The IASP (Int. Ass. Study of Pain) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Since its publication in 1979 this definition has been widely accepted notwithstanding that it was predefined in 1964 in Harold Merkey’s Ph.D. thesis “An Investigation of Pain in Psychological Illness” (H.M. was the chairman of the IASP task force searching for the definition). Fortunately the psychological bias of the definition did not prevent in the last decades an ever increasing investigation into the modes of operation of the nociceptive system including its physiological as well as its pathophysiological aspects. As will be outlined in this lecture considerable progress has been made in identifying the characteristics of nociceptors and of the pathways along which they send their signals to the cortical centers responsible for the conscious sensation of pain. Less progress has been made in elucidating the mechanisms, both physical and psychological, responsible for turning an acute pain into a chronic suffering particularly when the tissue damage has long gone or when it was not present in the first place. Even less progress can be reported regarding the mysteries of acute and chronic neuropathic pain, which according to the IASP taxonomy group is “pain caused by a lesion or disease of the somatosensory nervous system”. The reasons for our ignorance and possible ways to reduce it will be discussed.
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