”
InfluentialDance for Chronic Pain Conditions: A Systematic Review
Hickman, B., Pourkazemi, F., Pebdani, R. N., Hiller, C. E., & Yan, A. F. (2022) · Pain Medicine · doi:10.1093/pm/pnac092 · Cited by 67
Neuroimmune interactions and osteoarthritis pain: focus on macrophages
Geraghty, T., Winter, D. R., Miller, R. J., Miller, R. E., & Malfait, A. (2021) · PAIN Reports · doi:10.1097/pr9.0000000000000892 · Cited by 67
Welfare of cattle during transport
(AHAW), E. P. O. A. H. A. W., Nielsen, S. S., Alvarez, J., Bicout, D. J., Calistri, P., Canali, E., Drewe, J. A., Garin‐Bastuji, B., Gonzales Rojas, J. L., Gortázar Schmidt, C., et al. (2022) · EFSA Journal · doi:10.2903/j.efsa.2022.7442 · Cited by 64
The Interplay between Chronic Pain, Opioids, and the Immune System
Malafoglia, V., Ilari, S., Vitiello, L., Tenti, M., Balzani, E., Muscoli, C., Raffaeli, W., & Bonci, A. (2021) · The Neuroscientist · doi:10.1177/10738584211030493 · Cited by 64
The Similar and Distinct Roles of Satellite Glial Cells and Spinal Astrocytes in Neuropathic Pain
McGinnis, A., & Ji, R. (2023) · Cells · doi:10.3390/cells12060965 · Cited by 67
The NLRP3 inflammasome: role in the pathobiology of chronic pain
Chen, C., & Smith, M. T. (2023) · Inflammopharmacology · doi:10.1007/s10787-023-01235-8 · Cited by 64
Basic Mechanisms of Pain in Osteoarthritis
Malfait, A., Miller, R. E., & Miller, R. J. (2021) · Rheumatic Disease Clinics of North America · doi:10.1016/j.rdc.2020.12.002 · Cited by 63
Aboushaar, N., & Serrano, N. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1445280 · Cited by 76
Clinical validation of the short and long UNESP-Botucatu scales for feline pain assessment
Belli, M., de Oliveira, A. R., de Lima, M. T., Trindade, P. H. E., Steagall, P. V. M., & Luna, S. P. L. (2021) · PeerJ · doi:10.7717/peerj.11225 · Cited by 64
Wandner, L. D., Domenichiello, A. F., Beierlein, J. M., Pogorzala, L., Aquino, G., Siddons, A., Porter, L. L., & Atkinson, J. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.08.005 · Cited by 64
dos Reis, F. J. J., Nijs, J., Parker, R., Sharma, S., & Wideman, T. H. (2022) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2022.100442 · Cited by 66
The biopsychosocial model of pain in physiotherapy: past, present and future
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Electrical stimulation for therapeutic approach
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Reasons to Be Skeptical about Sentience and Pain in Fishes and Aquatic Invertebrates
Diggles, B. K., Arlinghaus, R., Browman, H. I., Cooke, S. J., Cooper, R. L., Cowx, I. G., Derby, C. D., Derbyshire, S. W. G., Hart, P. J. B., Jones, B., et al. (2023) · Reviews in Fisheries Science & Aquaculture · doi:10.1080/23308249.2023.2257802 · Cited by 65
“This wording was revised from the previous definition because it could have excluded those unable to verbally articulate their pain such as infants, elderly people, and non-human animals (Raja et al. 2020; IASP 2020).”
BackgroundThe Relationship Between Pain and Interoception: A Systematic Review and Meta-Analysis
Horsburgh, A., Summers, S. J., Lewis, A., Keegan, R. J., & Flood, A. P. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.341 · Cited by 70
Metadata
- Authors
- Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X.-J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K.
- Affiliations
- Johns Hopkins University (US)
- Tufts University (US)
- UNSW Sydney (AU)
- Aarhus University (DK)
- Heidelberg University (DE)
- The University of Melbourne (AU)
- Duke University (US)
- McGill University (CA)
- University of Iowa (US)
- Southern University of Science and Technology (CN)
- University of Toronto (CA)
- University of Washington (US)
- Dalhousie University (CA)
- Aichi Medical University (JP)
- Queen's University (CA)
- Corresponding author
- Raja, Srinivasa N.
- ORCID
- Venue
- Pain
- Published
- 2020-09
- Volume
- 161
- Issue
- 9
- Pages
- 1976-1982
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC7680716
- OpenAlex
- W3043476716
- Cited by
- 5,223
- References
- 34
- Citations by year
- 2026: 930 · 2025: 1042 · 2024: 1021 · 2023: 905 · 2022: 757 · 2021: 484 · 2020: 78
- FWCI
- 70.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- other-oa
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG064201, R01AG058702)
- National Cancer Institute (UG1CA189824)
- National Institute of Nursing Research (U2CNR014637, U24NR014637)
- National Institute of Neurological Disorders and Stroke (R01NS097221, R01NS026363, U24NS112873)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR073187, R01AR070875, UG3AR076387)
- National Center for Complementary and Integrative Health (U24AT010961, U24AT009676)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Social Sciences › Arts and Humanities › History and Philosophy of Science › Medicine, History, and Philosophy
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- pain definition, International Association for the Study of Pain, pain classification, concept of pain, tissue damage
- MeSH terms
- Humans, Pain
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