The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions

Roger B Fillingim¹, Stephen Bruehl², Robert H Dworkin³, Samuel F Dworkin⁴, John D Loeser⁵, Dennis C Turk⁶, Eva Widerstrom-Noga⁷, Lesley Arnold⁸, Robert Bennett⁹, Robert R Edwards¹⁰, Roy Freeman¹¹, Jennifer Gewandter¹², Sharon Hertz¹³, Marc Hochberg¹⁴, Elliot Krane¹⁵, Patrick W Mantyh¹⁶, John Markman¹⁷, Tuhina Neogi¹⁸, Richard Ohrbach¹⁹, Judith A Paice²⁰, Frank Porreca¹⁶, Bob A Rappaport¹³, Shannon M Smith¹², Thomas J Smith²¹, Mark D Sullivan²², G Nicholas Verne²³, Ajay D Wasan²⁴, Ursula Wesselmann²⁵

Affiliations

¹ Pain Research and Intervention Center of Excellence, Gainesville, Florida. Electronic address: rfilling@ufl.edu.
² Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
³ Department of Neurology in the Center for Human Experimental Therapeutics; and Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), University of Rochester School of Medicine and Dentistry, Rochester, New York.
⁴ Department of Psychiatry and Behavioral Sciences, School of Medicine, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington.
⁵ Department of Neurological Surgery, University of Washington, Seattle, Washington.
⁶ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
⁷ Health Scientist VHA, University of Miami, Miller School of Medicine, Miami Project to Cure Paralysis, Miami, Florida.
⁸ Department of Psychiatry and Behavioral Neuroscience, and Director, Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁹ Fibromyalgia Research Unit, Oregon Health & Science University, Portland, Oregon.
¹⁰ Brigham & Women's Hospital, Chestnut Hill, Massachusetts.
¹¹ Department of Neurology, Harvard Medical School, Cambridge, Massachusetts.
¹² Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
¹³ Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland.
¹⁴ Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland.
¹⁵ Departments of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, California.
¹⁶ Department of Pharmacology, University of Arizona, Tucson, Arizona.
¹⁷ University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York.
¹⁸ Clinical Epidemiology Unit, Boston, Massachusetts.
¹⁹ Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
²⁰ Director, Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
²¹ Department of Oncology, Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins Hospital, Baltimore, Maryland.
²² Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
²³ Department of Medicine, University of Texas Medical Branch, Galveston, Texas.
²⁴ Department of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
²⁵ Department of Anesthesiology and Neurology, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 24581634
PMCID: PMC4454364
DOI: 10.1016/j.jpain.2014.01.004

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions

Roger B Fillingim et al. J Pain. 2014 Mar.

. 2014 Mar;15(3):241-9.

doi: 10.1016/j.jpain.2014.01.004.

Authors

Affiliations

¹ Pain Research and Intervention Center of Excellence, Gainesville, Florida. Electronic address: rfilling@ufl.edu.
² Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
³ Department of Neurology in the Center for Human Experimental Therapeutics; and Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), University of Rochester School of Medicine and Dentistry, Rochester, New York.
⁴ Department of Psychiatry and Behavioral Sciences, School of Medicine, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington.
⁵ Department of Neurological Surgery, University of Washington, Seattle, Washington.
⁶ Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
⁷ Health Scientist VHA, University of Miami, Miller School of Medicine, Miami Project to Cure Paralysis, Miami, Florida.
⁸ Department of Psychiatry and Behavioral Neuroscience, and Director, Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio.
⁹ Fibromyalgia Research Unit, Oregon Health & Science University, Portland, Oregon.
¹⁰ Brigham & Women's Hospital, Chestnut Hill, Massachusetts.
¹¹ Department of Neurology, Harvard Medical School, Cambridge, Massachusetts.
¹² Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
¹³ Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland.
¹⁴ Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland.
¹⁵ Departments of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, California.
¹⁶ Department of Pharmacology, University of Arizona, Tucson, Arizona.
¹⁷ University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York.
¹⁸ Clinical Epidemiology Unit, Boston, Massachusetts.
¹⁹ Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
²⁰ Director, Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
²¹ Department of Oncology, Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins Hospital, Baltimore, Maryland.
²² Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
²³ Department of Medicine, University of Texas Medical Branch, Galveston, Texas.
²⁴ Department of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
²⁵ Department of Anesthesiology and Neurology, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 24581634
PMCID: PMC4454364
DOI: 10.1016/j.jpain.2014.01.004

Abstract

Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment.

Perspective: The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Keywords: Taxonomy; biopsychosocial; chronic pain; evidence-based; mechanism-based pain classification; pain classification.

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Conflict of interest statement

Conflict of Interest

The views expressed in this article are those of the authors, none of whom has a financial conflict of interest related to the specific issues discussed in this manuscript.

Comment in

Multidimensional approach to classifying chronic pain conditions--less is more.
Henriques AA, Dussán-Sarria JA, Botelho LM, Caumo W. Henriques AA, et al. J Pain. 2014 Nov;15(11):1199-1200. doi: 10.1016/j.jpain.2014.08.008. Epub 2014 Oct 31. J Pain. 2014. PMID: 25442487 No abstract available.
The ACTTION-APS Pain Taxonomy initiative: response to Henriques et al.
Fillingim RB, Dworkin RH, Turk DC. Fillingim RB, et al. J Pain. 2014 Nov;15(11):1201-1202. doi: 10.1016/j.jpain.2014.08.009. Epub 2014 Oct 31. J Pain. 2014. PMID: 25442488 No abstract available.

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The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions

Affiliations

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous