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Three determinants of pain 

Three determinants of pain
Three determinants of pain

Manon Choinière

, and M. Gabriella Pagé

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date: 27 October 2021

Building on the foundations laid by the gate control theory, Melzack and Casey theorized in 1968 the existence of three separate, yet related determinants of pain: sensory–discriminative, affective–motivational, and cognitive–evaluative. These determinants have roots in separate neurophysiological pathways that modulate the pain experience. The importance of this paper lies in its theoretical contribution to our understanding of pain. Melzack and Casey’s seminal paper, written almost 50 years ago, is not only still contemporary, as evidenced by the internationally agreed upon definition of chronic pain (the IASP taxonomy) but has also contributed to moving from a biomedical understanding of pain to a biopsychosocial model of evaluating and treating pain. This conceptualization of pain continues to influence the way pain is evaluated and is the foundation of the use of non-pharmacological and non-interventional modalities for the treatment of pain (e.g. psychological techniques), and multidisciplinary approaches to pain treatment.

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