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If there is a general agreement nowadays on the definition of pain, the recognition of pain as a disease remains debated. These first efforts have contributed to stimulate a worldwide debate on pain terms and classification, which continues today. 3 Among the first proposals of the association there were, indeed, the definition of pain and the classification of chronic pain syndromes. The development of a universally accepted definition of pain and related concepts was indicated by John J Bonica as one of the main goals of the then rising International Association for the Study of Pain (IASP). 2 Thus, in these circumstances, the peculiar nature of pain is revealed in its complexity, particularly because of the double value of the phenomenon, that is, pain is biologically a protective tool, but it can also lose its adaptive function and becomes a pathologic condition severely impacting quality of life. As stated by John J Bonica, the founding father of pain medicine, in 1953, pain “in its late phases, when it becomes intractable, it no longer serves a useful purpose and then becomes, through its mental and physical effects, a destructive force”. 1 Nevertheless, it is only with the discovery of abnormal pains that the phenomenon and its role start to be directly addressed in medicine, that is, when traditional interpretation of pain as a symptom of disease starts to weaken.
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An important step forward in the scientific characterization of pain has been taken with the Sherrington’s definition of the phenomenon as “the psychical adjunct of an imperative, protective reflex” and the description of its neurophysiological aspects. Pain has a valuable role in medical action, as the symptom par excellence and, therefore, as a precious and meaningful tool.
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The attempt to understand pain represents one of the oldest challenges in the history of medicine.