Ideal pain terminology is parsimonious, jargon-free, and scale-appropriate

Abstract

H yperalgesia and allodynia are recognized in the earliest medical texts. Bonica, in an excellent historical survey [1], notes that cutaneous tenderness caused by non-noxious , .. stimulation was used by ancient physicians in Egypt, India, China and Greece as an aid in the diagnosis of painful disorders [of the viscera]. The year 1996 marks the, thousandth anniversary of Avicenna's (980-1038) taking up the study of medicine.Avicenna's monumental Canon enumerates 15 types of pain: boring, squeezing, corrosive, dull, tiring, heavy, cutting, irritating, itching, pricking, relaxinq, stabbing, tearing, pulling, and throbbing [12]. Bonica credits Morgagni in 1761 as the first to employ the word hyperesthesia to connote upper abdominal skin sensitivity in a patient with basilar pneumonia, a finding we would now call allodynia. By Morgagni's time, an abundance of words were at clinicians' disposal to describe every sort of pain and altered sensation.These words were harnessed to provide vivid reports-still unsurpassed-of syndromes such as left arm allodynia during angina and hyperalgesia and allodynia after a musket ball wound of the arm. Indeed, the pain descriptors in the McGillMelzack questionnaire were originally derived from patients' descriptions of their own pain. Yet pain terminology continues to generate controversy [4]. Sufficient imprecision, confusion, and frank conflict surround the use of pain terminology that Chaplan and Sorkin agonize over this sorry state of affairs. This commentary presents two arguments for abandoning the introduction of terms intended to be used by both preclinical scientists and clinicians and recommends instead that one strive for jargon-free description of a reality unfiltered by categories and expectations.