Oct 5, 2015
The IASP Working Group on the Classification of Chronic Pain conducted a symposium at the 9th Congress of the European Pain Federation in September to discuss progress on the classification process and the novel concept of chronic primary pain. In 2013, IASP created the working group to create a new and pragmatic classification of chronic pain for inclusion in ICD-11.
Since its inception, the group has created a set of diagnoses structured in accord with ICD-11 principles with first priority given to pain etiology, followed by underlying pathophysiological mechanisms, and finally body site. Details appear in a topical review in PAIN.
For many forms of chronic pain the etiology is unknown. A particular concern of the working group concerned etiological assumptions insufficiently grounded in evidence. In discussing “chronic primary pain,” the group introduced a novel category that allows coding for chronic pain syndromes that cause distress and/or disability but cannot be better classified with any other diagnoses.
The symposium at EFIC was conducted by chairman of the working group, Rolf-Detlef Treede, and co-chair Winfried Rief, as well as Johan Vlaeyen, who was one of the moving spirits behind the concept of primary pain. Nearly 100 pain specialists attended the symposium, and a fruitful discussion ensued, in the course of which the IASP initiative was lauded by many speakers.
That the working group abstained from relying on etiological assumptions in the classification was welcomed as an important achievement. During the discussion, it was also noted that in many clinical conditions pain initially starts as a symptom, such as pain in an arthritic joint, postoperative wound, or after cancer radiotherapy. But in a substantial number of patients pain may persist in spite of causal treatment, as often is the case in treating joint inflammation. It is anticipated that these patients will be better recognized with a pain diagnosis in ICD-11 than with a diagnosis of their primary disease or condition.
The IASP working group is working closely with WHO to improve the classification of chronic pain conditions in ICD-11 so that they are not only useful in specialized settings but also apply in a wide range of contexts, including primary care and low-resource environments.
--Antonia Barke, MA, D.Phil, Dipl.Psych., University of Marburg in Germany, coordinates the IASP Working Group on the Classification of Chronic Pain.