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

Abstract

This article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called "chronic secondary pain" where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.

Relationship between Forward Head Posture and Tissue Mechanosensitivity: A Cross-Sectional Study

“…These discrepancies between studies could be due to the fact that chronic pain subjects show more complex interactions, with emotional distress hindering their pain modulation capability. We do not know if this result applies to subjects with acute neck pain, in which mechanical aspects are more important [31]. Headache was not found to be associated with FHP.…”

General health status of a sample of patients with burning mouth syndrome: A case–control study

“…Furthermore, Miller et al, 2019 questioned whether BMS should be considered a syndrome or a disorder, since patients who have BMS do not always suffer a consistent set of clinical features and in many cases patients suffering from it have other previous diseases. The debate is so deep that the IASP in its latest classification of diseases (ICD‐11) includes the term “Chronic burning mouth pain” within primary chronic pain (Nicholas et al, 2019) excluding the word “syndrome.”…”

Emotional distress: Specifying a neglected part of chronic pain

“…A striking case in which the reporting of pain-related distress would be especially important, are those chronic pain syndromes that are now classified as CPP in the ICD-11 (Nicholas et al, 2019). In the ICD-11, CPP is defined as chronic pain (persisting or recurring for longer than 3 months) that is characterized by significant emotional distress or interference, and that is not better accounted for by another disease, such as for example a tumor or arthritis (Nicholas et al, 2019). As for all forms of chronic pain, a biopsychosocial model is assumed, with psychological as well as biological factors contributing to the pain.…”

“…The diagnosis can be given independently of clearly identified psychological or biological contributors except if another diagnosis accounts for the pain. Examples for CPP include chronic widespread pain, chronic migraine and chronic primary low back pain (formerly often termed "chronic nonspecific low back pain") (Nicholas et al, 2019). Here in addition to the occurrence of pain for more than 3 months, disability or distress are not only further descriptors, but also part of the main criteria for the diagnosis.…”

“…The present paper is based on extensive screening of abstracts, titles and full texts in the field of chronic primary pain (CPP) and hence proposes that this severity code should be reported in all future randomized controlled trials (RCTs) on chronic pain. This becomes especially relevant when considering the example of CPP, a new diagnostic entity in the ICD-11 (Nicholas et al, 2019).…”