Pain as a Disease

There may often be a lack of consensus with respect to how pain is defined, even though it is something that affects almost all of us at some point in our lives. In many situations, pain is commonly defined based on its temporal nature, e.g., acute, subacute, or chronic. The International Association for the Study of Pain (IASP) first defined pain for clinicians in 1979, with the intention of helping improve the quality of pain care by identifying pain as both a sensory and emotional experience. Not until 2020, 41 years later did the IASP redefine pain to further achieve consensus about how pain is defined, how to better assess it, and how to approach its treatment. This chapter will describe both definitions of pain, a comparison of them, and discuss their relevance to clinical practice, exploring how misaligned definitions of pain can lead to stigmatization and lack of confidence and consensus of the utility of available treatment options, including opioid analgesics. Additionally, this chapter will discuss the value of exploring not only the person’s subjective rating of their pain, but also functional impact as a key factor in assessment and setting goals and expectations for treatment. A case will be made for the value proposition of considering pain as a disease similar to other common medical conditions, where things like trust and belief rarely impact the clinician-patient dynamic in the same way that pain-related complaints do.