International Association For The Study Of Pain Research Articles

Promoting multidisciplinary pain management in low- and middle-income countries—challenges and achievements

Abstract The burden of pain in low- and middle income countries (LMICs) is high and expected to rise further with their ageing populations. Multidisciplinary pain management approaches based on the biopsychosocial model of pain have been shown to be effective in reducing pain-related distress and disability, but these approaches are still lacking in many LMICs due to various factors, including low levels of awareness about the role of multidisciplinary pain clinics, lack of prioritisation for pain services, and lack of healthcare professionals trained in pain management. The International Association for the Study of Pain (IASP) has several educational programs to promote multidisciplinary pain management in LMICs, in the form of education grants, pain fellowships, pain camps and, most recently, the development of a Multidisciplinary Pain Centre Toolkit. This article describes the various educational programs, focusing on Southeast Asia, that demonstrate how targeted educational programs which include skills training, follow-up and mentorship, can translate into the formation of new multidisciplinary pain management services in settings with limited resources.

The concept of nociplastic pain—where to from here?

Abstract Nociplastic pain, a third mechanistic pain descriptor in addition to nociceptive and neuropathic pain, was adopted in 2017 by the International Association for the Study of Pain (IASP). It is defined as “pain that arises from altered nociception” not fully explained by nociceptive or neuropathic pain mechanisms. Peripheral and/or central sensitization, manifesting as allodynia and hyperalgesia, is typically present, although not specific for nociplastic pain. Criteria for possible nociplastic pain manifesting in the musculoskeletal system define a minimum of 4 conditions: (1) pain duration of more than 3 months; (2) regional, multifocal or widespread rather than discrete distribution of pain; (3) pain cannot entirely be explained by nociceptive or neuropathic mechanisms; and (4) clinical signs of pain hypersensitivity present in the region of pain. Educational endeavors and field testing of criteria are needed. Pharmacological treatment guidelines, based on the three pain types, need to be developed. Currently pharmacological treatments of nociplastic pain resemble those of neuropathic; however, opioids should be avoided. A major challenge is to unravel pathophysiological mechanisms driving altered nociception in patients suffering from nociplastic pain. Examples from fibromyalgia would include pathophysiology of the peripheral as well as central nervous system, such as autoreactive antibodies acting at the level of the dorsal root ganglia and aberrant cerebral pain processing, including altered brain network architecture. Understanding pathophysiological mechanisms and their interactions is a prerequisite for the development of diagnostic tests allowing for individualized treatments and development of new strategies for prevention and treatment.

Nociplastic Pain: A Critical Paradigm for Multidisciplinary Recognition and Management.

Our understanding of chronic pain has evolved significantly, shifting from a focus on peripheral damage to recognizing the central mechanisms underlying pain perception. This perspective article explores the concept of nociplastic pain, a term introduced by the International Association for the Study of Pain (IASP) in 2017, which describes pain arising from altered pain modulation within the central nervous system, without clear evidence of tissue damage or inflammation. The historical progression from fibrositis to fibromyalgia, and now to nociplastic pain, underscores the complexity of chronic pain syndromes and the need for a multidisciplinary approach to management. Nociplastic pain is characterized by central sensitization, leading to heightened pain sensitivity and often accompanied by comorbidities such as fatigue, sleep disturbances, and cognitive difficulties. Advances in neuroimaging have revealed altered connectivity within key brain networks, such as the default mode and salience networks, in patients with nociplastic pain, providing insights into the neural underpinnings of this condition. The article also addresses controversies surrounding the role of small fiber neuropathy and autonomic dysfunction in nociplastic pain, highlighting the ongoing debates in the field. The practical importance of recognizing nociplastic pain across various medical disciplines-including primary care, orthopedics, neurology, psychiatry, and rheumatology-is emphasized, with recommendations for integrating this knowledge into clinical practice. Emerging therapies, such as neurofeedback, hyperbaric oxygen therapy, and neuromodulation, offer new avenues for treatment, particularly for patients who do not respond to conventional approaches. The article calls for continued research into the mechanisms of nociplastic pain, the development of reliable diagnostic tools, and the exploration of novel therapeutic strategies to improve patient outcomes. The recognition and management of nociplastic pain are crucial for advancing the care of patients with chronic pain, necessitating interdisciplinary collaboration and a patient-centered approach.

Application of the IASP Grading System to Identify Underlying Pain Mechanisms in Patients With Knee Osteoarthritis: A Prospective Cohort Study.

This study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a "probable" versus "no or possible" nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response. A secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed. Thirty (15.22%-approach 4 pain locations) and 46 (23.35%-approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group. This study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.

Цервикалгия у пациентов с мигренью – коморбидная нозология или клинический аспект центральной сенситизации?

Relevance. The phenomenon of central sensitization occurs when physiological activity in nociceptive pathways increases and leads to abnormal sensitivity; it is defined as “increased sensitivity of nociceptive neurons of the central nervous system to their normal or subthreshold afferent input,” according to the definition provided by the International Association for the Study of Pain (IASP). The excitability of spinal cord neurons significantly modifies the gain of the somatosensory system. Chronic pain syndromes, anxiety-depressive disorder, sleep disorders are currently very common in the population, significantly reducing the quality of life of the population; the pathogenesis of these nosologies lies in central sensitization. Objective. To study the clinical manifestations of central sensitization in patients with episodic migraine associated with neck pain or cervicogenic headache. Materials and methods. The longitudinal prospective study included 180 patients, divided into 3 groups: 1) patients with a combination of migraine and cervicogenic headache – 60 people (study group); 2) patients with a combination of migraine and cervicalgia diagnoses – 60 people (control group); 3) patients diagnosed with migraine without complaints of pain and limitation of movements in the cervical spine – 60 people (additional group). Results. In patients with migraine and comorbid cervical headache, more pronounced central sensitization was revealed when compared with comorbid cervicalgia. Myofascial pain syndrome involving the trapezius and temporal muscles can resolve on its own with specific migraine therapy with monoclonal antibodies, however, to relieve tension and soreness in the masseter and inferior oblique muscles, the addition of therapeutic exercises and gentle manual techniques is more effective. Taking into account the identified direct relationships of moderate strength between the number of painful points of exit of the trigeminal nerve, the muscles of the pericranial region involved, as well as the effect of treatment of migraine attacks with monoclonal antibodies, it can be concluded that central sensitization is more pronounced when the masseter and inferior oblique muscles are involved. Conclusions. During examination of patients with migraine with comorbid active cervicalgic factor or even if it is absence, it is necessary to make a thorough examination of the facial and cranioverebral region muscles, even in the absence of patient complaints of pain in the face or neck, and also prescribe specific therapeutic exercises to increase the effectiveness of treatment. In all patients with migraine, regardless of chronicity, it is necessary to assess the intensity of central sensitization for timely and more complete provision of medical care.

Sex Differences in Visceral Pain and Comorbidities: Clinical Outcomes, Preclinical Models, and Cellular and Molecular Mechanisms.

Sexual dimorphism of visceral pain has been documented in clinics and experimental animal models. Aside from hormones, emerging evidence suggests the sex-differential intrinsic neural regulation of pain generation and maintenance. According to the International Association for the Study of Pain (IASP) and the American College of Gastroenterology (ACG), up to 25% of the population have visceral pain at any one time, and in the United States 10-15 percent of adults suffer from irritable bowel syndrome (IBS). Here we examine the preclinical and clinical evidence of sex differences in visceral pain focusing on IBS, other forms of bowel dysfunction and IBS-associated comorbidities. We summarize preclinical animal models that provide a means to investigate the underlying molecular mechanisms in the sexual dimorphism of visceral pain. Neurons and nonneuronal cells (glia and immune cells) in the peripheral and central nervous systems, and the communication of gut microbiota and neural systems all contribute to sex-dependent nociception and nociplasticity in visceral painful signal processing. Emotion is another factor in pain perception and appears to have sexual dimorphism.

MANAGEMENT OF NEUROPATHIC PAIN: A REVIEW OF CURRENT TRENDS .

The International Association for the Study of Pain (IASP) defines “pain” as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is a common symptom that knows no boundary. It differs with age, creed, sex, disease and specialty. Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. Its chronic debilitating nature and unpredictive response to medication make it a challenge to most physicians and the patient they treat. The use of treatment algorithms or guidelines have found common use in the treatment of neuropathic pain. This poses a need for periodic review. This review looked at the current trends in the management of neuropathic pain. We recommend a four-pronged approach in the evaluation and management of patients with neuropathic pain. This involved detailed review of the patient, the pain, the plan, and the pill. There is also a growing need to adopt less invasive techniques in the treatment of chronic recalcitrant pain.

Current Perspective in Mixed Pain

Pain is one of the 10 leading causes of medical consultation worldwide and is the alarm symptom of the organism in situations that threaten its integrity, however, when it becomes chronic, it loses its protective capacity and becomes, in many cases, the disease itself.
 According to the International Association for the Study of Pain (IASP) pain is classified as nociceptive, neuropathic and nociplastic. Mixed pain has been described years ago due to the coexistence of different types of pain.
 We can conclude that we do not have a screening tool and/or treatment algorithm for mixed pain, so it is preferable that pain management begins with a rigorous assessment, using the latest available tools, followed by individualized evidence-based treatment with multimodal therapy when appropriate.
 Keywords: nociceptive pain, neuropathic pain, mixed pain.

Entangled brains and the experience of pains.

The International Association for the Study of Pain (IASP) revised its definition of pain to "an unpleasant sensory and emotional experience." Three recent recommendations for understanding pain if there are no clear brain correlates include eliminativism, multiple realizability, and affordance-based approaches. I adumbrate a different path forward. Underlying each of the proposed approaches and the new IASP definition is the suspicion that there are no specific correlates for pain. I suggest that this basic assumption is misguided. As we learn more about brain function, it is becoming clear that many areas process many different types of information at the same time. In this study, I analogize how animal brains navigate in three-dimensional space with how the brain creates pain. Underlying both cases is a large-scale combinatorial system that feeds back on itself through a diversity of convergent and divergent bi-directional connections. Brains are not like combustion engines, with energy driving outputs via the structure of the machine, but are instead more like whirlpools, which are essentially dynamic patterns in some substrates. We should understand pain experiences as context-dependent, spatiotemporal trajectories that reflect heterogeneous, multiplex, and dynamically adaptive brain cells.

The deconstruction of chronic orofacial pain and a hiding inhibition pathway of orofacial pain: the trigeminal proprioceptive mesencephalic periaqueductal gray pathway.

Chronic orofacial pain has a significant negative impact that influences individuals' quality of life and our society. The prevalence is around 11.2% to 33.2% and remains high in females. Currently, there are two main diagnostic classification systems that are used internationally for chronic pain: the International Classification of Diseases, 11th Revision (ICD-11), which was published by the World Health Organization (WHO) in 2018, and the International Classification of Orofacial Pain, which was published by the International Association for the Study of Pain (IASP) in 2020. Deficits in ascending and descending pain modulation pathways may be involved in the chronic pain pathophysiology. A newly described "trigeminal proprioceptive mesencephalic periaqueductal gray pathway" is considered to be the mechanism of action of occlusal appliance in managing orofacial pain. The genetic basis of chronic orofacial pain is not yet fully understood, but a genetic susceptibility involving multiple genes among the peripheral nerves, brainstem and higher brain regions to regulate and suppress the transmission of pain signals, thereby modulating the perception of pain, is likely.

Neuropathic ocular pain: What is it and what to do about it?

Ocular surface pain (OSP) is a nonspecific symptom that can have a tremendous impact on quality of life. Individuals use various descriptors to characterize OSP including “dryness”, “burning”, “grittiness”,” shooting”, “discomfort”, “tenderness” and/or “aching”, to name a few. As feeling your eyes is “an unpleasant sensory and emotional experience”, these descriptors fit under the International Association for the Study of Pain (IASP) definition of pain.” Oftentimes, OSP is chronic in nature, lasting >3 months, although the intensity of pain can wax and wane over time. Furthermore, OSP can occur spontaneously or be triggered by stimuli such as light, wind or temperature change. In the past, OSP was placed under the umbrella term “dry eye”, as tear film abnormalities are one cause of OSP. However, it is now understood that factors beyond tear and ocular surface abnormalities may drive OSP and it is necessary to identify and address all potential contributors to pain. In general, contributors can be split across two broad categories: nociceptive contributors, defined as pain that arises directly from tissue damage at the level of the ocular surface and neuropathic contributors, defined as pain caused by a lesion or disease within peripheral or central nerves that connect the ocular surface to the brain. Or, as is the case in many individuals, pain contributors can arise from a combination of these two entities. Given the multiple potential contributors to OSP, a standardized examination and multimodal approach is necessary. In this presentation, we discuss advances in the diagnosis and management of OSP, with a focus on the diagnosis and treatment of neuropathic ocular surface pain (NOP).

Cannabidiol and pain.

Chronic pain presents significant personal, psychological, and socioeconomic hurdles, impacting over 30% of adults worldwide and substantially contributing to disability. Unfortunately, current pharmacotherapy often proves inadequate, leaving fewer than 70% of patients with relief. This shortfall has sparked a drive to seek alternative treatments offering superior safety and efficacy profiles. Cannabinoid-based pharmaceuticals, notably cannabidiol (CBD), hold promise in pain management, driven by their natural origins, versatility, and reduced risk of addiction. As we navigate the opioid crisis, ongoing research plunges into CBD's therapeutic potential, buoyed by animal studies revealing its pain-relieving prowess through various system tweaks. However, the efficacy of cannabis in chronic pain management remains a contentious and stigmatized issue. The International Association for the Study of Pain (IASP) presently refrains from endorsing cannabinoid use for pain relief. Nevertheless, evidence indicates their potential in alleviating cancer-related, neuropathic, arthritis, and musculoskeletal pain, necessitating further investigation. Crucially, our comprehension of CBD's role in pain management is a journey still unfolding, with animal studies illustrating its analgesic effects through interactions with the endocannabinoid, inflammatory, and nociceptive systems. As the plot thickens, it's clear: the saga of chronic pain and CBD's potential offers a compelling narrative ripe for further exploration and understanding.

Research Initiative in SARPS Countries: Fostering Pathways for Sustainable Development

The South Asian Regional Pain Society (SARPS), founded in 2003, attained the official status of a Federation-in-formation of the International Association for the Study of Pain (IASP) in 2020. It encompasses five member countries from the South Asian Association for Regional Cooperation (SAARC) region; Bangladesh, India, Pakistan, Sri Lanka, and Nepal. The Primary objective of SARPS is to supports its member countries in providing effective, accessible, affordable, and ethical care to individual suffering from pain conditions while also enhancing research collaboration across the region. Although there are many similarities, there are also variations within SARPS countries regarding the barriers they face in research. Addressing these challenges requires a concerted effort through SARPS to raise awareness about the importance of pain research. It is essential to establish clear priorities for pain treatment and research, improve higher education and governance systems, and invest in healthcare and research infrastructure.

Chronic Pain Management in The Basque Health Service: Starting from The Strategy

Introduction: Pain is defined by the International Association for the Study of Pain (IASP) as an "unpleasant, unpleasant, and unpleasant sensory and emotional experience of pain. (IASP) as an "unpleasant sensory and emotional experience, associated with or similar to that associated with actual or potential tissue damage". In Spain, it is estimated that 1 in 6 Spaniards (17%) suffers from chronic pain and that this disease represents the second cause of consultation in primary care (PC) and more than 50% of these interventions are related to it. Of the 10 most prevalent pathologies, half of them are related to pain, with a notably higher impact on women.
 Aims And Objectives:
 - To know the approach to pain, with special emphasis on chronic pain, in the Basque public health system.
 - To carry out an analysis of the results obtained in the survey and in the interviews with key clinical and management professionals.
 - Design and implement a pain strategy in Osakidetza.
 Material And Method: Design of an online survey with the different key areas of a strategy for pain management in a healthcare organization. 31 questions in 8 blocks.
 1.Pain management strategy or plan
 2.Resources allocated by the organization
 3.Assessment tools
 4.Pain management
 5.Training activities for professionals
 6.Information/sensitization and empowerment of the patients and families
 7.Coordination and continuity of care
 8.Evaluation indicators
 Results:
 All organizations have strategies or plans.
 67% of the Integrated care Organisation (ICO) have a Pain commission
 100% of the ICO has a Pain Unit.
 25% have specific resources for primary care.
 100% has medical protocols for referrals and 75% in infirmary.
 100% of ICO use the analog visual scale (AVS), among others.
 83% of the ICOs have drug management reconciliation activities and safety criteria in drug management, and 75% refer to non-pharmacological approach methodologies, mainly related to the neurosciences.
 58% of the OSIs consider that there are activities such as specific courses on pain and in 75% of them encourage an interdisciplinary approach with specific pain care plans such as musculoskeletal pain.
 67% believe that it promotes empowerment interventions, such as community interventions, patient empowerment, group approaches, and health education for both patients and caregivers.
 regarding continuity of care 75% have face-to-face activities and 100% have non-face-to-face activities.
 Realted to evaluation 60% uses AVS instrument and there is a high use of opioids
 Conclussion: Although there are a multitude of interventions and many agents involved in pain management, the truth is that there is great heterogeneity in the availability of the same resources in the different ICO. Pprimary care still has a residual role in the management of these patients as well as non-pharmacological treatments. the lack of psychological care for these patients is striking. Also noteworthy is the almost non-existent difference in care according to the patient's gender.
 Implications For Applicability And Limitations: A strategic plan is therefore necessary for the corporation

Research progress of nociplastic pain in the clinical treatment of chronic pain diseases

Chronic pain is increasingly developing into a worldwide health problem. Due to the money and treatment required for care and rehabilitation, as well as the complexity of the various types of pain, chronic pain sufferers often bear a huge financial burden as well as a psychological one. According to statistics, 23% of chronic pain sufferers have suicidal thoughts. In 2017, the third category pain named "nociplastic pain" was proposed for the first time by the International Association for the Study of Pain (IASP) which is disparate with the first kind nociceptive pain and the second pain neuropathic. The physiological mechanisms behind this type of pain are not known. However, it is commonly thought to be associated with a hypersensitivity response in the central nervous system and can be resulted in chronic nociceptive pain, so nociplastic pain is able to occur by itself, and can combine with other pain. At the same time, this type of pain affects the central system and produces other derived symptoms. Examples include stimulation of the limbic system, including impaired processing of emotions by the amygdala, amplified pain perception, sleep disturbances, increased fatigue and sensitivity to external environmental stimuli. There are no very clear and obvious diagnostic criteria or methods, and clinical detection is difficult. Due to the many symptoms, patients usually undergo multiple tests, with high medical costs and a poor prognosis. Patients suffer both physical and psychological distress. The disease with its complexity characteristic leads the difficulty for doctors to diagnosis it plagues patients with the condition, while increasing the difficulty of medical diagnosis and the cost of medical treatment. This article synthesizes the existing developments in outcomes in nociplastic pain from introduction and classification to diagnosis and treatment, it discusses the existing research findings.

What Interval of Daily Pain Assessment Is Required to Reliably Diagnose Chronic Pain in Sickle Cell Disease? the Pisces Study

Background: In Sickle Cell Disease (SCD), chronic pain, i.e., pain on most days over a 6 month time period, is a major complication associated with substantial morbidity and poor outcomes. In the landmark Pain in Sickle Cell Epidemiology Study (PiSCES), the largest study of pain in SCD, one-third of individuals age 16 years or older had daily or near-daily pain, and >50% had chronic pain. However, PiSCES required patients to have 5-6 months of completed diaries in order to qualify for chronic pain analysis. Practically, the International Association for the Study of Pain (IASP) has used three months as the interval upon which to base a definition of chronic pain. Shorter daily assessment intervals upon which to reliably base a definition of chronic pain would reduce respondent burden, and would improve the frequency and accuracy of pain phenotyping for clinical and research purposes. Method: We chose as the gold-standard for chronic pain definition subjects enrolled in PiSCES that had at least 5 months of daily diaries (n=127). We excluded 10 patients who had at least 182 diaries (essentially 6 months), but had at least 50% of diaries missing in any of months 1-4. We simulated daily diary assessment over less burdensome, shorter intervals, always beginning on day one of assessment, to mimic what would be done clinically. We chose the time frames of 2 weeks (2w), 4 weeks (4w), 1 month (1m), 2 months (2m), 3 months (3m), and 4 months (4m). To operationalize the definition of chronic pain, we used a definition of pain severity rated as >0 on > 50% of diary days, regardless of interval. To determine if using diaries collected over a shorter period of time would still classify patients correctly, we calculated the sensitivity and the number of false negatives, as well as the specificity and number of false positives of each simulated diary interval. Results: Within the gold standard sample, 51.3% of patients had chronic pain based on all diaries submitted. The Table shows the percent of patients diagnosed with chronic pain, the sensitivity as well as the number of false negatives, and the specificity as well as the number of false positives, for each simulated diary interval. Simulated intervals of two months or more of daily diaries yielded chronic pain percentage estimates with both high sensitivity and high specificity, compared to the gold standard estimate. Simulated intervals of two week and four weeks yielded increasingly lower specificity, i.e., increasingly more false-positive indications of chronic pain, as the interval shortened. However, each interval still yielded high sensitivity-few patients with gold-standard chronic pain were missed, even at two weeks. Results were very similar even if data from the entire 127 participants was used. Conclusion : For determining the presence of chronic SCD pain, defined as pain on more than 50% of days enrolled in PiSCES, simulated intervals of two months or more of daily diary collection yield both very good sensitivity and very good specificity, compared to intervals of 5-6 months. Clinicians and researchers may reliably choose to adopt two months of dairy collection, as a matter of practicality, to reduce respondent burden when phenotyping SCD pain as acute versus chronic.

The value of the International Association for the Study of Pain to developing countries.

Since it was founded, the International Association for the Study of Pain (IASP) has been at the forefront of improving pain research, education, and effective pain management in both developed and developing countries. As IASP activities progressed, major differences between the practice of pain management, education, and research in developed countries compared with developing countries were identified. This led to areas of focus by IASP that included pain education to address poor knowledge of pain assessment and treatment, prioritization of pain management by governments and official national legislation and programs, and availability of pain treatments (especially potent analgesics). A few pioneering IASP members from developing countries in the early years encouraged more multidisciplinary professionals to join IASP and attend conferences. Inauguration of national and regional chapters was also encouraged, and regular continuing medical education programs were held, especially on topics from IASP conferences and global pain events. Many IASP chapters in developing countries have established collaborations with groups from developed countries, whereas IASP also implemented other innovative approaches including the developing countries working group, educational grants, pain camps, and multidisciplinary pain hubs with toolkits to develop pain experts for regions in the developing world. Thus, the influence of IASP in many developing countries has had a multiplier effect on the progress made in effective pain management, education, and research. Nonetheless, challenges remain and include better integration of pain management, education, and research in national health systems and academic programs for health professionals.

Introduction and a brief historical overview of the International Association for the Study of Pain.

The mission of the International Association for the Study of Pain (IASP) is "to bring together scientists, clinicians, healthcare providers, and policymakers to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide." The IASP will celebrate its 50th anniversary next year, and the series of articles published in this special issue of its flagship journal PAIN highlights the IASP's achievements over the past 5 decades. This article provides a brief historical overview of the IASP's 50-year journey, including the key "players," events, and initiatives leading to its formation and contributing to its progress. It complements the other articles outlining the contributions that the IASP has made and likely will continue to make to advances in pain education, research, management and advocacy, and its value to the IASP members.

The value of the International Association for the Study of Pain to career development: perspectives of trainee and early career members.

Supporting its young members has been a key priority of the International Association for the Study of Pain (IASP) for the past 5 decades. The IASP, along with its federations, chapters, and special interest groups, has provided benefits to its trainee and early career members for their career development. This article summarizes various key IASP initiatives and benefits offered to IASP members and how these benefits have positively impacted their careers, including examples from the authors of this article. Suggestions are made for future directions that the IASP could implement to enhance the value provided to its trainee and early career members, which will in turn contribute to IASP achieving its mission to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide.

Beyond the study of pain: the evolving role of the International Association for the Study of Pain in global advocacy.

Although founded on the basis of the study of pain, the International Association for the Study of Pain (IASP) has actively advocated for improving pain relief and access to pain management in a variety of ways. The Global Year was launched in 2004 and has continued with a different theme each year, and "Pain Awareness Month" is held every September. The Declaration of Montreal (2010) emphasized that access to pain management is a fundamental human right as a result from the IASP-hosted International Pain Summit. The IASP has continued to publish timely statements related to pain and pain management. The work of IASP on the 11th version of the International Classification of Disease has ensured that chronic pain is recognized as a disease in its own right, and the establishment of the Global Alliance of Partners for Pain Advocacy Task Force recognizes the importance of engaging people with lived experience of pain in accomplishing IASP's mission. The Working Group on Global Advocacy now spearheads IASP's global efforts in capacity building to ensure that pain advocacy activities will continue to grow.