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      Reconsidering the International Association for the Study of Pain definition of pain

      a , * , b , c

      Pain Reports

      Wolters Kluwer

      Definition of pain

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          We argue for revision of the definition of pain to “a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.”



          The definition of pain promulgated by the International Association for the Study of Pain (IASP) is widely accepted as a pragmatic characterisation of that human experience. Although the Notes that accompany it characterise pain as “always subjective,” the IASP definition itself fails to sufficiently integrate phenomenological aspects of pain.


          This essay reviews the historical development of the IASP definition, and the commentaries and suggested modifications to it over almost 40 years. Common factors of pain experience identified in phenomenological studies are described, together with theoretical insights from philosophy and biology.


          A fuller understanding of the pain experience and of the clinical care of those experiencing pain is achievable through greater attention to the phenomenology of pain, the social “intersubjective space” in which pain occurs, and the limitations of language.


          Based on these results, a revised definition of pain is offered: Pain is a mutually recognizable somatic experience that reflects a person's apprehension of threat to their bodily or existential integrity.

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          Most cited references 47

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          Updating the definition of pain.

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            Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy.

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              Automatic decoding of facial movements reveals deceptive pain expressions.

              In highly social species such as humans, faces have evolved to convey rich information for social interaction, including expressions of emotions and pain [1-3]. Two motor pathways control facial movement [4-7]: a subcortical extrapyramidal motor system drives spontaneous facial expressions of felt emotions, and a cortical pyramidal motor system controls voluntary facial expressions. The pyramidal system enables humans to simulate facial expressions of emotions not actually experienced. Their simulation is so successful that they can deceive most observers [8-11]. However, machine vision may be able to distinguish deceptive facial signals from genuine facial signals by identifying the subtle differences between pyramidally and extrapyramidally driven movements. Here, we show that human observers could not discriminate real expressions of pain from faked expressions of pain better than chance, and after training human observers, we improved accuracy to a modest 55%. However, a computer vision system that automatically measures facial movements and performs pattern recognition on those movements attained 85% accuracy. The machine system's superiority is attributable to its ability to differentiate the dynamics of genuine expressions from faked expressions. Thus, by revealing the dynamics of facial action through machine vision systems, our approach has the potential to elucidate behavioral fingerprints of neural control systems involved in emotional signaling.

                Author and article information

                Pain Rep
                Pain Rep
                Pain Reports
                Wolters Kluwer (Philadelphia, PA )
                March 2018
                05 March 2018
                : 3
                : 2
                [a ]St Vincent's Clinical School, UNSW Sydney, New South Wales, Australia
                [b ]Arthritis and Osteoporosis WA, Shenton Park, Western Australia, Australia
                [c ]Department of Philosophy, School of Humanities, University of Tasmania, Tasmania, Australia
                Author notes
                [* ]Corresponding author. Address: Suite 401, St Vincent's Clinic, 438 Victoria St, Darlinghurst, New South Wales 2010, Australia. Tel.:+61 2 8382 6487. E-mail: M.Cohen@ 123456unsw.edu.au (M. Cohen).
                PAINREPORTS-D-17-0054 00003
                Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

                This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND) which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.

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