Chronic pain in the ICD-11: New diagnoses that clinical psychologists should know about

Abstract

Background In the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10), chronic pain was not represented adequately. Pain was left undefined and not recognized as a biopsychosocial phenomenon. Instead, a flawed dualism between psychological and somatic factors was implied. Individual diagnoses were ill-defined and scattered randomly through different chapters. Many patients received diagnoses in remainder categories devoid of meaningful clinical information. Method The International Association for the Study of Pain launched a Task Force to improve the diagnoses for the 11th revision of the ICD and this international expert team worked from 2013-2019 in cooperation with the WHO to develop a consensus based on available evidence and to improve the diagnoses. Results A new chapter on chronic pain was created with a biopsychosocial definition of pain. Chronic pain was operationalized as pain that persists or recurs longer than three months and subdivided into seven categories: Chronic primary pain and six types of chronic secondary pain. All diagnoses were based on explicit operationalized criteria. Optional extension codes allow coding pain-related parameters and the presence of psychosocial aspects together with each pain diagnosis. Conclusion First empirical studies demonstrated the integrity of the categories, the reliability, clinical utility, international applicability and superiority over the ICD-10. To improve reliability and ease of diagnosis, a classification algorithm is available. Clinical psychologists and other clinicians working with people with chronic pain should watch the national implementation strategies and advocate for multimodal and interdisciplinary treatments and adequate reimbursement for all providers involved.

Die Kodierung chronischer Schmerzen in der ICD-11

“…Diese Diagnose stand bekanntlich nur in der deutschen Modifikation der ICD-10 (ICD-10-GM) zur Verfügung 13 . Jedoch sind chronische primäre Schmerzen in der ICD-11 nicht im Kapitel für psychische Störungen angesiedelt 5 und behandlungsrelevante Differenzierungen sind aufgenommen worden 11 .…”

“…Bei vielen Diagnosen war die chronische Natur der Schmerzen nicht abgebildet und die Diagnosen waren über verschiedene Kapitel der ICD verteilt. Zudem herrschte ein nicht sachangemessener Dualismus vor: Schmerzen wurden entweder als somatisch oder psychisch verursacht angesehen und in unterschiedlichen Kapiteln klassifiziert 5 .…”

Update: Noziplastischer Schmerz

“…Unter dem ICD-10-Code „F45.41“ findet sich „Chronische Schmerzstörung mit somatischen und psychischen Faktoren“ 53 . Diese ist in der aktuellen Fassung der International Classification of Diseases (ICD-11) eliminiert, was den problematischen und stigmatisierenden Kontext beseitigt (eine ausgezeichnete Darstellung der Entwicklung des Konzepts findet sich in Barke et al 2023 54 ).…”

Overview: Chronic Pain and Cannabis-Based Medicines

“…As an epidemiological analysis in Germany has shown, one can speak of an independent pain disease, especially when chronic pain is associated with considerable emotional distress and functional impairment 2 . This definition corresponds to the current ICD-11 classification of chronic primary pain 3 .…”