Considerations about the new concept of pain

Dear Mr. editor,

The definition of pain adopted by the International Association for the Study of Pain (IASP), widely disseminated worldwide for the past 41 years, defined pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. When this definition was created, it was sufficient for conceptualizing pain as it was understood then. However, the last decades saw an intense technological development that also brought a better comprehension of the physiopathological conditions and mechanisms involved in nociception. There was also an increase in the humanization of medicine as a whole. Human beings started to be recognized with the empathy and complexity that they deserve and the concept of total pain, along with its multidisciplinary aspects, gained more ground in the medical community.

Nowadays it’s known that pain is not always related to a tissue injury evident in histopathological terms, and that the emotional state of the patient directly influences their perception of the pain. Thus, patients with chronic pain or other problems that affect psychological stability may report more severe pain. In that sense, the medical community started to accept more and more that the perception of pain is extremely individual and highly influenced by external factors. Therefore, the IASP has developed a new concept, capable of embracing everything that has been achieved in terms of technological and clinical advances, for the definition of pain. Thereby, pain is now conceptualized as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.

This update in the concept of pain, publish by the IASP task force in July, 2020¹, and translated into Portuguese by the Sociedade Brasileira para o Estudo da Dor (SBED - Brazilian Society for the Study of Pain)^2,3, highlights the presence of pain even in the absence of injury, by the means of an objective and concise formulation validated to several languages and cultures, integrated in one single phrase, benefiting researchers and clinicians through the determination of the concept to be investigated. Although accepted by the majority, several clinicians and some patients manifested their discontent about the update, specially in the social medias. We consider it important to emphasize that the definition of pain proposed by the IASP doesn’t have the ambition to establish diagnosis, conduct a treatment plan or predict a prognosis for patients with pain. The notes that follow the updated pain formulation emphasize the variability of the clinical manifestation of pain, as well as the various components that determine pain, showing respect for the subjectivity of each patient that suffers from it. We recognize and applaud the effort of the task force and the methodological rigor described in the article that published the new concept, which elegantly updates the understanding that the scientific community currently has about this dynamic phenomenon, pain!

REFERENCES

• ¹
  Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;23. doi: 10.1097/j.pain.0000000000001939. Online ahead of print.
  » https://doi.org/10.1097/j.pain.0000000000001939
• ²
  https://sbed.org.br/wp-content/uploads/2020/08/Defini%C3%A7%C3%A3o-revi-sada-de-dor_3.pdf
  » https://sbed.org.br/wp-content/uploads/2020/08/Defini%C3%A7%C3%A3o-revi-sada-de-dor_3.pdf
• ³
  Jornal Dor (Publicação da Sociedade Brasileira para o Estudo da Dor - Ano XVIII - 2º Trimestre de 2020 - edição 74, 11-8p.

Publication Dates

• Publication in this collection
  21 Sept 2020
• Date of issue
  Jul-Sep 2020