Reliability and clinical utility of the chronic pain classification in the 11th Revision of the International Classification of Diseases from a global perspective: results from India, Cuba, and New Zealand

Korwisi, Beatrice; Suarez, Barbara; Goswami, Subrata; Gunapati, Nischala Reddy; Hay, Ginea; Arteaga, Manuel Angel Hernández; Hill, Charlotte; Jones, David; Joshi, Meera; Kleinstäuber, Maria; Mantecón, Ana Marta López; Nandi, Gargi; Papagari, Chandra Shekhar Reddy; Martínez, María Del Carmen Rabí; Sarkar, Biplab; Swain, Nicola; Templer, Paul; Tulp, Maartje; White, Naomi Rosh; Treede, Rolf‐Detlef; Rief, Winfried; Barke, Antonia

doi:10.1097/j.pain.0000000000002379

Cited by 13 publications

(14 citation statements)

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“…For the first time, the biopsychosocial definition of chronic pain has been implemented in the ICD, overcoming the artificial dichotomization of "somatic" vs "psychogenic," "somatoform," or "functional" pain that was present in previous versions of the ICD. First field studies show that the classification fulfils the formal criteria required for its smooth use, 3,4 for its reliability and global applicability, 36 and improves the visibility of CP. 78 The clinicians who participated in these studies rated the clinical utility of the diagnoses as very high, indicating that they considered the classification as a tool that will help to improve the communication of pain diagnoses to patients and other colleagues, to unify language (eg, regarding clinical documentation and data collection), and to facilitate treatment selection as well as pain management.…”

Section: Discussionmentioning

confidence: 93%

“…The ICD-11 chronic pain classification aims at applicability in a variety of settings, including research (clinical as well as pre-clinical), primary care, 58 low-resource settings, 36 multidisciplinary pain treatment, and psychological pain treatment. The future clinical users will belong to a variety of professions, including pain physicians, family doctors, clinical and health psychologists, and physiotherapists among others.…”

Section: Resultsmentioning

confidence: 99%

“…First field tests provide evidence for the validity, reliability, and clinical utility of the ICD-11 chronic pain classification. 3,4,36…”

Section: Introductionmentioning

confidence: 99%

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Chronic pain in the 11th Revision of the International Classification of Diseases: users' questions answered

Korwisi

Barke

Rief

et al. 2021

Pain

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For the first time, the upcoming International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11) will include a comprehensive classification of chronic pain, which is based on the biopsychosocial definition of chronic pain. This presents a great opportunity for pain research and clinical practice. The new classification consists of 7 main diagnostic categories of chronic pain, which are further divided into increasingly specific levels of diagnoses. Each diagnosis is characterized by clearly defined operationalized criteria. Future users will need to familiarize themselves with the new system and its application. The aim of the present publication is to provide users of the ICD-11 chronic pain classification with answers to frequently asked questions regarding the ICD-11 as a whole, the ICD-11 chronic pain classification, and its application to common pain syndromes. The questions compiled in this study reached the International Association for the Study of Pain Task Force through different routes (eg, at conferences, by letter, or during field testing). Furthermore, the authors collected questions posted to the ICD-11 browser and contacted early users of the classification to enquire about their most frequent difficulties when applying the new diagnoses. The authors of the present publication prepared answers to these frequently asked questions. This publication intends to act as a guide for the future users of the new ICD-11 chronic pain classification, hence facilitating its implementation.

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Section: Discussionmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

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Chronic pain in the 11th Revision of the International Classification of Diseases: users' questions answered

Korwisi

Barke

Rief

et al. 2021

Pain

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“…A next step in reliability testing was testing the interrater-reliability of clinicians assigning diagnoses to real consecutive patients. In an international field testing study, consecutive patients were independently diagnosed by two clinicians and substantive Kappa coefficients for interrater reliabilities reported (0.596 < κ < 0.783) ( Korwisi, Garrido Suarez, et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…The Task Force provided both by striving for a consensus among the professionals working with patients with chronic pain and publishing the results in a series of papers ( Aziz et al, 2019 ; Bennett et al, 2019 ; Benoliel et al, 2019 ; Nicholas et al, 2019 ; Nugraha et al, 2019 ; Perrot et al, 2019 ; Scholz et al, 2019 ; Schug et al, 2019 ; Smith et al, 2019 ; Treede et al, 2019 ; Treede et al, 2015 ). The development was accompanied by formative evaluations ( Barke et al, 2018 ; Barke et al, 2022 ) and evaluative studies ( Hay et al, 2022 ; Korwisi, Garrido Suarez, et al, 2022 ; Korwisi et al, 2020 ; Zinboonyahgoon et al, 2021 ). In 2019, the World Health Assembly endorsed the ICD-11 with the new classification of chronic pain ( World Health Assembly, 2019 ).…”

Section: Methodsmentioning

confidence: 99%

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

Barke¹,

Korwisi

Rief

2022

Clin. Psychol. Eur.

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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.

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Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD‐11 (CAL‐CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study

Hay,

Korwisi,

Lahme‐Hütig

et al. 2024

European Journal of Pain

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BackgroundThe ICD‐11 classification of chronic pain comprises seven categories, each further subdivided. In total, it contains over 100 diagnoses each based on 5–7 criteria. To increase diagnostic reliability, the Classification Algorithm for Chronic Pain in the ICD‐11 (CAL‐CP) was developed. The current study aimed to evaluate the CAL‐CP regarding the correctness of assigned diagnoses, utility and ease of use.MethodsIn an international online study, n = 195 clinicians each diagnosed 4 out of 8 fictitious patients. The clinicians interacted via chat with the virtual patients to collect information and view medical histories and examination findings. The patient cases differed in complexity: simple patients had one chronic pain diagnosis; complex cases had two. In a 2 × 2 repeated‐measures design with the factors tool (algorithm/standard browser) and diagnostic complexity (simple/complex), clinicians used either the algorithm or the ICD‐11 browser for their diagnoses. After each case, clinicians indicated the pain diagnoses and rated the diagnostic process. The correctness of the assigned diagnoses and the ratings of the algorithm's utility and ease of use were analysed.ResultsThe use of the algorithm resulted in more correct diagnoses. This was true for chronic primary and secondary pain diagnoses. The clinicians preferred the algorithm over the ICD‐11 browser, rating it easier to work with and more useful. Especially novice users benefited from the algorithm.ConclusionsThe use of the algorithm increases the correctness of the diagnoses for chronic pain and is well accepted by clinicians. The CAL‐CP's use should be considered in routine care and research contexts.Significance StatementThe ICD‐11 has come into effect in January 2022. Clinicians and researchers will soon begin using the new classification of chronic pain. To facilitate clinicians training and diagnostic accuracy, a classification algorithm was developed. The paper investigates whether clinicians using the algorithm—as opposed to the generic tools provided by the WHO—reach more correct diagnoses when they diagnose standardized patients and how they rate the comparative utility of the diagnostic instruments available.

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Reliability and clinical utility of the chronic pain classification in the 11th Revision of the International Classification of Diseases from a global perspective: results from India, Cuba, and New Zealand

Abstract: The 11th Revision of the International Classification of Diseases chronic pain diagnoses are reliable and clinically useful in both low- and high-middle-income countries and a high-income country, showing their global applicability.

Cited by 13 publications

References 44 publications

Chronic pain in the 11th Revision of the International Classification of Diseases: users' questions answered

Chronic pain in the 11th Revision of the International Classification of Diseases: users' questions answered

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

Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD‐11 (CAL‐CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study

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