Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 7;18(1):1239.
doi: 10.1186/s12889-018-6135-9.

Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding

Antonia Barke  1 , Beatrice Korwisi  2 , Hans-Raimund Casser  3 , Egil A Fors  4 , Christian Geber  3 , Stephan A Schug  5 , Audun Stubhaug  6 , Takahiro Ushida  7 , Thomas Wetterling  3 , Winfried Rief  2 , Rolf-Detlef Treede  8
Affiliations

Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding

Antonia Barke et al. BMC Public Health. .

Abstract

Background: A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. The objective was to test whether the proposed categories were exhaustive and mutually exclusive. In addition, the perceived utility of the diagnoses and the raters' subjective diagnostic certainty were to be assessed.

Methods: Five independent pain centers in three continents coded 507 consecutive patients. The raters received the definitions for the main diagnostic categories of the proposed classification and were asked to allocate diagnostic categories to each patient. In addition, they were asked to indicate how useful they judged the diagnosis to be from 0 (not at all) to 3 (completely) and how confident they were in their category allocation.

Results: The two largest groups of patients were coded as either chronic primary pain or chronic secondary musculoskeletal pain. Of the 507 patients coded, 3.0% had chronic pain not fitting any of the proposed categories (97% exhaustiveness), 20.1% received more than one diagnosis. After adjusting for double coding due to technical reasons, 2.0% of cases remained (98% uniqueness). The mean perceived utility was 1.9 ± 1.0, the mean diagnostic confidence was 2.0 ± 1.0.

Conclusions: The categories proved exhaustive with few cases being classified as unspecified chronic pain, and they showed themselves to be mutually exclusive. The categories were regarded as useful with particularly high ratings for the newly introduced categories (chronic cancer-related pain among others). The confidence in allocating the diagnoses was good although no training regarding the ICD-11 categories had been possible at this stage of the development.

Keywords: Chronic pain; Classification; Clinical utility; Diagnostic categories; Ecological coding; Field testing; ICD-11.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

In Germany, a general ethics commitment for epidemiology and consumer surveys was agreed (www.adm-ev.de), that allows the conduct of single projects without specific ethical approval, as long as the principles of this commitment for epidemiological, social and consumer satisfaction purposes are accepted (e.g., only use of fully anonymized data for the specific purpose). These principles were observed and the procedure discussed with all centers. Raters were clinicians that volunteered their participation; no explicit consent was required in the participating countries.

Consent for publication

Not applicable.

Competing interests

ABs position is funded by the International Association for the Study of Pain (IASP). AS, BK, CW, HRC, SAS, TU, TW declare no competing interest.

RDT reports grants from European Union and EFPIA companies, grants from Pfizer, grants from BMBF, during the conduct of the study; grants from Boehringer Ingelheim, Astellas, AbbVie, Bayer, personal fees from Astellas, Grünenthal, Bauerfeind, Hydra, Bayer, outside the submitted work; in addition, RDT has a patent DE 103 31,250.1–35 with royalties paid to MRC Systems.

WR reports grants from IASP during the course of the study; personal fees from Heel and Berlin Chemie, outside the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
All cases (absolute numbers) and cases in which more than one diagnostic code was assigned, adjusted for various coding artefacts, such as true comorbidity, multiple parenting, and missing extension codes. HA/OFP: Chronic headache or orofacial pain, MSP: Chronic secondary musculoskeletal pain
See this image and copyright information in PMC

References

    1. IASP Taxonomy Working Group. Classification of Chronic Pain 2011. http://www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&n.... Accessed 25 Feb 2015.
    1. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015;156:1003–1007. doi: 10.1097/j.pain.0000000000000160. - DOI - PMC - PubMed
    1. Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic Pain as a symptom and a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases ICD-11. Pain. 2018;160(1). 10.1097/j.pain.0000000000001384. - PubMed
    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–297. doi: 10.1016/j.ejpain.2005.06.009. - DOI - PubMed
    1. Goldberg DS, Summer JM. Pain as a global public health priority. BMC Public Health. 2011;770. - PMC - PubMed