The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain

Abstract

Physical, mental, and social well-being are part of the concept of health according to the World Health Organization, in addition to the absence of disease and infirmity. Therefore, for a full description of a person's health status, the International Classification of Functioning, Disability and Health (ICF) was launched in 2001 to complement the existing International Classification of Diseases (ICD). The 11th version of the ICD (ICD-11) is based on so-called content models, which have 13 main parameters. One of them is functioning properties (FPs) that, according to the WHO, consist of the activities and participation components of the ICF. Recently, chronic pain codes were added to the 11th edition of the ICD, and hence, a specific set of FPs for chronic pain is required as a link to the ICF. In addition, pain is one of the 7 dimensions of the generic set of the ICF, which applies to any person. Thus, assessment and management of pain are also important for the implementation of the ICF in general. This article describes the current consensus proposal by the International Association for the Study of Pain (IASP) and the International Society of Physical and Rehabilitation Medicine (ISPRM) for a specific set of FPs of chronic pain, which will have to be empirically validated in a next step. The combined use of ICD-11 and ICF is expected to improve research reports on chronic pain by a more precise and adequate coding, as well as patient management through better diagnostic classification.

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

“…The impact of pain on health, functioning, and quality of life is profound with devastating effects on social, physical, psychological, and occupational functioning (Goldberg and McGee, ). Growing worldwide acknowledgment of disability associated with chronic pain will be recognized in the newest version of the International Classification of Diseases, 11th edition (ICD‐11), which will include the diagnosis of chronic pain for the first time (Nugraha et al, ), including chronic primary pain (e.g., chronic headache pain) and chronic secondary pain (e.g., musculoskeletal pain due to inflammation). The price of chronic pain is staggering, with direct healthcare costs in the United States estimated to range from $300 billion up to at least $600 billion per year when including costs associated with workplace productivity loss (Gaskin and Richard, ).…”

A perspective from experimental studies of burning mouth syndrome

“…The IASP classification of chronic pain has defined chronic primary pain [37]. In this classification, chronic widespread pain, including fibromyalgia, requires features of nociplastic pain, which consists of spontaneous or evoked pain in the symptomatic areas, and may be accompanied by sensitized pain perception (allodynia or hyperalgesia) and identified psychosocial contributors.…”

“…Nociplastic pain requires "altered nociceptive function" with "altered descending pain inhibition" [39], despite lacking clear evidence of tissue damage or diseases/lesions in somatosensory systems that lead to the activation of peripheral nociceptors [40]. Chronic primary headache or orofacial pain is another classification of chronic primary pain, and BMS should be classified into chronic primary orofacial pain [37]. BMS has a number of similarities to other chronic primary pain conditions with respect to features of nociplastic pain.…”

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“…This wide variety of goals clearly pointed out the importance of activities, participation, and intrinsic factors on the ICF framework. Recently, the International Association for the Study of Pain Taskforce for Chronic Pain highlighted the importance of measuring functioning or disability based on the ICF framework . Nevertheless, patients are often forced to rely on reporting their pain intensity when evaluating treatment outcomes.…”