For years, the World Health Organization (WHO)’s manual for classifying conditions has omitted Chronic Pain. Even the most recent version, the ICD-10, did not really code for chronic pain. But the updated handbook includes codes for structural and centralized syndromes, which better supports the Chronic Pain Community.
How the WHO’s Classification of Chronic Pain Helps You
If you struggle with persistent pain, you may have also had to overcome the misguided perceptions that other people – even doctors – have about your condition. Perhaps you’ve been questioned or doubted when you’ve tried to tell others about the pain you experience. Some people struggle to understand because they can’t see or pinpoint a physical reason for your pain. This is why it’s so validating that the World Health Organization (WHO) has updated its International Classification of Diseases (ICD) to include a classification for chronic pain. Given that the ICD is used by doctors and researchers across the world to make/code diagnoses and to establish treatment options, this is a huge step forward in the recognition of chronic pain as a legitimate global health problem. Let’s take a look at the updates that have been made to the ICD and how they may impact you.
The Global Prevalence of Chronic Pain
It is estimated that 50 million adults in the U.S. and 20% of the world’s population is impacted by chronic pain, which is recurrent pain that lasts for at least three months. This condition has serious effects and can cause those who suffer from it to be more likely to be unemployed and to struggle with regular life activities.
The New Chronic Pain Classification in the ICD
Even though this issue is so widespread and serious, chronic pain conditions like fibromyalgia and back pain, irritable bowel syndrome, and others used to be scattered throughout the ICD under various classifications. And in the past, many chronic pain conditions were classified as somatic symptom disorders in the ICD (indicating that the pain was the result of a mental or behavioral problem) because their pain origins weren’t known. However, within the revised 11th edition, all of these conditions are listed under chronic pain itself, which is now classified as a clinical condition along with others that are associated with recurrent pain. Giving chronic pain its own label unrelated to the other physical and/or somatic symptom disorders signifies that these conditions are legitimate no matter their cause.
Because of the addition of chronic pain as its own classification, some conditions listed in the ICD now overlap and are included in multiple categories. For example, trigeminal neuralgia is now listed under chronic pain as well as diseases of the nervous system. Similarly, chronic painful chemotherapy-induced polyneuropathy is also found under more than one label: chronic neuropathic pain and chronic cancer-related pain.
Primary Vs. Secondary Chronic Pain
The new ICD edition breaks chronic pain down even further into primary and secondary pain categories. In medical terms, primary refers to a condition that isn’t caused by another medical disorder, while secondary is the result of another condition. The addition of the chronic primary pain category in the ICD (which includes the following subgroups: chronic primary pain, chronic widespread pain, chronic primary visceral pain, chronic primary musculoskeletal pain, chronic primary headache or orofacial pain, and complex regional pain syndrome) is notable because it acknowledges that some chronic pain disorders aren’t caused by other medical conditions even if their own cause is still unknown. In these cases, the pain itself can sometimes be the medical condition of concern. The chronic secondary pain category in the ICD, on the other hand, includes conditions that have a known cause (like cancer).
A Cause for Celebration by Chronic Pain Sufferers
Ultimately, the recognition and classification of chronic pain as a disease in the ICD by the WHO should be celebrated by the millions of people across the world who live with persistent pain. It is a huge step forward for legitimizing the pain many of us struggle with every day and strive to overcome. It also encourages clinicians and policy makers to develop appropriate treatment models for this highly prevalent and often debilitating medical condition.
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