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

doi:10.1097/j.pain.0000000000001365

Review

. 2019 Jan;160(1):53-59.

doi: 10.1097/j.pain.0000000000001365.

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

Joachim Scholz^{1

2}, Nanna B Finnerup^{3

4}, Nadine Attal^{5

6}, Qasim Aziz⁷, Ralf Baron⁸, Michael I Bennett⁹, Rafael Benoliel¹⁰, Milton Cohen¹¹, Giorgio Cruccu¹², Karen D Davis^{13

14}, Stefan Evers^{15

16}, Michael First¹⁷, Maria Adele Giamberardino¹⁸, Per Hansson^{19

20}, Stein Kaasa^{21

22

23}, Beatrice Korwisi²⁴, Eva Kosek²⁵, Patricia Lavand'homme²⁶, Michael Nicholas²⁷, Turo Nurmikko²⁸, Serge Perrot²⁹, Srinivasa N Raja³⁰, Andrew S C Rice³¹, Michael C Rowbotham³², Stephan Schug³³, David M Simpson³⁴, Blair H Smith³⁵, Peter Svensson^{36

37}, Johan W S Vlaeyen^{38

39}, Shuu-Jiun Wang^{40

41}, Antonia Barke²⁴, Winfried Rief²⁴, Rolf-Detlef Treede⁴²; Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG)

Affiliations

¹ Departments of Anesthesiology and.
² Pharmacology, Columbia University Medical Center, New York, NY, United States.
³ Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
⁴ Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
⁵ INSERM U 987, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
⁶ Université Versailles Saint Quentin en Yvelines, Versailles, France.
⁷ Centre for Neuroscience and Trauma, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁸ Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
⁹ Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom.
¹⁰ Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, United States.
¹¹ St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
¹² Department of Human Neuroscience, Sapienza University, Rome, Italy.
¹³ Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
¹⁴ Division of Brain, Imaging and Behavior-Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
¹⁵ Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany.
¹⁶ Faculty of Medicine, University of Münster, Münster, Germany.
¹⁷ Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, United States.
¹⁸ Department of Medicine and Science of Aging, CeSI-MeT, G D'Annunzio University of Chieti, Chieti, Italy.
¹⁹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
²⁰ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
²¹ European Palliative Care Research Centre (PRC), Oslo, Norway.
²² Department of Oncology, Oslo University Hospital, Oslo, Norway.
²³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
²⁴ Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
²⁵ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
²⁶ Department of Anesthesiology and Acute Postoperative Pain Service, Saint Luc Hospital, Catholic University of Louvain, Brussels, Belgium.
²⁷ Pain Management Research Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
²⁸ Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
²⁹ INSERM U 987, Pain Clinic, Cochin Hospital, Paris Descartes University, Paris, France.
³⁰ Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
³¹ Pain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom.
³² California Pacific Medical Center Research Institute, San Francisco, CA, United States.
³³ Anaesthesiology and Pain Medicine, Medical School, University of Western Australia and Royal Perth Hospital, Perth, Australia.
³⁴ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³⁵ Division of Population Health and Genomics, University of Dundee, Dundee, Scotland.
³⁶ Section of Clinical Oral Physiology, School of Dentistry, Aarhus University, Aarhus, Denmark.
³⁷ Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
³⁸ Research Group Health Psychology, University of Leuven, Leuven, Belgium.
³⁹ Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands.
⁴⁰ Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴¹ Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
⁴² Department of Neurophysiology, CBTM, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany.

PMID: 30586071
PMCID: PMC6310153
DOI: 10.1097/j.pain.0000000000001365

Review

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

Joachim Scholz et al. Pain. 2019 Jan.

. 2019 Jan;160(1):53-59.

doi: 10.1097/j.pain.0000000000001365.

Authors

Affiliations

¹ Departments of Anesthesiology and.
² Pharmacology, Columbia University Medical Center, New York, NY, United States.
³ Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
⁴ Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
⁵ INSERM U 987, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France.
⁶ Université Versailles Saint Quentin en Yvelines, Versailles, France.
⁷ Centre for Neuroscience and Trauma, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁸ Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
⁹ Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom.
¹⁰ Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, United States.
¹¹ St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
¹² Department of Human Neuroscience, Sapienza University, Rome, Italy.
¹³ Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
¹⁴ Division of Brain, Imaging and Behavior-Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
¹⁵ Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany.
¹⁶ Faculty of Medicine, University of Münster, Münster, Germany.
¹⁷ Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, United States.
¹⁸ Department of Medicine and Science of Aging, CeSI-MeT, G D'Annunzio University of Chieti, Chieti, Italy.
¹⁹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
²⁰ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
²¹ European Palliative Care Research Centre (PRC), Oslo, Norway.
²² Department of Oncology, Oslo University Hospital, Oslo, Norway.
²³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
²⁴ Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
²⁵ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
²⁶ Department of Anesthesiology and Acute Postoperative Pain Service, Saint Luc Hospital, Catholic University of Louvain, Brussels, Belgium.
²⁷ Pain Management Research Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
²⁸ Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
²⁹ INSERM U 987, Pain Clinic, Cochin Hospital, Paris Descartes University, Paris, France.
³⁰ Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
³¹ Pain Research, Department of Surgery and Cancer, Imperial College, London, United Kingdom.
³² California Pacific Medical Center Research Institute, San Francisco, CA, United States.
³³ Anaesthesiology and Pain Medicine, Medical School, University of Western Australia and Royal Perth Hospital, Perth, Australia.
³⁴ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³⁵ Division of Population Health and Genomics, University of Dundee, Dundee, Scotland.
³⁶ Section of Clinical Oral Physiology, School of Dentistry, Aarhus University, Aarhus, Denmark.
³⁷ Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
³⁸ Research Group Health Psychology, University of Leuven, Leuven, Belgium.
³⁹ Experimental Health Psychology, Maastricht University, Maastricht, the Netherlands.
⁴⁰ Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴¹ Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
⁴² Department of Neurophysiology, CBTM, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany.

PMID: 30586071
PMCID: PMC6310153
DOI: 10.1097/j.pain.0000000000001365

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.

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Conflict of interest statement

Joachim Scholz has received research support from the Thompson Family Foundation and Acetylon, and is now an employee of Biogen. This work was completed before he joined the company. Biogen did not have a role in the design, conduct, analysis, interpretation or funding of the research related to this work. Nanna B. Finnerup has received honoraria for serving on advisory boards or speaker panels from Teva, Novartis, Astellas, Grünenthal, Mitshubishe Tanabe, Novartis and Teva. Nadine Attal has received speaker fees from Pfizer and consultant fees from Aptinyx, Grünenthal, Mundipharma, Novartis, Sanofi Pasteur, and Teva. Ralf Baron reports receiving research grants from Genzyme, Grünenthal, Mundipharma and Pfizer, and honoraria for serving on advisory boards or speakers panels from Abbvie, Allergan, Astellas, AstraZeneca, Bayer, Biogen, Biotest Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Desitin, Eisai, Galapagos NV, Genentech, Genzyme, Glenmark, Grünenthal, Kyowa Kirin, Lilly, Medtronic, Merck MSD, Mundipharma, Novartis, Pfizer, Sanofi Pasteur, Seqirus, TAD, Teva, and Vertex. He is also member of the Innovative Medicines Initiative (IMI), a public-private partnership between the European Union and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Giorgio Cruccu reports grants or personal fees from Alfa Sigma, Angelini, Biogen, Mundipharma, and Pfizer. Michael First reports personal fees from Lundbeck International Neuroscience Foundation, outside the submitted work. Maria Adele Giamberardino reports personal fees from IBSA Institute Biochimique, personal fees from EPITECH Group, personal fees from Helsinn Healthcare, grants from EPITECH Group, grants from Helsinn Healthcare, outside the submitted work. Stein Kaasa reports that he is Eir solution - stockholder. Turo Nurmikko has received personal fees from Abide, Astellas, Mundipharma and Nexstim, and research grants from the Pain Relief Foundation and the National Institute of Health Research in the United Kingdom. Srinivasa N. Raja has received research grants from Medtronic, and serves in the advisory boards of Allergan, Daiichi Sankyo, and Aptinyx. Andrew S.C. Rice has received research funding from Orion, has consulted or participated in advisory boards for Imperial College Consultants, including remunerated work for Abide, Astellas, Galapagos, Lateral, Peter McNaughton from King’s College London and Cambridge University, Merck, Mitsubishi, Novartis, Orion, Pharmaleads, Quartet, and Toray. He owned share options in Spinifex from which personal benefit accrued upon the acquisition of Spinifex by Novartis, and from which future milestone payments may occur. ASCR is also named inventor on patents WO 2005/079771, EP13702262.0, and WO2013/110945. Shuu-Jiun Wang reports personal fees from Eli-Lilly, personal fees from Daiichi-Sankyo, grants and personal fees from Pfizer, Taiwan, personal fees from Eisai, personal fees from Bayer, personal fees from Boehringer Ingelheim, outside the submitted work. Antonia Barke reports personal fees from IASP, during the conduct of the study. Winfried Rief reports grants from IASP, during the conduct of the study; personal fees from Heel, personal fees from Berlin Chemie, outside the submitted work. Rolf-Detlef Treede reports grants from Boehringer Ingelheim, Astellas, AbbVie, Bayer, personal fees from Astellas, Grünenthal, Bauerfeind, Hydra, Bayer, grants from EU, DFG, BMBF, outside the submitted work. The remaining authors have no conflicts of interest to declare.

Figures

**Figure 1.. Classification of chronic neuropathic pain in ICD-11.**
Level 1 and 2 diagnoses are part of ICD-11 beta. Specific entities of chronic neuropathic pain are included at the next level. According to the new concept of multiple parenting in ICD-11, these entities may be referred to from other divisions of the chronic pain classification, e.g., chronic posttraumatic pain or chronic secondary headaches and orofacial pains.

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References

1. Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, Finnerup NB, Haanpaa M, Hansson P, Hullemann P, Jensen TS, Freynhagen R, Kennedy JD, Magerl W, Mainka T, Reimer M, Rice AS, Segerdahl M, Serra J, Sindrup S, Sommer C, Tolle T, Vollert J, Treede RD. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 2017;158:261–272. - PMC - PubMed
1. Bennett* MI, Kaasa* S, Barke* A, Korwisi B, Rief W, Treede R-D, The IASP Taskforce for the Classification of Chronic Pain. The IASP Classification of Chronic Pain for ICD-11: Chronic cancer-related pain. Pain 2018. - PubMed
1. Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. The Lancet Neurology 2012;11:521–534. - PMC - PubMed
1. Cavaletti G, Alberti P, Frigeni B, Piatti M, Susani E. Chemotherapy-induced neuropathy. Curr Treat Options Neurol 2011;13:180–190. - PubMed
1. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017;3:17002. - PMC - PubMed

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[1] Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, Finnerup NB, Haanpaa M, Hansson P, Hullemann P, Jensen TS, Freynhagen R, Kennedy JD, Magerl W, Mainka T, Reimer M, Rice AS, Segerdahl M, Serra J, Sindrup S, Sommer C, Tolle T, Vollert J, Treede RD. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 2017;158:261–272. - PMC - PubMed

[2] Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, Finnerup NB, Haanpaa M, Hansson P, Hullemann P, Jensen TS, Freynhagen R, Kennedy JD, Magerl W, Mainka T, Reimer M, Rice AS, Segerdahl M, Serra J, Sindrup S, Sommer C, Tolle T, Vollert J, Treede RD. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain 2017;158:261–272. - PMC - PubMed

[3] Bennett* MI, Kaasa* S, Barke* A, Korwisi B, Rief W, Treede R-D, The IASP Taskforce for the Classification of Chronic Pain. The IASP Classification of Chronic Pain for ICD-11: Chronic cancer-related pain. Pain 2018. - PubMed

[4] Bennett* MI, Kaasa* S, Barke* A, Korwisi B, Rief W, Treede R-D, The IASP Taskforce for the Classification of Chronic Pain. The IASP Classification of Chronic Pain for ICD-11: Chronic cancer-related pain. Pain 2018. - PubMed

[5] Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. The Lancet Neurology 2012;11:521–534. - PMC - PubMed

[6] Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. The Lancet Neurology 2012;11:521–534. - PMC - PubMed

[7] Cavaletti G, Alberti P, Frigeni B, Piatti M, Susani E. Chemotherapy-induced neuropathy. Curr Treat Options Neurol 2011;13:180–190. - PubMed

[8] Cavaletti G, Alberti P, Frigeni B, Piatti M, Susani E. Chemotherapy-induced neuropathy. Curr Treat Options Neurol 2011;13:180–190. - PubMed

[9] Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017;3:17002. - PMC - PubMed

[10] Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers 2017;3:17002. - PMC - PubMed

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

Affiliations

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

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