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

ABSTRACT: The upcoming 11th revision of the International Statistical 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, poststroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are captured in residual categories of ICD-11. Conditions of chronic neuropathic pain 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 this public health need and the therapeutic challenges related to chronic neuropathic pain.

SUBMITTER: Scholz J

PROVIDER: S-EPMC6310153 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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

Scholz Joachim J Finnerup Nanna B NB Attal Nadine N Aziz Qasim Q Baron Ralf R Bennett Michael I MI Benoliel Rafael R Cohen Milton M Cruccu Giorgio G Davis Karen D KD Evers Stefan S First Michael M Giamberardino Maria Adele MA Hansson Per P Kaasa Stein S Korwisi Beatrice B Kosek Eva E Lavand'homme Patricia P Nicholas Michael M Nurmikko Turo T Perrot Serge S Raja Srinivasa N SN Rice Andrew S C ASC Rowbotham Michael C MC Schug Stephan S Simpson David M DM Smith Blair H BH Svensson Peter P Vlaeyen Johan W S JWS Wang Shuu-Jiun SJ Barke Antonia A Rief Winfried W Treede Rolf-Detlef RD

Pain 20190101 1

The upcoming 11th revision of the International Statistical 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 ...[more]

PMID: 30586071

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Project description:BackgroundRecently, a new classification system for chronic pain was included in the 11th edition of the International Classification of Diseases (ICD-11). This study aims to investigate how expectancies of coping, that is pain catastrophizing and general self-efficacy, are associated with ICD-11 chronic pain categories in a large pain clinic population. Furthermore, we investigate how coping expectancies are associated with pain-related disability, cross-sectionally and longitudinally across the novel pain classifications.MethodsThe sample was retrieved from the Oslo University Hospital Pain Registry and included baseline data from 2875 chronic pain patients and 12-month follow-up data for 920 patients. Demographic and clinical variables were compared across the ICD-11 chronic pain categories through ANOVA. Multiple regression models were carried out to investigate cross-sectional and longitudinal associations.ResultsWith the exception of age, our data showed no significant differences across the ICD-11 chronic pain categories. Coping expectancies were associated with disability at baseline. At 12-month follow-up, coping expectancies did not predict pain-related disability when controlling for baseline levels of disability, pain intensity and pain duration. Pain classification (primary vs secondary) did not contribute significantly to the models. Helplessness had the strongest simple relationship to disability, compared with global pain catastrophizing and its additional subscales, both cross-sectionally and longitudinally.ConclusionCoping expectancies, pain intensity and pain-related disability appear similar across the novel chronic pain classifications, indicating that all pain patients may benefit from targeting these variables. Consistent with recent developments in stress theory, helplessness and self-efficacy were cross-sectionally associated with negative pain outcomes.SignificanceLevels of coping expectancies, demographic characteristics, pain-related disability and pain intensity are similar across all ICD-11 chronic pain diagnostic categories. Thus, chronic primary pain is not stronger associated with psychosocial factors such as catastrophizing and self-efficacy than chronic secondary pain. Therefore, chronic pain patients, independent of diagnosis, may benefit from the assessment of these psychosocial factors and targeted interventions such as CBT should be considered.

Project description:Pain is one of the most disabling symptoms of Gaucher disease. It is referred by the majority of Gaucher patients and often persists despite long-term enzyme replacement treatment. It has been mainly considered as nociceptive pain secondary to skeletal involvement but it is described even in the absence of bone disease without a clear explanation. In the last years an increasing number of reports have described the presence of neurological manifestation in Gaucher type 1 patients, including subclinical large fibre neuropathy. In our Gaucher clinic we have observed the recurrence of painful symptoms in a group of type 1 Gaucher patients even after a long-term enzyme replacement therapy.A cross-sectional study was designed to investigate the pathophysiology of pain in a cohort of 25 Gaucher patients (13 females, 12 males). Twenty-two patients received enzyme replacement therapy for a period of time ranging from 10 to >20 years, while three were new diagnosis. Pain was classified as bone or neurologic related on the basis of anamnestic data, clinical and electrophysilogical examinations. Intensity and quality of pain were recorded by Douleur Neuropathique en 4 questionnaire and Neuropathic Pain Symptom Inventory. Neuroalgological evaluation, quantitative sensory testing, nerve conduction studies and evaluation of epidermal nerve fibres density were performed. Comorbidities for peripheral neuropathy were excluded.Thirteen patients complained of pain suggestive of neuropathic origin with proximal patchy distribution, six manifested severe pain paroxysmal, nine pinprick hypoesthesia and 17 thermal hypoesthesia. At quantitative sensory testing, all of them showed high cold thresholds with errata sensation (burning instead of cold), paradoxical heat sensation and mechanic hypoesthesia; three patients showed pressure pain hyperalgesia. Epidermal denervation was present in 19 patients, 12 of them with non-length dependent pattern.These results confirm the role of peripheral neuropathy in Gaucher pain and demonstrate that skin denervation is as a constitutive feature of the disorder. In addition, they further confirm the existence of a continuum Gaucher phenotype, and provide a new interpretation of pain origin that should be considered for an appropriate disease management and to avoid unnecessary dose escalations of enzyme therapy.

Dataset Information

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

Publications

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

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