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Current understanding of the mixed pain concept: a brief narrative review.

a Department of Anaesthesiology , Critical Care Medicine, Pain Therapy and Palliative Care, Benedictus Hospital Tutzing , Tutzing , Germany. b Department of Anaesthesiology , Klinikum Rechts der Isar, Technische Universität München , Munich , Germany. c Sports medicine private practice , Bogota , Colombia. d Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences , Universidad del Rosario , Bogota , Colombia. e Center For Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario , Bogota , Colombia. f Pain Clinic , Hospital Santo Tomas , Panama City , Panama. g Neurology Department , Medical Faculty of Syiah Kuala University/Dr Zainoel Abidin Hospital (RSUZA) , Banda Aceh , Indonesia. h Department of Orthopaedics , Universidad Nacional de Trujillo , Trujillo , Peru. i Clinica Neurologia y Neurofisiologica Integral , Guatemala City, Guatemala. j Pain Management Service , Raffles Hospital , Singapore. k Department of Pain and Palliative Care , Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico. l Hong Kong Pain Medicine Centre , Central , Hong Kong. m Department of Geriatrics , Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico. n Department of Anesthesiology, Faculty of Medicine , Prince of Songkla University , Hat Yai , Thailand. o Department of Anesthesiology , Asian Hospital and Medical Center , Muntinlupa City , Philippines. p Department of Anesthesiology , The Medical City , Pasig City , Philippines. q Pain Center, Department of Neurology , Hospital das Clinicas FMUSP , São Paulo , Brazil.

Current medical research and opinion. 2019;(6):1011-1018
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Abstract

Despite having been referenced in the literature for over a decade, the term "mixed pain" has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of "nociplastic pain" in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term "mixed pain" is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group's discussions, a Medline search for the Medical Subject Heading "mixed pain" was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group's consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain.

Methodological quality

Publication Type : Review

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MeSH terms : Pain ; Pain Measurement