The IASP classification of chronic pain for ICD-11: chronic neuropathic pain

Abstract

The upcoming 11th revision of the International Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary task force of pain specialists. Here we present the case for a reclassification of nervous system lesions or diseases associated with persistent or recurrent pain for ≥ 3 months. The new classification lists the most common conditions of peripheral neuropathic pain: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy. Conditions of central neuropathic pain include pain caused by spinal cord or brain injury, post-stroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are automatically captured in the residual categories of ICD-11. These conditions are either insufficiently defined or missing in the current version of the ICD despite their prevalence and clinical importance. We provide the short definitions of diagnostic entities for which we submitted more detailed content models to the WHO. Definitions and content models were established in collaboration with the Classification Committee of the IASP’s Neuropathic Pain Special Interest Group (NeuPSIG). Up to 10% of the general population experience neuropathic pain. The majority of these patients do not receive satisfactory relief with existing treatments. A precise classification of chronic neuropathic pain in ICD-11 is necessary to document adequately this public health need and the therapeutic challenges related to chronic neuropathic pain.

Pharmacokinetic and pharmacodynamic considerations for NMDA-receptor antagonist ketamine in the treatment of chronic neuropathic pain: an update of the most recent literature

“…On their website, the International Association for the Study of Pain (IASP) defines neuropathic pain (NP) as 'pain caused by a lesion of the somatosensory nervous system' [1,2]. The IASP further states that NP is a description rather than a diagnosis that requires a detectable lesion or a disease according to recognized neurologic criteria.…”

“…Therapeutically, ketamine is used as an anesthetic, analgesic for acute and chronic (cancer and non-cancer) pain, and since a few years as an antidepressant. Additionally, ketamine is occasionally used as an anti-inflammatory agent in perioperative care, in the treatment of post-traumatic stress disorder, and finally to induce bronchodilation in refractory asthma [2,[15][16][17].…”

Persistent dentoalveolar pain disorder: A putative intraoral chronic overlapping pain condition

“…PDAP is frequently considered a neuropathic condition, defined as pain caused by a lesion or disease of the somatosensory nervous system (Treede et al, 2008). In this context, the presence of an injury caused by an event (i.e., trauma or dental procedure) and loss of function (i.e., sensory loss as assessed with QST) are considered two key features for its categorization as a neuropathic pain condition (Finnerup et al, 2016;Scholz et al, 2019). Nonetheless, it must be kept in mind the following: (a) some reports indicate that more than half of PDAP cases are not associated with traumatic events or dental procedures (Ram et al, 2009); and (b) although results are mixed, it appears that PDAP patients present more consistently with sensory gain than sensory loss when assessed with QST (Baad-Hansen et al, 2013;Baad-Hansen et al, 2013;Porporatti, Costa, Stuginski-Barbosa, Bonjardim, Contic, & Svensson, 2015;Porporatti et al, 2017).…”

Comprehensive Analysis of Differentially Expressed Genes and Key Pathways in Neuropathic Pain by Spinal Nerve Ligation

“…However, neuropathic pain is a type of chronic pain with a pathological state. The clinical manifestations of neuropathic pain are spontaneous pain, allodynia, and hyperalgesia, and such condition causes serious physical discomfort and potential economic consequences for 11-19% of the adult population in the United States [4][5][6]. There are several potential causes of neuralgia, including mechanical injuries, metabolic or nutritional neurological changes, and neurotransmitter dysfunction [7][8][9].…”