Considering Precision and Utility When we Talk About Pain. Comment on Cohen et al

      We applaud many of the sentiments put forward by Cohen et al in their critique of language and logic in pain medicine.
      • Cohen M
      • Weisman A
      • Quintner J
      Pain is not a “thing”: How that error affects language and logic in pain medicine.
      Pleas to avoid conflation between nociception and pain are not new - “The mislabelling of nociceptors as pain fibres was not an elegant simplification but a most unfortunate trivialisation of pain”
      • Wall PD
      • McMahon SB
      The relationship of perceived pain to afferent nerve impulses.
      ; “.. we don't actually have ‘pain receptors’, or ‘pain nerves’ or ‘pain pathways’ or ‘pain centres.’”
      • Butler DS
      • Moseley GL
      Explain Pain.
      We are among those who see such conflation as contrasting with contemporary understandings of ‘how pain works’ and undermining evidence-based treatment approaches.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Arthritis Research UK: Understanding arthritis: A parliamentary guide to musculoskeletal health [Internet]. Arthritis Research UK; 2013 [cited 2022 May 12]. Available at: Accessed May 12, 2022.

        • Balcetis E
        • Dunning D
        Wishful seeing: more desired objects are seen as closer.
        Psychol Sci. 2010; 21: 147-152
        • Butler D
        • Moseley GL
        Explain Pain.
        2nd ed. Noigroup Publications, Adelaide2013
        • Butler DS
        • Moseley GL
        Explain Pain.
        Noigroup Publications, Adelaide2003
        • Chimenti RL
        • Frey-Law LA
        • Sluka KA
        A mechanism-based approach to physical therapist management of pain.
        Phys Ther. 2018; 98: 302-314
        • Clarke CL
        • Ryan CG
        • Martin DJ
        Pain neurophysiology education for the management of individuals with chronic low back pain: Systematic review and meta-analysis.
        Man Ther. 2011; 16: 544-549
        • Cohen M
        • Quintner J
        • van Rysewyk S
        Reconsidering the International association for the study of pain definition of pain.
        PAIN Reports. 2018; 3: e634
        • Cohen M
        • Weisman A
        • Quintner J
        Pain is not a “thing”: How that error affects language and logic in pain medicine.
        J Pain. 2022; 8: 1283-1293
        • Cohen ML
        Proposed clinical criteria for nociplastic pain in the musculoskeletal system are flawed.
        PAIN. 2022; 163: e606
        • Cuenda-Gago JD
        • Espejo-Antunez L
        Effectiveness of education based on neuroscience in the treatment of musculoskeletal chronic pain.
        Rev Neurol. 2017; 65: 1-12
        • Kosek E
        • Clauw D
        • Nijs J
        • Baron R
        • Gilron I
        • Harris RE
        • Mico J-A
        • Rice ASC
        • Sterling M
        Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system.
        Pain. 2021; 162: 2629-2634
        • Leake HB
        • Moseley GL
        • Stanton TR
        • O'Hagan ET
        • Heathcote LC
        What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education.
        Pain. 2021; 162: 2558-2568
        • Louw A
        • Diener I
        • Butler DS
        • Puentedura EJ
        The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain.
        Arch Phys Med Rehab. 2011; 92: 2041-2056
        • Louw A
        • Zimney K
        • Puentedura EJ
        • Diener I
        The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature.
        Physiother Theory Pract. 2016; 32: 332-355
        • Magerl W
        • Hansen N
        • Treede R-D
        • Klein T
        The human pain system exhibits higher-order plasticity (metaplasticity).
        Neurobiol Learn Memory. 2018; 154: 112-120
        • Moseley GL
        Painful Yarns.
        Dancing Giraffe Press, Canberra, Australia2007
        • Moseley GL
        Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for?.
        Br J Sports Med. 2019; 53: 588-589
        • Moseley GL
        • Butler DS
        The Explain Pain Handbook: Protectometer.
        Noigroup Publications, Adelaide, Australia2015
        • Moseley GL
        • Butler DS
        Fifteen years of explaining pain: the past, present, and future.
        J Pain. 2015; 16: 807-813
        • Moseley GL
        • Butler DS
        Explain Pain Supercharged.
        Noigroup Publications, Adelaide2017
      2. Neck Pain [Internet]. International association for the study of pain (IASP). [cited 2022 May 12]. Available at: Accessed May 12, 2022.

        • Siddall B
        • Ram A
        • Jones MD
        • Booth J
        • Perriman D
        • Summers SJ
        Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis.
        Pain. 2022; 163: e20-e30
        • Stanton TR
        • Moseley GL
        • Wong AYL
        • Kawchuk GN
        Feeling stiffness in the back: A protective perceptual inference in chronic back pain.
        Sci Rep. 2017; 7: 9681
        • Tabor A
        • Catley MJ
        • Gandevia S
        • Thacker MA
        • Moseley LG
        Perceptual bias in pain: A switch looks closer when it will relieve pain than when it won't.
        Pain. 2013; 154: 1961-1965
        • Tegner H
        • Frederiksen P
        • Esbensen BA
        • Juhl C
        Neurophysiological pain education for patients with chronic low back pain: A systematic review and meta-analysis.
        Clin J Pain. 2018; 34: 778-786
        • Toye F
        • Belton J
        • Hannink E
        • Seers K
        • Barker K
        A healing journey with chronic pain: A meta-ethnography synthesizing 195 qualitative studies.
        Pain Med. 2021; 22: 1333-1344
      3. Versus Arthritis: The state of musculoskeletal health 2021: Arthritis and other musculoskeletal conditions in numbers [Internet]. Versus Arthritis; 2021 [cited 2022 May 12]. Available at: Accessed May 12, 2022.

      4. Wall P: Pain: The Science of Suffering. 1st edition. Columbia University Press; 2002.

        • Wall PD
        • McMahon SB
        The relationship of perceived pain to afferent nerve impulses.
        Trends in Neurosciences. 1986; 9: 254-255
        • Watson JA
        • Ryan CG
        • Cooper L
        • Ellington D
        • Whittle R
        • Lavender M
        • Dixon J
        • Atkinson G
        • Cooper K
        • Martin DJ
        Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis.
        J Pain. 2019; 20: 1140.e1-1140.e22
        • Williams MT
        • Gerlach Y
        • Moseley L
        The ‘survival perceptions’: Time to put some Bacon on our plates?.
        J Physiother. 2012; 58: 73-75
        • Willis WD
        • Westlund KN
        Neuroanatomy of the pain system and of the pathways that modulate pain.
        J Clin Neurophysiol. 1997; 14: 2-31
        • Wood L
        • Hendrick PA
        A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability.
        Eur J Pain. 2019; 23: 234-249
        • Woodburn SC
        • Bollinger JL
        • Wohleb ES
        The semantics of microglia activation: Neuroinflammation, homeostasis, and stress.
        J Neuroinflamm. 2021; 18: 258
        • Woolf CJ
        What is this thing called pain?.
        J Clin Invest Am Soc Clin Invest. 2010; 120: 3742-3744
      5. Yun J: A comparison of pain neurophysiology education with therapeutic interventions versus therapeutic interventions alone on pain and function in individuals with chronic low back pain: a meta-analysis. Available at: Accessed May 12, 2022.