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Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)
Open accessAbstract
Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases , chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup “chronic primary pain.” In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as “chronic secondary pain” where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.
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“FM is currently considered an irresolvable primary chronic pain condition (Treede et al., 2019).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Treede et al., 2019
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“The International Association for the Study of Pain (IASP) has shown that primary chronic pain (e.g.fibromyalgia or non-specific LBP) is different in character and diagnosis than secondary chronic pain (e.g.osteoarthritis or hamstring strain) which has a known underlying MSK disease or injury (Treede et al., 2019).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Treede et al., 2019
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“Given these considerations and in line with existing guidelines, the establishment of a probable diagnosis of neuropathic pain may be adequate for prompting analgesic treatments in pwMS, provided that the patient has a valid diagnosis of MS (Finnerup et al. 2016; Treede et al. 2019).”
From The Prevalence of Neuropathic Pain in Multiple Sclerosis—A Systematic Review and Meta‐Analysis Using the NeuPSIG Algorithm (2026) · cites this paper as Treede et al. 2019
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“Chronic pain is defined as pain that lasts for over three months in the absence of tissue damage, impacting both physical and emotional health [1].”
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“Participants were adults, met ICD-11 criteria for chronic pain (persistent or recurring noncancer pain lasting ≥3 months) (Treede et al., 2019), and met the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria for OUD (American Psychiatric Association, 2013).”
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“FM is currently considered an irresolvable primary chronic pain condition (Treede et al., 2019).”
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“According to the International Association for the Study of Pain (IASP), CPSP is defined as chronic pain that develops or increases in intensity after a surgical procedure and is categorized as secondary chronic pain [32].”
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Metadata
- Authors
- 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.
- Affiliations
- Heidelberg University (DE)
- Philipps University of Marburg (DE)
- University of London (GB)
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
- Rutgers, The State University of New Jersey (US)
- UNSW Sydney (AU)
- University of Münster (DE)
- Aarhus University (DK)
- New York State Psychiatric Institute (US)
- University of Chieti-Pescara (IT)
- Oslo University Hospital (NO)
- Karolinska University Hospital (SE)
- Cliniques Universitaires Saint-Luc (BE)
- The University of Sydney (AU)
- Université Paris Descartes (FR)
- Columbia University (US)
- The University of Western Australia (AU)
- University of Dundee (GB)
- Maastricht University (NL)
- Corresponding author
- Treede, Rolf-Detlef
- ORCID
- Treede, Rolf-Detlef
- Rief, Winfried
- Barke, Antonia
- Aziz, Qasim
- Benoliel, Rafael
- Cohen, Milton
- Evers, Stefan
- Finnerup, Nanna B.
- First, Michael B.
- Giamberardino, Maria Adele
- Kaasa, Stein
- Korwisi, Beatrice
- Kosek, Eva
- Lavand'homme, Patricia
- Nicholas, Michael
- Perrot, Serge
- Scholz, Joachim
- Schug, Stephan
- Smith, Blair H.
- Svensson, Peter
- Vlaeyen, Johan W.S.
- Wang, Shuu-Jiun
- Venue
- Pain
- Published
- 2019-01
- Volume
- 160
- Issue
- 1
- Pages
- 19-27
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W2905788968
- Cited by
- 3,478
- References
- 46
- Citations by year
- 2026: 563 · 2025: 669 · 2024: 571 · 2023: 501 · 2022: 493 · 2021: 392 · 2020: 199 · 2019: 64
- FWCI
- 19.44
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (acceptedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Digital Access to Libraries (submittedVersion, other-oa)
- Publication Server of the Catholic University Eichstätt-Ingolstadt (Catholic University of Eichstätt-Ingolstadt) (submittedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- Biogen
- International Association for the Study of Pain
- Teva Pharmaceutical Industries
- Helsinn
- Les Laboratories Pierre Fabre
- Thompson Family Foundation
- Daiichi-Sankyo
- Eisai
- Astellas Pharma
- H. Lundbeck A/S
- Seqirus
- Allergan
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Keywords
- chronic pain, ICD-11, diagnosis coding, chronic primary pain, chronic neuropathic pain, chronic headache, orofacial pain, musculoskeletal pain, fibromyalgia, non-specific low back pain, pain epidemiology
- MeSH terms
- Persons with Disabilities, Humans, International Cooperation, Organizations, Pain Measurement, International Classification of Diseases, Chronic Pain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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