11 Classifications and why chronic pain is important
Chronic pain is perhaps the most misunderstood of medical conditions.
Chronic pain is defined as pain that persists past normal healing time and is commonly referred to as being chronic after 3 months. Chronic pain is a frequent condition affecting an estimated 20% of people worldwide and accounting for 15% to 20% of physician visits.
Following trauma what so often happens to clients of mine who suffer serious soft tissue injuries of all types is that they will have very limited inpatient treatment in the hospital or via a GP with short-lived rehab and then be seen typically by a medico-legal orthopaedic surgeon or neurologist after 6 months or a year who can give no clinical organic reason for the ongoing continuing pain and/or recommendations for treatment. It is often then left for pain consultants to find an explanation for the pain that remains. Until about 10 or 15 years ago experts of this type were considered very much on the periphery of medical science and compared with the orthodox fields of orthopaedic surgery and neurology very much took second place.
During this time thankfully much more weight has been given to the opinions of such experts in the medical profession itself and by the courts and this has assisted in our understanding the causes of chronic pain and the treatments to deal with the problem. The latest ICD report is perhaps a further sign showing how things have advanced.
The 7 groups of IDC
The International Classification of Diseases (ICD) of The World Health Organisation is the predominant tool for coding diagnoses and the new ICD 11 category for “Chronic Pain” has clarified the definition. The disorders are divided into 7 groups. As far as trauma related chronic pain is concerned groups 1: chronic primary pain, 3: chronic post traumatic and post surgical pain 4: chronic neuropathic pain, 5: chronic headache and orofacial pain, 6: chronic visceral pain and 7: chronic musculoskeletal pain are the main relevant groups.
Chronic primary pain is pain in a region of the body that persists for longer than 3 months and is associated with significant emotional distress or significant functional disability and that cannot be better explained by another chronic pain condition. Common conditions such as back pain that is neither identified as musculoskeletal or neuropathic pain, chronic widespread pain, fibromyalgia will be found in this definition and biological findings contributing to the pain problem may not be present. In other words, if the pain cannot be explained organically or biologically it can still come under this definition.
The ICD 11 classification, which came in last year, represents the first systematic approach to implementing a classification of chronic pain in the ICD. Some clinically important definitions that were neglected in the former ICD revisions have now been mentioned such as chronic neuropathic pain.
The classification is an important step in lending further legitimacy to pain syndrome conditions and assisting clients who have these conditions in understanding their conditions, having appropriate treatment for them and being adequately compensated.
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