Cited by 5,223Pain Mechanisms and TreatmentsMedicine, History, and PhilosophyPain Management and Treatment

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The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises

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Raja, Srinivasa N., Carr, Daniel B., Cohen, Milton, Finnerup, Nanna B., Flor, Herta, Gibson, Stephen, Keefe, Francis J., Mogil, Jeffrey S., Ringkamp, Matthias, Sluka, Kathleen A., Song, Xue-Jun, Stevens, Bonnie, Sullivan, Mark D., Tutelman, Perri R., Ushida, Takahiro, Vader, Kyle·2020·Pain

DOI 10.1097/j.pain.0000000000001939PMC PMC7680716

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Abstract

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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The qualitative content analysis process
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Method
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Self-citation
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Self-citation
Untitled work
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Background
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“Pain can be classified into four primary categories: nociceptive, neuropathic, nociplastic and mixed pain 24 .”
Influential
Social dimensions as explanatory approaches for the development of chronic pain: a meta-ethnography of qualitative studies
Potthoff, S., Koesling, D., & Bozzaro, C. (2025) · International Journal for Equity in Health · doi:10.1186/s12939-025-02560-w · Cited by 20
“The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” and this experience is “always a personal experience” ([49], p. 1977).”
Pain Perception and Modulation: Fundamental Neurobiology and Recent Advances
van Strien, W. W. J., & Hollmann, M. W. (2025) · European Journal of Neuroscience · doi:10.1111/ejn.70275 · Cited by 22
“Pain, on the other hand, is by definition a conscious multidimensional experience (see Box 2) (Raja et al. 2020).”
Single-injection regional analgesia techniques for mastectomy surgery
CASSAI, A. D., Zarantonello, F., Geraldini, F., Boscolo, A., Pasin, L., Pinto, S. D., Leardini, G., Basile, F., Disarò, L., Sella, N., et al. (2021) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001644 · Cited by 16
A practical guide to recognize, assess, treat and evaluate (RATE) primary care patients with chronic pain
Gebke, K. B., McCarberg, B. H., Shaw, E., Turk, D. C., Wright, W. L., & Semel, D. (2022) · Postgraduate Medicine · doi:10.1080/00325481.2021.2017201 · Cited by 20
Effects of acupressure on cancer-related pain management: A systematic review and meta-analysis of randomized controlled trials
Mai, Q.-L., Li, X., Yang, D., Zhang, X., Peng, K., & Hao, Y. (2022) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2022.102120 · Cited by 16
Chronischer Schmerz als existenzielle Herausforderung
Kieselbach, K., Koesling, D., Wabel, T., Frede, U., & Bozzaro, C. (2022) · Der Schmerz · doi:10.1007/s00482-022-00632-2 · Cited by 15
Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies
Demori, I., Molinari, E., Rapallo, F., Mucci, V., Marinelli, L., Losacco, S., & Burlando, B. (2022) · Healthcare · doi:10.3390/healthcare10101975 · Cited by 16
Reliability and Validity of UNESP-Botucatu Cattle Pain Scale and Cow Pain Scale in Bos taurus and Bos indicus Bulls to Assess Postoperative Pain of Surgical Orchiectomy
Tomacheuski, R. M., de Oliveira, A. R., Trindade, P. H. E., de Oliveira, F. A., Candido, C. P., Neto, F. J. T., Steagall, P. V. M., & Luna, S. P. L. (2023) · Animals · doi:10.3390/ani13030364 · Cited by 15
The Relationship Between Chronic Pain, Depression, Psychosocial Factors, and Suicidality in Adolescents
Wildeboer, E. M., Chambers, C. T., Soltani, S., & Noel, M. E. (2023) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001108 · Cited by 16
Neurotechnology for Pain
Fisher, L. E., & Lempka, S. F. (2023) · Annual Review of Biomedical Engineering · doi:10.1146/annurev-bioeng-111022-121637 · Cited by 16
Effects of Exergaming on Musculoskeletal Pain in Older Adults: Systematic Review and Meta-analysis
Mo, N., Feng, J. Y., Liu, H. X., Chen, X. Y., Zhang, H., & Zeng, H. (2023) · JMIR Serious Games · doi:10.2196/42944 · Cited by 19
“The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with or resembling actual or potential tissue damage [1].”
Background
Upper trapezius muscle elasticity in cervical myofascial pain syndrome measured using real-time ultrasound shear-wave elastography
Hao, C.-J., Kang, X.-Y., Kang, C., Li, T., Huo, J.-Z., Xu, Q., Xiao, W.-L., Zhao, Z.-X., Ji, X.-H., & Zhang, Q. (2023) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-22-797 · Cited by 22
The role of evolving concepts and new technologies and approaches in advancing pain research, management, and education since the establishment of the International Association for the Study of Pain
Flor, H., Noguchi, K., Treede, R., & Turk, D. C. (2023) · Pain · doi:10.1097/j.pain.0000000000003063 · Cited by 16
Self-citation
Association between pain and cognitive and daily functional impairment in older institutional residents: a cross-sectional study
Wu, S., Lin, C., Lu, I., Yeh, M.-S., Hsu, C.-C., & Yang, Y. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04337-8 · Cited by 20
“Pain is a subjective experience that involves an unpleas-ant sensory and emotional response, usually associated with actual or potential tissue damage [1].”
Background
The Challenges of Pain Assessment in Geriatric Patients With Dementia: A Review
El-Tallawy, S. N., Ahmed, R. S., Shabi, S. M., Al-Zabidi, F. Z., Zaidi, A. R. Z., Varrassi, G., Pergolizzi, J. V., LeQuang, J. A., & Paladini, A. (2023) · Cureus · doi:10.7759/cureus.49639 · Cited by 18
“Inadequate verbal communication does not rule out the potential that a person is in pain and needs to be offered adequate pain-relieving treatment [7].”
Background
Fibromyalgia is associated with hypersensitivity but not with abnormal pain modulation: evidence from QST trials and spinal fMRI
Staud, R. M., Godfrey, M. M., & Stroman, P. W. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1284103 · Cited by 17
Unveiling the Pain Relief Potential: Harnessing Analgesic Peptides from Animal Venoms
Pereira, A. F. M., Cavalcante, J. S., Angstmam, D. G., de Almeida, C. A. S., Soares, G. S., Pucca, M. B., & Ferreira, R. S. (2023) · Pharmaceutics · doi:10.3390/pharmaceutics15122766 · Cited by 18
Systematic review and co‐ordinate based meta‐analysis to summarize the utilization of functional brain imaging in conjunction with human models of peripheral and central sensitization
Clarke, S., Rogers, R., Wanigasekera, V., Fardo, F., Pia, H., Nochi, Z., Macian, N., Leray, V., Finnerup, N. B., Pickering, G. P., et al. (2024) · European Journal of Pain · doi:10.1002/ejp.2251 · Cited by 17
“Finally, it should be noted that fMRI cannot replace patient-reported outcomes, because pain, by definition is subjective (Davis et al., 2017; Raja et al., 2020).”
Self-citation
Relationship between Pain and Dementia: The Mediating Effect of Depression among Chinese Elderly
Duan, W., Huang, J. H., Huang, Q., & Dong, B. (2024) · Actas Españolas de Psiquiatría · doi:10.62641/aep.v52i2.1530 · Cited by 16
“When pain persists or recurs for more than 3 months, it is characterized as chronic pain [1].”
Background
Radiation-induced Chronic Pain Plagues Head and Neck Cancer Survivors: A Cross-sectional Analysis From the Cohort in Radiotherapy-related Nervous System Complications
Zuo, X., Chen, Y., Zhu, Y., Pan, D., Rong, X., Shen, Q., Li, H., Xu, Y., & Tang, Y. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104612 · Cited by 16
Ruscogenin Exerts Anxiolytic‐Like Effect via Microglial NF ‐ κB / MAPKs / NLRP3 Signaling Pathways in Mouse Model of Chronic Inflammatory Pain
Qi, J., Jin, Y., Wang, X., Yang, L.-K., Lu, L., Yue, J., Yang, F., Liu, Y., Jiang, Y., Song, D., et al. (2024) · Phytotherapy Research · doi:10.1002/ptr.8325 · Cited by 16
“Chronic pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience,” and it may share some similar neural mechanisms with mood disorders (Raja et al. 2020).”
Cellular models of pain: New technologies and their potential to progress preclinical research
Chrysostomidou, P., Cooper, A. H., & Weir, G. A. (2021) · Neurobiology of Pain · doi:10.1016/j.ynpai.2021.100063 · Cited by 20
Intraoperative Nociception Monitoring
Shanthanna, H., Uppal, V., & Joshi, G. P. (2021) · Anesthesiology Clinics · doi:10.1016/j.anclin.2021.03.008 · Cited by 16
King’s Parkinson’s Disease Pain Scale (KPPS): Cross-cultural adaptation to Brazilian Portuguese and content validity
Coimbra, M. R., Almeida‐Leite, C. M., Faria‐Fortini, I., Christo, P. P., & Scalzo, P. L. (2021) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2021.106815 · Cited by 16
Nozizeptionsmonitoring
Nitzschke, R., Fischer, M., & Funcke, S. (2021) · Der Anaesthesist · doi:10.1007/s00101-021-01022-6 · Cited by 16
Cross-Validation of the Foundation Pain Index with PROMIS-29 in Chronic Pain Patients
Pope, J. E., Fishman, M. A., Gunn, J., Cotten, B. M., Hill, M. M., & Deer, T. R. (2021) · Journal of Pain Research · doi:10.2147/jpr.s314021 · Cited by 16
Lamiaceae in Mexican Species, a Great but Scarcely Explored Source of Secondary Metabolites with Potential Pharmacological Effects in Pain Relief
Hernández-León, A., Moreno-Pérez, G. F., Martínez-Gordillo, M. J., Aguirre-Hernández, E., Valle-Dorado, M. G., Díaz‐Reval, I., González-Trujano, M. E., & Pellicer, F. (2021) · Molecules · doi:10.3390/molecules26247632 · Cited by 18
Effects of Botulinum Toxin Type A on the Psychosocial Features of Myofascial Pain TMD Subjects: A Randomized Controlled Trial
Canales, G. D. L. T., Poluha, R. L., Pinzón, Y., Conti, P. C. R., Manfredini, D., Sánchez‐Ayala, A., & Rizzatti‐Barbosa, C. M. (2021) · Journal of Oral & Facial Pain and Headache · doi:10.11607/ofph.2917 · Cited by 16
Neonates as intrinsically worthy recipients of pain management in neonatal intensive care
İlhan, E., Pacey, V., Brown, L. S., Spence, K., Gray, K., Rowland, J., White, K., & Hush, J. M. (2020) · Medicine Health Care and Philosophy · doi:10.1007/s11019-020-09982-z · Cited by 16
Predictors of Mental Health Status among Older United States Adults with Pain
Axon, D. R., & Chien, J. (2021) · Behavioral Sciences · doi:10.3390/bs11020023 · Cited by 16
Oral administration of essential oil from Psidium glaziovianum Kiaersk leaves alleviates pain and inflammation in mice
Costa, W. K., do Nascimento, M. F., dos Santos, C. R. B., de Aguiar, J. C. R. D. O. F., Navarro, D. M. D. A. F., Napoleão, T. H., Correia, M. T. D. S., Brayner, F. A., de Oliveira, A. M., & da Silva, M. V. (2022) · Inflammopharmacology · doi:10.1007/s10787-022-00940-0 · Cited by 16
Nurses’ Knowledge and Attitudes Toward Pain Assessment and Management: A Cross‐Sectional Study
Alanizi, A. W., Shaqiqi, W., Cabaldo, L., Awaji, R. M., Alotaibi, R. A., & Alanazi, A. M. (2025) · Nursing Research and Practice · doi:10.1155/nrp/6646998 · Cited by 15
“According to IASP, pain is classifed as acute or chronic, and each has a diferent management approach [2].”
Differential placebo effect of sham acupuncture for chronic pain: a network meta-analysis of randomized controlled trials
Wan, R., Zheng, Q., Zeng, X., Luo, Y., Sun, L., Chen, S., Luo, F., Zhang, Y., Zhu, Z., Chen, X., et al. (2025) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-025-05055-x · Cited by 16
“…identify additional studies and screen the citations of relevant reviews and articles. non-cancer Pain was defined and classified according to the International Association for the Study of Pain (IASP) criteria [20]) who had undergone acupuncture treatment for at least 4 weeks prior to the study.”
The notorious neurophilosophy of pain: A family resemblance approach to idiosyncrasy and generalizability
Coninx, S. (2021) · Mind & Language · doi:10.1111/mila.12378 · Cited by 18
Recognition and Assessment of Pain-Related Behaviors in Avian Species: An Integrative Review
Mikoni, N. A., Guzman, D. S.-M., Fausak, E. D., & Paul‐Murphy, J. (2022) · Journal of Avian Medicine and Surgery · doi:10.1647/21-00008 · Cited by 15

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: Raja, Srinivasa N.
Cohen, Milton
Finnerup, Nanna B.
Flor, Herta
Gibson, Stephen
Keefe, Francis J.
Mogil, Jeffrey S.
Ringkamp, Matthias
Sluka, Kathleen A.
Song, Xue-Jun
Stevens, Bonnie
Sullivan, Mark D.
Tutelman, Perri R.
Ushida, Takahiro
Vader, Kyle
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2020-09
Volume: 161
Issue: 9
Pages: 1976-1982
ISSN: 0304-3959 (ISSN-L)
1872-6623
DOI: 10.1097/j.pain.0000000000001939
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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The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises

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