We need a new pain definition

What should the definition consider?

Marsaxlokk market with traditional Luzzu fishing boats

Tomorrow I head off to Malta for the Societal Impact of Pain Conference 2017. The areas that will be discussed include:

  1. Pain as a quality indicator for health systems
  2. Building platforms to address the societal impact of pain
  3. Impact of pain on labour and employment
  4. Challenges, models and lighthouses in pain policy
  5. Evolving concepts in the definition of chronic pain: a dynamic process

Overarching the meeting is the multi-stakeholder platform (SiP) that is described on the website as:

The “Societal Impact of Pain” (SIP) is an international platform created in 2009 as a joint initiative of European Pain Federation EFIC® and the pharmaceutical Grünenthal GmbH and aims for

  • raising awareness of the relevance of the impact that pain has on our societies, health and economic systems
  • exchanging information and sharing best-practices across all member states of the European Union
  • developing and fostering European-wide policy strategies & activities for an improved pain care in Europe (Pain Policy).

The platform provides opportunities for discussion for health care professionals, pain advocacy groups, politicians, insurances, representatives of health authorities, regulators and budget holders.

The scientific framework of the SIP platform is under the responsibility of the European Pain Federation EFIC®. Co-operation partners for SIP 2017 are Pain Alliance Europe and Active Citizenship Network. The SIP 2017 symposium is co-hosted by the Malta Health Network and the No Pain Foundation. The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support. SIP 2017 is made possible with the financial support of the Ministry for Finance in Malta.

There are some very important conversations that need to be had, and these must then be translated into positive work. I am absolutely focused on the positive work aspect because we need change, society needs change and we need results. I believe that this is achievable. Of course with all this talk of pain, the question is whether we are talking about the same thing?

The IASP definition of pain:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

This was published in 1979 and based on work from 1964 by Harold Merskey. Perhaps it is time for an update! The IASP definition certainly captures some of the features but there is one major bit missing as far as I am concerned. The person.

Pain is a whole person experience. Regular readers will have an understanding of pain now, and the fact that pain is not grounded in any structure or pathology (the biomedical model). Instead, pain is part of a whole person state of protection when there is a perceived threat. The key word is perception and much of perception involves biology in the dark and the hidden causes of sensory events; i.e./ we are aware of certain expectations with regards to pain, but most of the biology is going on without our conscious knowing.

A person suffering chronic pain spends a significant amount of time in a state of protect, much by habit. The range of contexts within which the experience emerges in the person widens as threatening situations are increasingly interpreted (biologically and consciously via habits of thought) as threatening.

I would encourage people to think about a definition of pain encompassing these key features:

  • the whole person
  • perception
  • threat

This would be a good start point. From there we can consider the sense of self and how our understanding of this contributes to the experience of pain. I love the notion of ‘expecting yourself’ as put forward by Prof Andy Clark, a leading philosopher who’s work I think will impact enormously on our thinking about pain, together with Dr Mick Thacker and others who are leading the way.

Exciting times and exciting times ahead. There is MUCH hope now and so there should be. This thinking needs to pervade society and this is the purpose of UP, to deliver the right messages and to deliver solutions with results. Positive work to be done!


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