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SAT0605 Towards A Taxonomy That Is Science-Based and Clinically Useful: The New Who - ICD11 Classification of Musculoskeletal Pain Disorders
  1. S. Perrot1,
  2. M. Cohen2
  1. 1Pain Clinic, Cochin Hospital, Assistance Publique Hopitaux de Paris, Universite Paris Descartes, INSERM U 987, Paris, France
  2. 2Pain Medicine & Rheumatology, St Vincent's Clinical School, Sydney, Australia

Abstract

Background The current ICD 10 classification of musculoskeletal pain disorders is not relevant, combining anatomical, pathophysiological and clinical approaches.

In 2015, the WHO started a new program for ICD11 classification, to be delivered in 2017. In this new program, physicians and researchers from rheumatology and pain clinics have been involved for the musculoskeletal pain chapter that will be developed in collaboration with the IASP/ International Association for the Study of Pain.

Objectives To develop a taxonomy for musculoskeletal (MSK) pain conditions that merge insights from both pain pathophysiology and rheumatological clinical classification for both clinical and scientific uses.

Methods As members of the IASP-WHO Task Force for the Classification of Chronic Pain in ICD-11, the authors have reviewed the taxonomy of musculoskeletal conditions in ICD-10 and earlier iterations and conventional taxonomy in rheumatology, all of which are disease-based and commonly do not reflect the problems encountered in the practice of pain medicine. The authors have pragmatically integrated recent advances in musculoskeletal pain pathophysiology into diagnostic labelling in this diverse field as a prelude to a multiaxial approach.

Results Two sets of taxonomic reforms will be presented. The first conforms to the format required by ICD which remains anatomically or disease based. This comprises four main categories: chronic musculoskeletal pain from persistent inflammation; chronic musculoskeletal pain associated with structural changes; chronic musculoskeletal pain due to disease of the nervous system; and chronic primary musculoskeletal pain (to include spinal pain and widespread pain).

The second prefers classification by pain mechanisms and identifies conditions characterized by nociceptive pain and primary hyperalgesia and those characterized by nociplastic* pain and secondary hyperalgesia.

Conclusions The authors contend that the somatic dimension of musculoskeletal pain conditions is better conceptualized by incorporating underlying pain pathophysiology in conventional disease labels rather than by describing MSK pain as different disease entities or as “pain syndromes”. These proposed new taxonomic sets are not mutually exclusive and can probably be integrated for clinical purposes, not only in pain clinics but also in rheumatology settings. Although they refer to the somatic or biomedical dimension of the complex experience of musculoskeletal pain, they can be readily integrated with the psychological and social axes of evolving taxonomy.

Disclosure of Interest None declared

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