IASP Working Group on Classification of Chronic Pain Reports Progress on ICD-11

Jun 19, 2015

To clinicians treating chronic pain conditions, epidemiologists studying them, and health-care systems billing for related treatment, the lack of adequate coding for these conditions in the International Classification of Diseases, 10th Revision (ICD-10), has been a major obstacle. Adequate coding is required for appropriate diagnosis, treatment, and reimbursement, as well as appropriate data storage, research, and national resource allocation for health care.

ICD-10 is the standard diagnostic tool for epidemiology, health management, and clinical diagnosis, but it was endorsed by the World Health Organization (WHO) in 1990 and adopted by member countries in 1994. Although updates followed annually through 2011, ICD-11 represents a major revision. It is planned for publication in 2017.

Recognizing the critical importance of a pragmatic classification of chronic pain based on the latest research, IASP created the Working Group on the Classification of Chronic Pain in 2013. The Working Group is working closely with WHO to improve the classification of chronic pain conditions in ICD-11 so that they are not only useful in specialized settings but also apply in a wide range of contexts, including primary care and low-resource environments.

Beyond improving coding, the Working Group is focused on enhancing the recognition of chronic pain as a major health problem. The new classification system will likely contribute to improved access to adequate pain treatment for persons with chronic pain worldwide.

In the proposed classification, chronic pain will be defined as pain that persists or recurs for more than three months. Under this heading, diagnoses in which pain is either the sole or a leading complaint of the patient will be listed. As a result of IASP’s efforts, several improvements can be expected in ICD-11: Chronic pain will be noted as requiring special consideration and treatments. In addition, chronic pain conditions that were neglected in previous ICD versions will be represented with their own codes (for example, chronic cancer pain and chronic neuropathic pain). Thus, the new ICD will advance IASP’s mission and vision, encouraging more attention to and treatment of pain worldwide.

To be represented in the ICD, all diagnoses require the generation of “content models.” The content models have to be aligned with WHO requirements. On a day-to-day basis, this means the Working Group must agree on, and write, a full content model for each diagnosis and identify potential overlaps and problems. The general approach the Working Group developed was outlined in a topical review, which is now available in the journal PAIN.

The Working Group is in regular contact with WHO representatives in charge of the ICD-11 revision process, and the proposed diagnostic categories have been submitted to the ICD-11 beta browser. To view the proposals, you will have to register with the ICD-11 beta browser (free), as proposals and comments can only be accessed by registered users. Once registered, you can search for the name of the diagnosis and see all proposals attached to it.

To improve the classification, the Working Group welcomes all comments on the topical review and on the individual content models.

The Working Group, which meets annually in Frankfurt, Germany, is co-chaired by IASP President Rolf-Detlef Treede, Prof. Dr.med., and Winfried Rief, PhD, a professor of clinical psychology and psychotherapy at the University of Marburg in Germany. It consists of more than 20 experts who work in teams of two on the major areas of pain.

--Antonia Barke, MA, D.Phil, Dipl.Psych., University of Marburg in Germany, coordinates the IASP Working Group on the Classification of Chronic Pain.