Paradoxes weaken the International Association for the Study of Pain definition of pain

Abstract

A compound paradox has been identified in the revised (2020) International Association for the Study of Pain (IASP) definition of pain, such that it simultaneously prescribes a connection between pain and tissue damage and allows that prescription to be violated. In a narrative form, the objective of this paper is to reveal these paradoxes and to offer a pathway to their resolution, thus clarifying the definition of pain for the purposes of scientific study and clinical application. The first paradox is that contradictory true positions can be held, when the experiencer claims to be “in pain” and the observer cannot find the required association with tissue damage or, preferably as is argued, nociception. The second paradox is revealed by the construct of “nociplastic” pain, which contradicts the IASP definition to the extent that nociceptors have not been activated, yet at the same time is consistent with that definition to the extent that it “resembles” an experience associated with actual or potential tissue damage. In the interests of all concerned parties, the IASP definition of pain can be strengthened by removing the current ambiguity of interpretation, grounding the experience in a reconceptualisation of nociception as activation of a nociceptive apparatus, and clearly distinguishing it from suffering.