The current IASP definition of pain has come under renewed criticisms recently. There is a new momentum for its revision as reflected by the fact that IASP has now a Presidential Task Force dedicated to look into whether there is enough warrant to update the definition. I critically review all the major criticisms of the current definition in detail, and raise new difficulties rarely discussed before. I show that none of the major criticisms has enough warrant to force (...) us to substantially revise the current definition. Combined with the discussion of the new difficulties, there is nonetheless a need to restate the definition using slightly different terminology that will make the original intent of the current definition clearer and more precise. A restatement of the definition is proposed and its potential is discussed in light of some empirical questions that remain. [The IASP Council has now approved a revised definition and published its rationale here: Pain 2020 Sep 1; 161(9), pp. 1976–1982. The new definition follows (most of) my recommendations.]. (shrink)

The official definition of ‘pain’ by the International Association for the Study of Pain (IASP) hasn’t seen much revision since its publication in 1979. There have been various criticisms of the definition in the literature from different quarters. In my view, most of these criticisms depend on misunderstandings or on uncharitable interpretations. My aim is to go over the definition, clarify some potential ambiguities, and argue that these criticisms don’t cut much ice. At the end, I will present a (...) few slightly reworded versions of the definition that I claim are more felicitous and capture the original intended meaning by the members of the taxonomic committee in a much better and transparent way that avoids all the major extant criticisms in the literature. (shrink)

This is a Letter to Editor of _Pain_ recommending revision of a pain term ('nociplastic pain') recently added to the IASP Pain Terms. (With a response from the Taxonomy Committee, Eva Kosek et al. PAIN: June 2018 - Volume 159 - Issue 6 - p 1177–1178.

Like other fundamental experiences, the phenomenal qualities of pain seem to defy description. But, unlike these experiences, it is difficult to define pain in terms of a consistent relationship with the extra-mental world. The IASP's solution is to qualify an imprecise characterization of pain's phenomenal qualities through an association with tissue damage and an ability to recognize pain sensation. In this paper I will argue that the IASP's definition lacks the clarity and coherence necessary to provide an adequate (...) definition of pain. I begin by setting out the difficulties of defining pain. I then describe the IASP's solution and provide a detailed criticism of their approach. I also discuss inconsistencies evident in their wider taxonomy. In the final section I argue that pain can be objectively grounded by reference to pain's evolutionary role and suggest an alternative definition. (shrink)

When it comes to communication of pain, Anna Wierzbicka (2012) takes issue with the scientific definition of pain and turns to natural semantic metalanguage (NSM). However, “pain” is not one of the 64 semantic primes in NSM, and therefore Wierzbicka suggests words such as “body,” “bad,” and “don’t want.” This blurs the boundaries between pain and other aversive sensations and it also challenges certain clinical features of the pain experience.

The IASP definition of 'pain' defines pain as a subjective experience. The Note accompanying the definition emphasizes that as such pains are not to be identified with objective conditions of body parts (such as actual or potential tissue damage). Nevertheless, it goes on to state that a pain "is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience." This generates a puzzle that philosophers have been (...) well familiar with: how to understand our utterances and judgments attributing pain to body parts. (The puzzle is of course general extending to all sensations routinely located in body parts.) The present work tackles this puzzle. I go over various options specifying the truth-conditions for pain attributing judgments, and at the end make my own recommendation which is an adverbialist, qualia-friendly proposal with completely naturalistic credentials that is also compatible with forms of weak intentionalism. The results are generalizable to other bodily sensations and can be used to illustrate, quite generally, the viability of a qualia-friendly adverbialist (but naturalist and weakly intentionalist) account of perception. (shrink)

This is a Letter to Editor responding to another Letter by Dr. LR Bernstein (PAIN Reports 5, 2020, e814) reacting to my previous article on the IASP definition of pain that appeared in PAIN Reports 4(2019)e777.

[Open access] This is a Letter to Editor responding to the reaction by Ken Craig, Amanda Williams, KJS Anand, to my previous article on the IASP definition of pain that appeared in PAIN Reports 4(2019)e777. The reaction is also in the form of a Letter to Editor in PAIN Reports 5(2020)e811.

[DOI: 10.1097/j.pain.0000000000000765] Amanda Williams and Kenneth Craig, in a recent article in the IASP official journal _Pain_ (DOI: 10.1097/j.pain.0000000000000613), have argued that it is time to revise the IASP's well-entrenched definition of 'pain'. They propose an alternative definition. We critically discuss their proposed revision and argue that it admits clear counterexamples as both sufficient and necessary conditions. We further discuss the wisdom of replacing 'unpleasant' in the IASP definition with 'distress' as Williams and Craig propose. [Craig and (...) Williams respond to our criticism in DOI: 10.1097/j.pain.0000000000000766]. (shrink)

: Psychogenic pain is considered to be pain that has a psychological origin. In this paper, I provide a brief history of the ways in which such pain has been interpreted and classified, highlighting the problem that psychogenic pain is typically defined by excluding organic evidence that could account for the sufferer’s experience. This has led to ambiguous disease classifications, which challenges the authenticity of the patient’s suffering. Today psychogenic pain is no longer considered a valid diagnosis, because it is (...) deemed to stigmatize the patient by implying that their pain is imaginary. But such stigmatization continues in the modern approach to chronic pain. Addressing this issue requires us to understand the relationship between “emotional” and “physical” pain and acknowledge the reality of all suffering. Radden tackles these issues by showing that even though pain and suffering can be accompanied by mistaken beliefs, such experiences cannot be delusional. Keywords: Psychogenic Pain; Imaginary Pain; Chronic Pain; IASP; DSM Dolore psicogeno e dolore immaginario Riassunto: Con dolore psicogeno si intende un dolore di origine psicologica. In questo lavoro presento una breve storia delle interpretazioni e classificazioni di questa forma di sofferenza, evidenziando che queste si sono fondate perlopiù sull’esclusione di evidenze organiche a giustificazione dell’esperienza del sofferente. Ciò ha portato ad ambigue classificazioni di malattia che mettono in discussione l’autenticità della sofferenza del paziente. Oggi, quella di dolore psicogeno non è più considerata una diagnosi valida perché ritenuta stigmatizzante, implicando che il dolore del paziente sia immaginario. Ciononostante, la stigmatizzazione persiste nell’approccio odierno al dolore cronico. Affrontare questo problema comporta la comprensione della relazione tra dolore “emozionale” e dolore “fisico” ed il riconoscimento della realtà di tutte le forme di sofferenza. Nel suo lavoro, Radden esamina queste tematiche mostrando che, sebbene esperienze di dolore e sofferenza possano essere accompagnate da credenze errate, le esperienze stesse non possono essere illusorie. Parole chiave: Dolore psicogeno; dolore immaginario; dolore cronico; IASP; DSM. (shrink)

Pains are unpleasant, universally unpleasant. What seems trivially true has been rejected by various pain scientists because of several phenomena which allegedly show that there can be pain which is not unpleasant. This rejection is partly based on the ambiguity of ‘pain unpleasantness’ which can be avoided by distinguishing between primary and secondary pain affect. As for the alleged counterexamples to the above, I will argue that experiences of episodic analgesia as well as the ‘pain’ experiences of some lobotomized and (...) morphine patients should not be construed as cases in which pain and unpleasantness come apart, but rather as cases in which nociceptive activity and pain dissociate. Regarding the notorious case of pain asymbolia, I will demonstrate that the behaviour of patients with this syndrome suggests that they do feel pain, and that their pain sensations are unpleasant, but much less unpleasant than the pains normal people would have if exposed to the same noxious stimuli. Adopting such an account of these phenomena allows us to retain the widely accepted IASP definition of pain, and thus avoids the issue of integrating non-unpleasant pains into a plausible definition of pain. (shrink)

The scientific and philosophical approach to pain must be supplemented by a hermeneutics studying how racism has complicated the communication of pain. Such an investigation reveals that not only are non-white people seen as credibly speaking their pain, but also pain “science” is one of the ways races have historically been constructed. I illustrate this through a study of Frantz Fanon’s clinical writings, along with eighteenth- and nineteenth-century slave-owners’ medical manuals and related documents. I suggest that, with this history, what (...) philosophers understand as the problem of pain is best framed as the problem of colonial violence. (shrink)

Conceptual engineering is often understood as the practice of assessing and improving our representational tools with specific aims in mind. In this paper, I contribute to the engineering of the concept of pain with a particular focus on clinical utility. My engineering efforts center on the International Association for the Study of Pain’s (IASP) “official” definition of pain, first introduced in 1979 and revised in 2020. I discuss the general process of conceptual engineering and the original IASP definition (...) of pain and identify three desiderata for a definition suitable for clinical practice: it should be accurate, cognitively tractable, and promote justice in patient care. Evaluating the revised IASP definition against these desiderata, I argue that it is vague and fails to fully address persistent misconceptions about pain, and that additional revisions are therefore needed. I then propose an alternative definition engineered to better meet the demands of effective and just clinical practice. (shrink)

Contemporary pain literature increasingly acknowledges the need of a multidimensional approach to pain, which accounts for its complex biological, psychological and social components. This is reflected in the recently revised definition of the International Association for the Study of Pain (IASP) and some contemporary philosophical positions. This paper addresses the need to offer a theoretical approach that integrates the biopsychosocial and qualitative multidimensionality of pain by developing the “social grounding view of pain”. My focus is on seeking a multidimensional (...) philosophical approach that accounts not only for its complex biological and psychological aspects but also and specifically does justice to its social dimension. I draw from some of the most recent multidimensional theoretical and methodological approaches that attempt to account for the social component of pain, including enactivism and interpretative phenomenological analysis (IPA), to propose the advancement of the social grounding view, which has a particular focus on socially shared linguistic concepts in relation to the meaning and modulation of pain. More specifically, the social grounding view is based on the argument that the meaning of the experience of pain is determined in part by socially shareable linguistic concepts habitually associated with pain. I test this view against empirical cases drawn from pain neuroscience education (PNE) and try to demonstrate how the modification of the linguistic concepts of pain could be used effectively to modulate its experience. (shrink)

We present an ontology of pain and of other pain-related phenomena, building on the definition of pain provided by the International Association for the Study of Pain (IASP). Our strategy is to identify an evolutionarily basic canonical pain phenomenon, involving unpleasant sensory and emotional experience based causally in localized tissue damage that is concordant with that experience. We then show how different variant cases of this canonical pain phenomenon can be distinguished, including pain that is elevated relative to peripheral (...) trauma, pain that is caused neuropathically (thus with no necessary peripheral stimulus), and pain reports arising through deception either of self or of others. We describe how our approach can answer some of the objections raised against the IASP definition, and sketch how it can be used to support more sophisticated discrimination of different types of pain resulting in improved data analysis that can help in advancing pain research. (shrink)

This paper is an attempt to spell out what makes the scientific study of pain so distinctive from a philosophical perspective. Using the IASP definition of ‘pain’ as our guide, we raise a number of questions about the philosophical assumptions underlying the scientific study of pain. We argue that unlike the study of ordinary perception, the study of pain focuses from the very start on the experience itself and its qualities, without making deep assumptions about whether pain experiences are (...) perceptual. This in turn puts scientific explanation in a curious position due to pain’s inherently subjective epistemic nature. The reason for this focus on the experience itself and its qualities, we argue, has to do with pain’s complex phenomenology involving an affective/motivational dimension. We argue for the scientific legitimacy of first‐person phenomenological studies and attempts to correlate phenomenology with neural events. We argue that this methodological procedure is inevitable and has no anti‐physicalist ontological implications when properly understood. We end the paper by commenting on a discussion between two prominent pain scientists in the field, Don Price and Howard Fields, about the need to distinguish more dimensions in the phenomenology of pain and how to classify them vis‐à‐vis the recent scientific findings. Our interest in this discussion is not only to introduce some clarifications but also to show how “neurophenomenology” has already been shaping the scientific research and to back our claim about why this methodology is inevitable with an example. (shrink)

Is a phenomenal pain a conscious primitive or composed of more primitive phenomenal states? Are pain experiences necessarily or only contingently unpleasant? Here, I sketch how to answer such questions concerning intra-phenomenal metaphysics using the example of pain and unpleasantness. Arguments for a symmetrical metaphysical independence of phenomenal pain and unpleasant affect are presented, rejecting a composite view like the IASP definition and dimensional views. The motivating intuition of these views is explained by common binding mechanisms in consciousness and (...) characterized as fallacious if generalized. There are, however, underlying commonalities between pain perception and unpleasant affect, e.g. formal content or evolutionary ancestry. (shrink)

In this chapter we consider the tension between how pain researchers today typically define pains and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, providing evidence that during (...) large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

I argue that the understanding of "pain" as presented in the official medical definition by the IASP is ambiguous and likely a cluster concept.

In 2020, the International Association for the Study of Pain (IASP) changed its definition of pain to just an "an unpleasant sensory and emotional experience. " Since then, several philosophers have attempted to reaffirm the impossibility of reducing pain to neurobiology from a variety of approaches, including eliminativism, multiple realizability, and intersubjectivity. All of their arguments assume that there are no specific biomarkers for pain. I adumbrate a more ecumenical path: that while these approaches have some merit, they also (...) misstate how brains function. Once we shift our view regarding how brains operate, then pain processing is just as "mysterious" as other types of complex brain processes. (shrink)

The English word ‘pain’ is commonly used by lay people in a ‘messy’ life-world of imprecise meanings. It has a complex etymology, including legal and political uses as ‘punishment’. Understandings of pain in the political theory of Hobbes and Bentham are summarized. This wider historical and philosophical account of the uses of ‘pain’ means the IASP definition can be seen in relation to medical history and to present-day clinical challenges. We can consider the misunderstandings that may occur between clinicians (...) and pain sufferers, and the ways in which ‘pain’, although ‘subjective’, is inescapably a political concern. Using Wittgenstein’s approach to meaning, however, we can envisage a context-sensitive and flexible approach to communication about pain. (shrink)

In August 2019, the fifth international congress of the 'International Association for the Study of the Philosophy of Edith Stein' (IASPES) took place at the University of Cologne. Of the 57 papers presented at this prominent conference prepared and chaired by the historian and theologian Harm Klueting, 54 were accepted for publication in revised versions. Professor Klueting was able to add three other contributions -- among them by the director of the Research Institute of the German Province of the Carmelites (...) at Bamberg, the historian and theologian Edeltraud Klueting, who acts as co-editor. The congress volume, published only a little more than a year after the congress despite significant constraints due to the Corona pandemic, contains 29 contributions in English, 21 in German, and seven in Spanish or French on the subjects 'Biographical questions', 'Edith Stein and thinkers of the past', 'Edith Stein and other contemporary thinkers', 'Anthropology -- Women and men', 'Philosophy -- phenomenology and Christian philosophy', 'Society and politics', 'Theology and spirituality', and 'Experiences with Edith Stein'. (shrink)

This volume brings together revised versions of papers presented at the inaugural conference of the International Association for the Study of the Philosophy of Edith Stein (IASPES). The conference papers are supplemented by a number of specially commissioned essays in order to provide a representative sample of the best research currently being carried out on Stein’s philosophy in the English speaking world. The first part of the volume centres on Stein’s phenomenology; the second part looks at her Christian philosophy; and (...) the third part explores the contexts of her philosophical work. (shrink)

In this article, I focus on what is we know when we know pain or that someone is in pain. I argue that claims of knowledge about pains are problematic because of the complex nature of the phenomenon and because of "pain" is a cluster concept.