Main Content

Chronic Pain Classification in the ICD-11

Project information

To improve the diagnosis of chronic pain in the 11th revision of the International Statistical Classification of Diseases (ICD-11), an international taskforce of the International Association for the Study of Pain (IASP), chaired by Prof. Dr. Rolf-Detlef Treede and Prof. Dr. Winfried Rief, has developed a new classification of chronic pain. This new classification includes seven categories of chronic pain, and now is included in the ICD-11. The ICD-11 was officially adopted on 25 May 2019. The ICD-11, and with it the new diagnostic codes for chronic pain, will come into effect on 1 January 2022. The ICD-11 classification of chronic pain is being evaluated in various international field studies, among others in cooperation with the World Health Organization (WHO). The project is coordinated at the University of Marburg.

Subprojects 

  • Pilot field study 

    In a first pilot field study, patients in pain clinics were classified according to the seven main chronic pain categories of ICD-11. The results showed that the categories are mutually exclusive and that only a few patients were assigned to a residual category. Furthermore, the clinical utility of the classification was rated as high (Barke et al., 2018).

  • WHO field study

    In cooperation with the WHO, an international online study was conducted in which pain specialists assigned the new diagnostic codes to short case descriptions. Subsequently, the diagnoses were evaluated, e.g. with regard to clinical utility. Furthermore, the correctness of the diagnostic code assignments and differences to diagnostics according to ICD-10 were analyzed. (Barke et al. 2021)

  • International patient survey

    In an international online survey, patients with chronic pain were informed about the new diagnoses through a short video. They then evaluated the new classification, for example with regard to access to treatment and communication. (Korwisi et al. in preparation)

  • International field study in a clinical setting

    In an international field study (ICE TEA study: ICD-11 Chronic Pain Codes Ecological Testing and Assessment), the new classification was evaluated in pain clinics in various countries with different cultural backgrounds and different income levels. The inter-rater reliability as well as the perceived clinical utility of the new diagnoses was very high. A second phase of data collection is currently in preparation. (Korwisi et al., 2021; published study protocol: Korwisi et al., 2020)

  • Validation of the extension code for pain severity

    As part of the ICD-11 classification of chronic pain, an optional extension code was developed to assess pain severity. This code consists of 3 ratings on a 0-10 NRS (or a 10 cm VAS): Pain intensity, pain-related distress, and pain-related interference. The extension codes for pain-related distress and pain-related interference are validated by correlative analyses using psychometric questionnaires. (Hay et al. in preparation)

  • Development and evaluation of a diagnostic algorithm for chronic pain

    In order to facilitate the use of the new chronic pain diagnoses, a classification algorithm was developed. The algorithm is designed as a linear decision tree that aims at guiding through the required diagnostic criteria (Korwisi et al., 2021). This classification algorithm will be evaluated as a next step (data collection in process).

Current project status

The ICD-11 was approved in May 2019, the implementation phase begins on 1 January 2022. First field studies have been completed, further studies are currently being conducted and prepared.

Team 

Collaborations

Funding

The project is funded by the International Association for the Study of Pain (IASP).

Links 

  • Links to publications on the ICD-11 classification of chronic pain:

    Barke, A., Korwisi, B., Jakob, R., Konstanjsek, N., Rief, W. & Treede, R.-D. (2021). Classification of chronic pain for the International Classification of Diseases (ICD 11): Results of the 2017 international WHO field testing. PAIN. Epub ahead of print. https://doi.org/ 10.1097/j.pain.0000000000002287

    Barke, A., Rief, W., Korwisi, B., Treede, R.-D. (2021). Reply to Goebel & Molloy. PAIN, 162(1), 322.  https://doi.org/ 10.1097/j.pain.0000000000002131

    Korwisi, B., Barke, A., Treede, R.-D. (2021). The evidence- and consensus-based adaption of the IASP CRPS diagnostic criteria to the ICD-11 category of chronic primary pain: A successful cooperation of the IASP with the WHO. PAIN. Epub ahead of print. https://doi.org/ 10.1097/j.pain.0000000000002246

    Korwisi, B., Garrido Suárez, B. B., Goswami, S., Gunapati, N. R., Hay, G., Hernández Arteaga, M. A., Hill, C., Jones, D., Joshi, M., Kleinstäuber, M., López Mantecón, A. M., Nandi, G., Papagari, C. S. R., Rabí Martínez, M. C., Sarkar, B., Swain, N., Templer, P., Tulp, M., White, N., Treede, R.-D., Rief, W. & Barke, A. (2021). Reliability and clinical utility of the chronic pain classification in the ICD-11 from a global perspective: Results from India, Cuba, and New Zealand. Accepted for publication in PAIN.


    Korwisi, B., Hay, G., Attal, N., Aziz, Q., Bennet, M. I., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Schug, S., Smith, B. H., Svensson, P., Vlaeyen, J. W. S., Wang, S.-J., Treede, R.-D., Rief, W. & Barke, A. (2021). Classification algorithm for the ICD-11 chronic pain classification (CAL-CP): Development and results from a preliminary pilot evaluation. PAIN. Epub ahead of print. https://doi.org/ 10.1097/j.pain.0000000000002208

    Zinboonyahgoon, N., Luansritisakul, C., Eiamtanasate, S., Duangburong, S., Sanansilp, V., Korwisi, B., Barke, A., Rief, W., Treede, R.-D. (2021). Comparing the ICD-11 chronic pain classification with ICD-10. PAIN. Epub ahead of print. https://doi.org/10.1097/j.pain.0000000000002196

    Barke, A, Koechlin, H, Korwisi, B & Locher, C. (2020). Emotional distress: Specifying a neglected part of chronic pain. European Journal of Pain, 24, 477–480. https://doi.org/10.1002/ejp.1525

    Korwisi, B., Treede, R.-D., Rief, W., & Barke, A. (2020). Evaluation of the International Classification of Diseases-11 chronic pain classification: study protocol for an ecological implementation field study in low-, middle-, and high-income countries. PAIN Reports, 5, e825. http://dx.doi.org/10.1097/PR9.0000000000000825

    Aziz, Q., Giamberardino, M. A., Barke, A., Korwisi, B., Baranowski, A., Wesselmann, U., Rief, W., Treede, R.-D. & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: chronic secondary visceral pain. PAIN(1), 160, 69–76.
    https://doi.org/10.1097/j.pain.0000000000001362 

    Bennett, M. I., Kaasa, S., Barke, A., Korwisi, B., Rief, W., Treede, R.-D., & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of
    chronic pain for ICD-11: chronic cancer-related pain. PAIN, 160(1), 38–44.
    https://doi.org/10.1097/j.pain.0000000000001363

    Benoliel, R., Svensson, P., Evers, S., Wang, S.-J., Barke, A., Korwisi, B., Rief, W., Treede, R.-D. & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: chronic secondary headache and orofacial pain. PAIN, 160(1), 60–68. https://doi.org/10.1097/j.pain.0000000000001435

    Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., Korwisi B., Perrot, S., Svensson, P., Wang, S.-J., Treede, R.-D. & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. PAIN, 160(1), 28–37. https://doi.org/10.1097/j.pain.0000000000001390

    Nugraha, B., Gutenbrunner, C., Barke, A., Karst, M., Schiller, J., Schäfer, P., Falter, S., Korwisi, B., Rief, W., Treede, R.-D. & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: functioning properties of
    chronic pain. PAIN, 160(1), 88–94.
    https://doi.org/10.1097/j.pain.0000000000001433

    Perrot, S., Cohen, M., Barke, A., Korwisi, B., Rief, W., Treede, R.-D., & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. PAIN, 160(1), 77–82.
    https://doi.org/10.1097/j.pain.0000000000001389 

    Rief, W., Korwisi, B., Nicholas, M., Vlaeyen, J. W. S., Smith, B. H., First, M. B., Kosek, E., Barke, A., Treede , R.-D. (2019). Reply to Henningsen et al. PAIN, 160(7), 1684–1685.
    http://dx.doi.org/10.1097/j.pain.0000000000001564

    Scholz, J., Finnerup, N. B., Attal, N., Aziz, Q., Baron, R., Bennett, M. I., Benoliel, R., Cohen, M., Cruccu, G., Davis, K. D., Evers, S., First, M., Giamberardino, M. A., Hansson, P., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Nurmikko, T., Perrot, S., Raja, S. N., Rice, A. S. C., Rowbotham, M. C., Schug, S., Simpson, D. M., Smith, B. H., Svensson, P., Vlaeyen, J. W. S., Wang, S.-J., Barke, A., Rief, W., Treede R. D., Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG) & The IASP Taskforce for the Classification of Chronic Pain (2019). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. PAIN, 160(1), 53–59.  https://doi.org/10.1097/j.pain.0000000000001365

    Schug, S., Lavand’homme, P., Barke, A., Korwisi, B., Rief, W., Treede, R.-D., & The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: chronic postsurgical and posttraumatic pain. PAIN, 160(1), 45-52. https://doi.org/10.1097/j.pain.0000000000001413

    Smith, B. H., Fors, E. A., Korwisi, B., Barke, A., Cameron, P., Colvin, L., Richardson, C., Rief, W., Treede, R.-D. &  The IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: applicability in primary care. PAIN, 160(1), 83–87. https://doi.org/10.1097/j.pain.0000000000001360

    Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., Vlaeyen, J. W. S. & Wang, S.-J. (2019). Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the International Classification of Diseases ICD-11. PAIN, 160(1), 19–27. https://doi.org/10.1097/j.pain.0000000000001384

    Treede, R.-D., Rief, W., Korwisi, B., Aziz, Q., Giamberardino, M. A., & Barke, A. (2019). Reply to Bornstein et al. PAIN, 160(7), 1681–1683.
    http://dx.doi.org/10.1097/j.pain.0000000000001558

    Treede, R.-D., Rief, W., Korwisi, B., Perrot, S., Cohen, M., Nicholas, M., Vlaeyen, J. W. S., & Barke, A. (2019). Reply to Häuser et al. PAIN, 160(11), 2652-2653.
    http://dx.doi.org/10.1097/j.pain.0000000000001687

    Barke, A., Korwisi, B., Casser, H. R., Fors, E. A., Geber, C., Schug, S. A., … Treede, R.-D. (2018). Pilot field testing of the chronic pain classification for ICD-11: The results of
    ecological coding. BMC Public Health, 18:1239.
    https://doi.org/10.1186/s12889-018-6135-9