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J Pain. 2014 Mar;15(3):241-9. doi: 10.1016/j.jpain.2014.01.004.

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

Author information

  • 1Pain Research and Intervention Center of Excellence, Gainesville, Florida. Electronic address: rfilling@ufl.edu.
  • 2Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
  • 3Department of Neurology in the Center for Human Experimental Therapeutics; and Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), University of Rochester School of Medicine and Dentistry, Rochester, New York.
  • 4Department of Psychiatry and Behavioral Sciences, School of Medicine, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington.
  • 5Department of Neurological Surgery, University of Washington, Seattle, Washington.
  • 6Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
  • 7Health Scientist VHA, University of Miami, Miller School of Medicine, Miami Project to Cure Paralysis, Miami, Florida.
  • 8Department of Psychiatry and Behavioral Neuroscience, and Director, Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • 9Fibromyalgia Research Unit, Oregon Health & Science University, Portland, Oregon.
  • 10Brigham & Women's Hospital, Chestnut Hill, Massachusetts.
  • 11Department of Neurology, Harvard Medical School, Cambridge, Massachusetts.
  • 12Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
  • 13Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland.
  • 14Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland.
  • 15Departments of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, California.
  • 16Department of Pharmacology, University of Arizona, Tucson, Arizona.
  • 17University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York.
  • 18Clinical Epidemiology Unit, Boston, Massachusetts.
  • 19Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
  • 20Director, Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
  • 21Department of Oncology, Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins Hospital, Baltimore, Maryland.
  • 22Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
  • 23Department of Medicine, University of Texas Medical Branch, Galveston, Texas.
  • 24Department of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • 25Department of Anesthesiology and Neurology, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment.

PERSPECTIVE:

The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Taxonomy; biopsychosocial; chronic pain; evidence-based; mechanism-based pain classification; pain classification

PMID:
24581634
[PubMed - in process]
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