Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)

Rolf-Detlef Treede, Winfried Rief, Antonia Barke (Lead / Corresponding author), Qasim Aziz, Michael I. Bennett, Rafael Benoliel, Milton Cohen, Stefan Evers, Nanna B. Finnerup, Michael B. First, Maria Adele Giamberardino, Stein Kaasa, Beatrice Korwisi, Eva Kosek, Patricia Lavandʼhomme, Michael Nicholas, Serge Perrot, Joachim Scholz, Stephan Schug, Blair H. SmithPeter Svensson, Johan W. S. Vlaeyen, Shuu-Jiun Wang

Research output: Contribution to journalReview article

46 Citations (Scopus)

Abstract

Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.

Original languageEnglish
Pages (from-to)19-27
Number of pages9
JournalPain
Volume160
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

International Classification of Diseases
Chronic Pain
Pain
Visceral Pain
Musculoskeletal Pain
Facial Pain
Headache Disorders
Fibromyalgia
Neuralgia
Pain Management
Health Policy
Low Back Pain
Psychological Stress
Primary Health Care
Medicine

Keywords

  • Classification
  • ICD-11
  • Chronic Pain
  • Symptom
  • Disease
  • Chronic Primary Pain
  • Chronic Secondary Pain
  • Functioning
  • Diagnoses
  • Coding

Cite this

Treede, Rolf-Detlef ; Rief, Winfried ; Barke, Antonia ; Aziz, Qasim ; Bennett, Michael I. ; Benoliel, Rafael ; Cohen, Milton ; Evers, Stefan ; Finnerup, Nanna B. ; First, Michael B. ; Giamberardino, Maria Adele ; Kaasa, Stein ; Korwisi, Beatrice ; Kosek, Eva ; Lavandʼhomme, Patricia ; Nicholas, Michael ; Perrot, Serge ; Scholz, Joachim ; Schug, Stephan ; Smith, Blair H. ; Svensson, Peter ; Vlaeyen, Johan W. S. ; Wang, Shuu-Jiun. / Chronic pain as a symptom or a disease : the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). In: Pain. 2019 ; Vol. 160, No. 1. pp. 19-27.
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Treede, R-D, Rief, W, Barke, A, Aziz, Q, Bennett, MI, Benoliel, R, Cohen, M, Evers, S, Finnerup, NB, First, MB, Giamberardino, MA, Kaasa, S, Korwisi, B, Kosek, E, Lavandʼhomme, P, Nicholas, M, Perrot, S, Scholz, J, Schug, S, Smith, BH, Svensson, P, Vlaeyen, JWS & Wang, S-J 2019, 'Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)', Pain, vol. 160, no. 1, pp. 19-27. https://doi.org/10.1097/j.pain.0000000000001384

Chronic pain as a symptom or a disease : the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). / Treede, Rolf-Detlef; Rief, Winfried; Barke, Antonia (Lead / Corresponding author); Aziz, Qasim; Bennett, Michael I.; Benoliel, Rafael; Cohen, Milton; Evers, Stefan; Finnerup, Nanna B.; First, Michael B.; Giamberardino, Maria Adele; Kaasa, Stein; Korwisi, Beatrice; Kosek, Eva; Lavandʼhomme, Patricia; Nicholas, Michael; Perrot, Serge; Scholz, Joachim; Schug, Stephan; Smith, Blair H.; Svensson, Peter; Vlaeyen, Johan W. S.; Wang, Shuu-Jiun.

In: Pain, Vol. 160, No. 1, 01.01.2019, p. 19-27.

Research output: Contribution to journalReview article

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T2 - the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)

AU - Treede, Rolf-Detlef

AU - Rief, Winfried

AU - Barke, Antonia

AU - Aziz, Qasim

AU - Bennett, Michael I.

AU - Benoliel, Rafael

AU - Cohen, Milton

AU - Evers, Stefan

AU - Finnerup, Nanna B.

AU - First, Michael B.

AU - Giamberardino, Maria Adele

AU - Kaasa, Stein

AU - Korwisi, Beatrice

AU - Kosek, Eva

AU - Lavandʼhomme, Patricia

AU - Nicholas, Michael

AU - Perrot, Serge

AU - Scholz, Joachim

AU - Schug, Stephan

AU - Smith, Blair H.

AU - Svensson, Peter

AU - Vlaeyen, Johan W. S.

AU - Wang, Shuu-Jiun

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.

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