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Pain. 2019 Jan;160(1):19-27. doi: 10.1097/j.pain.0000000000001384.

Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11).

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Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany.
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
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, United Kingdom.
Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom.
Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, Newark, NJ, United States.
St Vincent's Clinical School, UNSW, Sydney, New South Wales, Australia.
Department of Neurology, Krankenhaus Lindenbrunn, Faculty of Medicine, University of Münster, Münster, Germany.
Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, United States.
Department of Medicine and Science of Aging, CeSI-MeT, G D'Annunzio University of Chieti, Chieti, Italy.
European Palliative Care Research Centre (PRC).
Department of Oncology, Oslo University Hospital, Oslo, Norway.
University of Oslo, Oslo, Norway.
Department of Clinical Neuroscience, Karolinska Institute, and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Anesthesiology, Acute Postoperative Pain Service, Saint Luc Hospital, Catholic University of Louvain, Brussels, Belgium.
University of Sydney Medical School, Sydney, Australia.
Pain Clinic, Hotel Dieu Hospital, Paris Descartes University, Paris, France.
Departments of Anesthesiology and Pharmacology, Columbia University, New York, NY, United States.
Discipline of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, Australia.
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia.
Division of Population Health and Genomics, University of Dundee, Scotland.
Section of Clinical Oral Physiology, School of Dentistry, Aarhus University, Aarhus, Denmark.
Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.
Research Group Health Psychology, University of Leuven, Leuven, Belgium.
TRACE, Center for Translational Health Research, KU Leuven, Ziekenhuis Oost-Limburg, Genk, Belgium.
Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Brain Research Center and Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.


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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