{ "abstract": "BACKGROUND: For decades, clinicians and researchers have struggled to classify pain conditions that do not fit neatly into the nociceptive, neuropathic or nociplastic frameworks. Many common disorders-from chronic low back pain to cancer pain and osteoarthritis-exhibit overlapping mechanisms and have long fallen into the 'grey zone' of mixed pain. This area has intrigued researchers yet frustrated clinicians due to the absence of a clear, unified definition. METHODS: Through an international consensus process led by global leading experts, mixed pain has now been defined as pain that is associated with a lesion, disease or disorder resulting in an overlap of at least two mechanistic pain descriptors (nociceptive, neuropathic or nociplastic). CONCLUSIONS: This new definition may help provide the context needed to align research, refine diagnosis and design mechanism-based therapies for patients with mixed pain. It marks an important step towards conceptual clarification-from confusion to consensus, from overlap to action-transforming mixed pain from an ambiguous concept into a potential framework of modern pain taxonomy. SIGNIFICANCE STATEMENT: This work provides an internationally unified consensus definition of mixed pain, addressing inconsistency in pain terminology and mechanistic classification. By defining mixed pain as the overlap of at least two mechanistic pain descriptors (nociceptive, neuropathic or nociplastic), the framework clarifies conceptual ambiguity while stressing the importance of identifying the underlying pain descriptors, supports a mechanism-based assessment and may facilitate more individualized treatment approaches in complex pain conditions while providing a practical foundation for future research, validation and clinical application.", "abstract_shown": true, "affiliations": [ "Department of Anaesthesiology Klinikum Rechts der Isar, Technische Universität München Munich Germany", "Department of Anaesthesiology, Critical Care Medicine & Pain Therapy Benedictus Hospital Feldafing & Tutzing Feldafing Germany", "Department of Cardiovascular Sciences, Section Anaesthesiology and Algology KU Leuven‐University of Leuven Leuven Belgium", "The Leuven Centre for Algology and Pain Management University Hospitals Leuven Leuven Belgium", "Servicio Extremeño de Salud Trujillo Spain", "Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine Aalborg University Aalborg Denmark", "Pain and Palliative Medicine Instituto Nacional de Ciencias Médicines y Nutrición Salvador Zubirán Mexico City Mexico", "Centre for Innovation in Pain and Health Research (CIPHeR) The University of Queensland Brisbane Australia", "Department of Anesthesiology Prince of Songkla University Hat Yai Songkhla Thailand", "Department of Anaesthesiology, Intensive Care, and Pain Medicine Univerisity Hospital Münster Germany", "Pain Clinic, Christiaan Barnard Memorial Hospital Cape Town South Africa", "Instituto Argentino de Investigación Neurológica Universidad de Buenos Aires Buenos Aires Argentina", "Diabetes Research Unit Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK", "Department of Human Neuroscience Sapienza University Rome Italy", "Fondazione Paolo Procacci Rome Italy", "Division of Neurological Pain Research and Therapy, Department of Neurology Christian‐Albrechts‐Universität Kiel Kiel Germany" ], "article_type": null, "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0, 1 ], "name": "Rainer Freynhagen", "orcid": "0000-0002-3759-1508" }, { "affs": [ 2, 3 ], "name": "Bart J. Morlion", "orcid": "0000-0002-6156-880X" }, { "affs": [ 4 ], "name": "Antonio Alcántara Montero", "orcid": "0009-0001-5994-2970" }, { "affs": [ 5 ], "name": "Daniel Ciampi de Andrade", "orcid": "0000-0003-3411-632X" }, { "affs": [ 6 ], "name": "Andrés Hernández-Ortiz" }, { "affs": [ 7 ], "name": "Paul W. Hodges", "orcid": "0000-0002-1206-9107" }, { "affs": [ 8 ], "name": "Sasikaan Nimmaanrat", "orcid": "0000-0001-8483-6291" }, { "affs": [ 9 ], "name": "Esther Miriam Pogatzki-Zahn", "orcid": "0000-0003-0981-3940" }, { "affs": [ 10 ], "name": "Milton Raff", "orcid": "0000-0002-1194-2656" }, { "affs": [ 11 ], "name": "Roberto D. Rey" }, { "affs": [ 12 ], "name": "Solomon Hailemariam Tesfaye", "orcid": "0000-0003-1190-1472" }, { "affs": [ 13 ], "name": "Andrea Truini", "orcid": "0000-0002-2630-7647" }, { "affs": [ 14 ], "name": "Giustino Varrassi", "orcid": "0000-0002-3822-2923" }, { "affs": [ 15 ], "name": "Ralf Baron" } ], "bibtex": "https://research.draconitic.com/paper/7vyw7tbv6z113.bib", "cited_by": 9, "doi": "10.1002/ejp.70356", "fulltext_url": null, "id": "7vyw7tbv6z113", "issns": [ "1090-3801", "1532-2149" ], "landing_url": "https://doi.org/10.1002/ejp.70356", "language": "en", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2737|Pain Mechanisms and Treatments" ] ], "openalex": "W7196964487", "pdf_url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejp.70356", "pmcid": "PMC13445151", "pmid": "42559696", "published": "2026-08-01", "publisher": "Wiley", "ris": "https://research.draconitic.com/paper/7vyw7tbv6z113.ris", "sources": [ { "first_seen": "2026-10-30T13:26:56Z", "native_id": "W7196964487", "source": "openalex", "url": "https://doi.org/10.1002/ejp.70356" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2737|Pain Mechanisms and Treatments", "subfield": "physiology" } ], "title": "Mixed Pain: Toward a Consensus Definition and a Mechanism‐Based Framework", "title_text": "Mixed Pain: Toward a Consensus Definition and a Mechanism‐Based Framework", "type": "peer-reviewed", "updated_at": "2026-11-03T13:20:37Z", "url": "https://research.draconitic.com/paper/7vyw7tbv6z113", "venue": "European Journal of Pain", "versions": [] }