It is the first world title established in LPW, having been introduced in 2003 as the Psychotic Wrestling Alliance (PWA) World Heavyweight Championship. After the PWA forked following a management disagreement, the promotion was renamed Lords of Pain Wrestling (LPW) to reflect the Lords of Pain.net home that had hosted the e-federation, with the title also renamed to reflect the acronym.
The first champion was Marty, who won the championship in 2003 during the Golden Age. Overall, there have been 12 different official champions, with SoL, X, and cYnical having the most reigns at two.
After winning the title during season 3, Pen announced he would retire after Altered Reality III and would vacate the title. During the Schizo LIVE from Cleveland show, Schizo GM Stanman announced a 12-man World Championship Tournament to decide a new champion.