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J Pain. 2017 May;18(5):479-489. doi: 10.1016/j.jpain.2017.02.421.

The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions.

Author information

1
Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland. Electronic address: michael.l.kent22.mil@mail.mil.
2
Department of Anesthesiology, University of Florida, Gainesville, Florida.
3
Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD.
4
Department of Anesthesiology, University of Iowa, Iowa City, Iowa.
5
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
6
Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan.
7
Defense and Veteran's Center for Integrative Pain Management, Uniformed Services University, Bethesda, Maryland.
8
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois.
9
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
10
Desjardins Associates LLC, Maplewood, New Jersey.
11
Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida.
12
Department of Anesthesiology, University of Rochester Medical Center, Rochester, New York.
13
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
14
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
15
Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
16
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Neurological Surgery, University of Washington, Seattle, Washington.
17
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California.
18
Departments of Anesthesiology and Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina.
19
Department of Biobehavioral Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
20
Department of Anesthesiology, University of California, Los Angeles, California.
21
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
22
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California.
23
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
24
Yale School of Public Health, New Haven, Connecticut; Schachtel Associates, Inc, Jupiter, Florida.
25
Department of Anesthesiology and Pain Management, Brigham and Women's Hospital, Boston, Massachusetts.
26
Center for Pain Relief, University of Washington Medical Center, Seattle, Washington.
27
Swedish Pain Services, Swedish Health System, Seattle, Washington.
28
EMLine.
29
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
30
Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts.
31
School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York.

Abstract

OBJECTIVE:

With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain.

SETTING:

Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM).

METHODS:

As a complement to a taxonomy recently developed for chronic pain, the ACTTION public-private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions.

PERSPECTIVE:

The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms.

CONCLUSIONS:

Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.

KEYWORDS:

AAAPT; AAPT; ACTTION; Acute pain; biopsychosocial; taxonomy

PMID:
28495013
DOI:
10.1016/j.jpain.2017.02.421
[Indexed for MEDLINE]
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