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
Elo, S., & Kyngäs, H. (2008) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04569.x · Cited by 22,617 · cited 1×
“Responses to the open-ended questions were analyzed by using inductive content analysis.(16) We received 808 responses from individuals across 46 countries.”
Method
Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)
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Self-citation
A classification of chronic pain for ICD-11
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Self-citation
Untitled work
(1979) · PubMed · Cited by 1,355
A new definition of neuropathic pain
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Self-citation
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Background
Updating the definition of pain
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“experience of pain.(37) In addition, the term “unpleasant” has been debated as potentially trivializing the severe pain and suffering associated with many acute and chronic clinical pain states and fails to capture “the full range of words that could be used to describe the experience” and its associated suffering.”
Background
Editorial The need of a taxonomy
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Parallel Spinal Pathways for Transmitting Reflexive and Affective Dimensions of Nocifensive Behaviors Evoked by Selective Activation of the Mas-Related G Protein-Coupled Receptor D-Positive and Transient Receptor Potential Vanilloid 1-Positive Subsets of Nociceptors
Wang, L., Su, X.-J., Wu, Q., Xu, X. M., Wang, X., Chen, M., Ye, J.-R., Maimaitiabula, A., Liu, X., Sun, W. R., et al. (2022) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2022.910670 · Cited by 13
“When I’m in Pain, Everything Is Overwhelming”: Implications of Pain in Adults With Autism on Their Daily Living and Participation
Levi, M. K., Schreuer, N., Granovsky, Y., Bar‐Shalita, T., Weissman‐Fogel, I., Hoffman, T., & Gal, E. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.911756 · Cited by 17
Brain Functional Alteration at Different Stages of Neuropathic Pain With Allodynia and Emotional Disorders
Zhang, Y.-N., Xing, X., Chen, L., Dong, X., Pan, H., Hua, X., & Wang, K. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.843815 · Cited by 12
Pain Behaviors Analyzed by Videorecording in Brain-Injured Patients Admitted to the Intensive Care Unit
López-López, C., Arranz‐Esteban, A., Sánchez-Sánchez, M. M., Pérez, T., Arias-Rivera, S., Muñoz, M. S., & Latorre-Marco, I. (2022) · Pain Management Nursing · doi:10.1016/j.pmn.2022.07.008 · Cited by 12
PSD-95 in the anterior cingulate cortex contributes to neuropathic pain by interdependent activation with NR2B
Li, A., Huang, C.-J., Gu, K.-P., Huang, Y., Huang, Y., Zhang, H., Lin, J.-P., Liu, Y., Yang, Y., & Yao, Y.-X. (2022) · Scientific Reports · doi:10.1038/s41598-022-21488-7 · Cited by 12
Factors that influence the impact of Chronic Non-Cancer Pain on daily life: A partial least squares modelling approach
Cáceres‐Matos, R., Gil‐García, E., Vázquez-Santiago, S., & Cabrera‐León, A. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104383 · Cited by 14
Bibliometric and visual analysis of research on the links between the gut microbiota and pain from 2002 to 2021
Mao, M., Zhou, Y., Jiao, Y., Yin, S., Cheung, C., Yu, W., Gao, P., & Yang, L. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.975376 · Cited by 14
Attitudes and beliefs towards low back pain (LBP) among physiotherapists in Spain
Pérez, S. E. M., González, L. L., Acevedo, I. A., Barrera, R. B., Pérez, J. L. A., Romero, E. A. S., Sosa-Reina, M. D., Pérez, I. M. M., & Villafañe, J. H. (2022) · Bulletin of Faculty of Physical Therapy · doi:10.1186/s43161-022-00112-9 · Cited by 14
Bone marrow mesenchymal stem cells alleviate stress-induced hyperalgesia via restoring gut microbiota and inhibiting neuroinflammation in the spinal cord by targeting the AMPK/NF-κB signaling pathway
Tan, X., Wang, D., Lu, P., Guan, S., Zheng, Q., Du, X., & Xu, H. (2022) · Life Sciences · doi:10.1016/j.lfs.2022.121318 · Cited by 12
Wrist-ankle acupuncture has a positive effect on chronic pain: a systematic review and meta-analysis
Pan, M., Lan, Y., & Wang, Z. (2023) · Acupuncture and Herbal Medicine · doi:10.1097/hm9.0000000000000059 · Cited by 12
Does past/current pain change pain experience? Comparing self-reports and pupillary responses
Yoo, H., Cho, Y., & Cho, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1094903 · Cited by 14
Thirty-year survey of bibliometrics used in the research literature of pain: Analysis, evolution, and pitfalls
Robert, C., & Wilson, C. S. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1071453 · Cited by 13
Identifying patients presenting in pain to the adult emergency department: A binary classification task and description of prevalence
Hughes, J. A., Douglas, C., Jones, L. V., Brown, N. J., Nguyen, A. N., Jarugula, R., Lyrstedt, A.-L., Hazelwood, S., Wu, Y., Saleh, F. Q., et al. (2023) · International Emergency Nursing · doi:10.1016/j.ienj.2023.101272 · Cited by 12
Cerebral cortical hemodynamic metrics to aid in assessing pain levels? A pilot study of functional near-infrared spectroscopy
Du, J., Shi, P., Fang, F., & Yu, H. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1136820 · Cited by 12
Prevalence of low back pain among medical doctors of the teaching hospitals in Karachi, Pakistan: A cross-sectional survey
Javed, S., Dawood, M. H., Memon, M. W., Selod, I. Z., & Seja, A. (2023) · SAGE Open Medicine · doi:10.1177/20503121231157217 · Cited by 12
Discovery of selective NaV1.8 inhibitors based on 5-chloro-2-(4,4-difluoroazepan-1-yl)-6-methyl nicotinamide scaffold for the treatment of pain
Qin, H., Wei, A., Wang, Y., Wang, L., Xu, H., Yan, Z., Tian, X., Zheng, Y., Gao, Z., & Hu, Y. (2023) · European Journal of Medicinal Chemistry · doi:10.1016/j.ejmech.2023.115371 · Cited by 12
Lipödemschmerz – das vernachlässigte Symptom
Hucho, T. B. (2023) · Die Dermatologie · doi:10.1007/s00105-023-05189-4 · Cited by 12
Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors
Rosenberger, D. C., Segelcke, D., & Pogatzki-Zahn, E. M. (2023) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000673 · Cited by 12
Numeric rating scale for pain should be used in an ordinal but not interval manner. A retrospective analysis of 346,892 patient reports of the quality improvement in postoperative pain treatment registry
Stijic, M., Messerer, B., Meißner, W., & Avian, A. (2023) · Pain · doi:10.1097/j.pain.0000000000003078 · Cited by 13
Pain
Williams, A. C. D. C. (2023) · Evolution Medicine and Public Health · doi:10.1093/emph/eoad038 · Cited by 15
“…mechanisms and have contributed to the definition of pain in humans: ‘An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ [8], asserting the centrality of subjective experience and the importance of emotion.”
Optogenetic Activation of Peripheral Somatosensory Neurons in Transgenic Mice as a Neuropathic Pain Model for Assessing the Therapeutic Efficacy of Analgesics
Chen, H., Mohsin, M., Ge, J.-Y., Feng, Y., Wang, J., Ou, Y.-S., Jiang, Z., Hu, B.-Y., & Liu, X. (2023) · ACS Pharmacology & Translational Science · doi:10.1021/acsptsci.3c00254 · Cited by 12
Inflammation, brain connectivity, and neuromodulation in post-traumatic headache
Fiorin, F. D. S., Santo, C. C. D. E., Silva, J. T. D., & Chung, M. (2024) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2024.100723 · Cited by 12
“Pain is defined as “ an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage ” (Raja et al., 2020).”
Background
Clinical aspects of mastication myalgia—an overview
Barjandi, G., Svedenlöf, J., Jasim, H., Collin, M., Hedenberg‐Magnusson, B., Christidis, N., & Ernberg, M. M. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1306475 · Cited by 12
Does brain entrainment using binaural auditory beats affect pain perception in acute and chronic pain?: a systematic review
Shamsi, F., Azadinia, F., & Shaygan, M. (2024) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-024-04339-y · Cited by 12
Pain: its prevalence and correlates among the oldest old
Bokermann, J., König, H., & Hajek, A. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-023-02653-y · Cited by 12
“While acute pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” [9], chronic pain “lasts or recurs for longer than 3 months” [10].”
Background
Dermorphin [D-Arg2, Lys4] (1-4) Amide Alleviates Frostbite-Induced Pain by Regulating TRP Channel-Mediated Microglial Activation and Neuroinflammation
Ummadisetty, O., Akhilesh, A., Gadepalli, A., Chouhan, D., Patil, U. P., Singh, S. P., Singh, S. P., & Tiwari, V. (2024) · Molecular Neurobiology · doi:10.1007/s12035-024-03949-4 · Cited by 12
Effect of preemptive use of a nonsteroidal anti‐inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double‐blind placebo‐controlled clinical trial
Rodrigues, G. A., Hizatugu, R., Bronzato, J. D., Soares, A. D. J., & Frozoni, M. R. D. S. (2024) · International Endodontic Journal · doi:10.1111/iej.14030 · Cited by 12
Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study
Yang, Q., Yi, R., Wang, N., & Zhang, P. (2024) · Geriatric Nursing · doi:10.1016/j.gerinurse.2024.02.013 · Cited by 13
Nociplastic pain mechanisms and toll-like receptors as promising targets for its management
Rodríguez-Palma, E. J., de la Cruz, S. H., Islas-Espinoza, A. M., Castañeda‐Corral, G., Granados‐Soto, V., & Khanna, R. (2024) · Pain · doi:10.1097/j.pain.0000000000003238 · Cited by 14
The autobiographical memory system and chronic pain: A neurocognitive framework for the initiation and maintenance of chronic pain
Waisman, A. S., & Katz, J. D. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105736 · Cited by 15
“Seeing as pain is subjective (Raja et al., 2020), there is great inter-individual variability in its experience (Mogil, 2021).”
Background
Gender differences in the quantitative and qualitative assessment of chronic pain among older people
Puto, G., Repka, I. B., & Gniadek, A. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1344381 · Cited by 12
Assessment of the nociceptive response to the use of cannabidiol alone and in combination with meloxicam through infrared pupillometry in female dogs undergoing elective ovariohysterectomy
Casas-Alvarado, A., Martı́nez-Burnes, J., Hernández-Ávalos, I., Mora‐Medina, P., Miranda-Cortés, A. E., Domínguez-Oliva, A., & Mota‐Rojas, D. (2024) · Frontiers in Veterinary Science · doi:10.3389/fvets.2024.1380022 · Cited by 12
A systematic literature review on patient-reported outcome domains and measures in nonsurgical efficacy trials related to chronic pain associated with endometriosis: an urgent call to action
Rosenberger, D. C., Mennicken, E., Schmieg, I., Medkour, T., Péchard, M., Sachau, J., Fuchtmann, F., Birch, J. V., Schnabel, K., Vincent, K., et al. (2024) · Pain · doi:10.1097/j.pain.0000000000003290 · Cited by 13
“164 Consequently, a variety of pain-related outcomes for trials have been recommended several years ago already as a minimum to be assessed, 67 and a very recent update can be found here.”
Background
Perceived factors influencing the success of pain neuroscience education in chronic musculoskeletal pain: a meta-synthesis of qualitative studies
Ciolan, F., Bertoni, G., Crestani, M., Maistrello, L. F., Coppola, I., Rossettini, G., & Battista, S. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2024.2398141 · Cited by 12
“Moreover, chronic MSK pain negatively impacts individuals’ psychological sphere, leading to anxiety, anger, frustration, and depressed mood [5,6].”
Association between sleep duration and chronic musculoskeletal pain in US adults: a cross-sectional study
Li, C., Huang, H., Xia, Q., & Zhang, L. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1461785 · Cited by 12
Pain management in people with inflammatory arthritis: British Society for Rheumatology guideline scope
Scott, I. C., Babatunde, O. O., Barker, C., Beesley, R., Beesley, R. P., Birkinshaw, H., Brooke, M., Chaplin, H., Chapman, L. S., Ciurtin, C., et al. (2024) · Rheumatology Advances in Practice · doi:10.1093/rap/rkae128 · Cited by 12

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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