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

Abstract

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.

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Affiliated Institutions

• Cliniques Universitaires Saint-Luc BE
• KU Leuven BE
• Université Paris Cité FR
• University of Dundee GB
• University Hospital Heidelberg DE
• UCLouvain BE
• Maastricht University NL
• Aarhus University DK
• Aarhus University Hospital DK
• Royal Perth Hospital AU
• University of Chieti-Pescara IT
• The University of Western Australia AU
• University of Oslo
• UNSW Sydney AU
• Karolinska Institutet SE
• Danish Pain Research Center DK
• Genomics (United Kingdom) GB
• Oslo University Hospital
• Krankenhaus Lindenbrunn DE
• European Association for Palliative Care BE
• New York Psychoanalytic Society and Institute US
• Karolinska University Hospital SE
• Queen Mary University of London GB
• University of Münster DE
• Columbia University US
• University Medical Centre Mannheim DE
• University of Leeds GB
• St Vincent's Clinic AU
• The University of Sydney AU
• Philipps University of Marburg DE
• Rutgers, The State University of New Jersey US
• New York State Psychiatric Institute
• Ziekenhuis Oost-Limburg BE
• Heidelberg University DE

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