{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:09:13Z","timestamp":1792202953765,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2014from chronic low back pain to cancer pain and osteoarthritis\u2014exhibit overlapping mechanisms and have long fallen into the \u2018grey zone\u2019 of mixed pain. This area has intrigued researchers yet frustrated clinicians due to the absence of a clear, unified definition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This new definition may help provide the context needed to align research, refine diagnosis and design mechanism\u2010based therapies for patients with mixed pain. It marks an important step towards conceptual clarification\u2014from confusion to consensus, from overlap to action\u2014transforming mixed pain from an ambiguous concept into a potential framework of modern pain taxonomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>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\u2010based assessment and may facilitate more individualized treatment approaches in complex pain conditions while providing a practical foundation for future research, validation and clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70356","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T09:22:12Z","timestamp":1786008132000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Mixed Pain: Toward a Consensus Definition and a Mechanism\u2010Based Framework"],"prefix":"10.1002","volume":"30","author":[{"given":"Rainer","family":"Freynhagen","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Critical Care Medicine &amp; Pain Therapy Benedictus Hospital Feldafing &amp; Tutzing  Feldafing Germany"},{"name":"Department of Anaesthesiology Klinikum Rechts der Isar, Technische Universit\u00e4t M\u00fcnchen  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Morlion","sequence":"additional","affiliation":[{"name":"The Leuven Centre for Algology and Pain Management University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Cardiovascular Sciences, Section Anaesthesiology and Algology KU Leuven\u2010University of Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Alc\u00e1ntara Montero","sequence":"additional","affiliation":[{"name":"Servicio Extreme\u00f1o de Salud  Trujillo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ciampi de Andrade","sequence":"additional","affiliation":[{"name":"Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s","family":"Hern\u00e1ndez\u2010Ortiz","sequence":"additional","affiliation":[{"name":"Pain and Palliative Medicine Instituto Nacional de Ciencias M\u00e9dicines y Nutrici\u00f3n Salvador Zubir\u00e1n  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Hodges","sequence":"additional","affiliation":[{"name":"Centre for Innovation in Pain and Health Research (CIPHeR) The University of Queensland  Brisbane Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasikaan","family":"Nimmaanrat","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Prince of Songkla University Hat Yai  Songkhla Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther M.","family":"Pogatzki\u2010Zahn","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care, and Pain Medicine Univerisity Hospital  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Raff","sequence":"additional","affiliation":[{"name":"Pain Clinic, Christiaan Barnard Memorial Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto D.","family":"Rey","sequence":"additional","affiliation":[{"name":"Instituto Argentino de Investigaci\u00f3n Neurol\u00f3gica Universidad de Buenos Aires  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"Diabetes Research Unit Sheffield Teaching Hospitals NHS Foundation Trust  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Truini","sequence":"additional","affiliation":[{"name":"Department of Human Neuroscience Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giustino","family":"Varrassi","sequence":"additional","affiliation":[{"name":"Fondazione Paolo Procacci  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Baron","sequence":"additional","affiliation":[{"name":"Division of Neurological Pain Research and Therapy, Department of Neurology Christian\u2010Albrechts\u2010Universit\u00e4t Kiel  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers18040646"},{"issue":"107","key":"e_1_2_12_3_1","first-page":"79","article-title":"The Role of Centralised Pain in Osteoarthritis","volume":"35","author":"Clauw D. 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