1. Updating the definition of pain
Amanda C de C Williams
University College London
and
Kenneth D Craig
University of British Columbia

2. Strengths: Applies to acute and chronic pain
IASP definition of pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (1979).
Strengths:
Applies to acute and chronic pain
Emphasises subjective experience
Does not require evidence of tissue damage or pathology
Gives weight to sensory and emotional aspects
Applicable in scientific and clinical settings

3. Problems: Clinical pain is almost always more than “unpleasant”
IASP definition of pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Problems:
Clinical pain is almost always more than “unpleasant”
Refers only to sensory and emotional qualities, neglecting important features
The final phrase, “or described in terms of such damage” is ambiguous

4. Problems: Pain is a distressing experience
Clinical pain is almost always more than “unpleasant”
The final phrase, “or described in terms of such damage” is ambiguous
Refers only to sensory and emotional qualities, neglecting important features
[Pain is] An unpleasant sensory and emotional experience
Pain is a distressing experience
associated with actual or potential tissue damage,
or described in terms of such damage.
with sensory, emotional, cognitive and social components.

5. Pain is a distressing experience associated with actual or potential tissue damage, with sensory, emotional, cognitive and social components.
Improvements:
Adds cognitive and social components seen in human and nonhuman animals
Cognitive neuroscience highlights attention, memory, appraisal, descending modulation
Personal narratives highlight social contexts: family, work, participation
Removes unnecessary reference to self-report in use of the word “describes”

6. We would also revise the Note that qualifies the definition:
We would shorten it, and remove inconsistencies
As before, the Note specifies assessment methods for different circumstances and needs
Conclusion
Pain science and practice need an improved definition.
We hope to contribute to this through active discussion and debate of our proposal.