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New Classification for Chronic Pain

The World Health Organization (WHO) has updated the International Classification of Diseases (ICD-11). For the first time, they have included chronic pain and provided specific pain diagnoses. Under the new system, chronic pain is classified as either chronic primary pain or chronic secondary pain.

Chronic primary pain is defined as pain that persists for longer than three months and is associated with significant emotional distress or functional disability and that cannot be explained by another chronic condition. This new definition applies to chronic pain syndromes that are best conceived as health conditions in their own right.  Examples of chronic primary pain conditions include fibromyalgia, complex regional pain syndrome, chronic migraine, irritable bowel syndrome and non-specific low-back pain.

Chronic secondary pain syndromes are defined as pain that may initially be regarded as a symptom of other diseases having said disease being the underlying cause. However, a diagnosis of chronic secondary pain marks the stage when the chronic pain becomes a problem in its own right. In many cases, the chronic pain may continue beyond successful treatment of the initial cause; in such cases, the pain diagnosis will remain, even after the diagnosis of the underlying disease is no longer relevant. Examples of chronic secondary pain are chronic pain related to cancer, surgery, injury, internal disease, disease in the muscles, bones or joints, headaches or nerve damage.

More detail can be found in the online edition of Pain: The Journal of the International Association for the Study of Pain:

journals.lww.com/pain/Fulltext/2019/01000/Chronic_pain_as_a_symptom_or_a_disease__the_IASP.3.aspx.

Comments

Very good information and not just oh you will have to put up with that pa n especially after having such large surgeries

Good to finally take this subject seriously. I have no doubt about the link between negative emotions as the cause of chronic physical pain symptoms. This deserves its own branch of diagnostics, therapies, counseling, and medicine. So well done taking this problem that afflicts so many and bringing it into the light.., People have the right to not be made to feel like they are nuts, being made to feel as if they should just go away, because this pain is a very real symptom of long term chronic emotional stress causing physical syndromes to manifest, thus the new official catagory of “chronic primary pain” is much appreciated. Thank you.

I have been suffering chronic pain for years I’ve also been to a pain clinic and a pain consultant. A few weeks ago I went to see my GP after having a major pain flare up in my ribs my waist and in my legs. The GP concerned said “you will have to live with the pain I’m not prescribing painkillers” I never even asked for painkillers. Then she said can I help you with anything else at which point I said no , thank you for seeing me.
Some days I can barely walk 🥺
I think some doctors need to be educated. It felt like I’ve been mocked by the doctor.

I have been in chronic pain since age 11 since I started menstruation I had to wait 28 yrs till 1999 for a diagnosis of Endometriosis & only got then due to ovarian torsion due to calcified endometriomas. I got a diagnosis earlier that year of CFS/FMS. In my experience all pain is secondary. I haven’t had a pain in my life that I can’t attribute to a underlying issue either Endometriosis Arthritis, UTI’s, Fibroids. When people have to still wait an average of 1o yrs for diagnosis for Endometriosis thats a long time to be labelled withprimary chronic pain.

Karen.lothe@nhs.net

This is a step in the right direction. However, with the latest guidelines, GPs in particular could feel disempowered with dwindling therapeutic options available for managing chronic pain. Advise to refer to physical and psychological services is all well and good but these services are not always easily available.
The definition of primary chronic pain “cannot be explained by another chronic condition” is useful BUT, not detracting from the psychosocial aspect of chronic pain management, as doctors we must continue to be vigilant. Awareness of the more unusual causes of chronic pain allows treatment options for patients who would otherwise be burdened by their pain.

Comments are closed.

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