Chronic pain gets its own categorization in WHO’s ICD-11 update
As the revised WHO ICD-11 comes into effect, chronic pain coding could lead to better assessments and treatment decisions.
As of January 1, 2022, the latest revision of the International Classification of Diseases (ICD), ICD-11, came into effect. The revisions include important changes and additions that affect people with chronic pain and the pain management specialists who diagnose and treat them. Pain experts predict that the more accurate classification system and view of chronic pain will make life easier for those affected, as well as the doctors and advanced practitioners who care for them.
ICD-11 chronic pain codes
A key “first” in ICD-11 is that the new system provides a unique diagnosis code for chronic pain (MG30.0 Chronic primary pain). The manual also provides other codes for the most common and relevant groups of pain conditions. According to the ICD-11, pain is not only recognized as a health on its own, but it is also recognized as a symptom this may be secondary to other underlying health conditions. The review makes it clear that chronic pain can lead to disability and distress, which is probably a welcome direction for those who have been stigmatized for their often invisible condition.
Chronic pain reclassified in ICD-11
According to the new classification, chronic pain is defined as “pain that persists or recurs for more than 3 months”, as was the case previously. Classification goes one step further to differentiate types of pain. Pain can be the only complaint or one of the main complaints, requiring special treatment and care. Other subgroups specify that the pain may be secondary to an underlying disease. For example, there may be chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic secondary headache, and orofacial pain, to name a few categories.
The ICD is managed by the World Health Organization (WHO) and considered “the global standard for diagnostic health information” worldwide. In the United States alone, the review and its pain changes have the potential to impact millions of people. According to 2019 CDC statistics, released in 2020, just over 20% of American adults had chronic pain, and of these, about 7% of adults had chronic pain that often limited life activities or labor in the previous 3 months (known as high pain). -impact on chronic pain).1 Adults aged 65 and over were most likely to be affected, as chronic pain and high-impact chronic pain increase with age.
The new CIM classification for pain states was created in collaboration with the WHO and a working group of the International Association for the Study of Pain (IASP) dating back several years (member of the IASP Task Force Joachim Scholz, MD shared the background) with Practical Pain Management (PPM) in 2019.
ICD-11 Chronic Pain Modifications to Improve Pain Practice
Pain specialists applaud ICD-11 changes. In addition to the new unique diagnostic code, as well as codes for pain secondary to other conditions, another benefit is that the review “takes into account not only pain intensity, but also disability and of pain-related distress,” says Jeff Gudin, MD, pain specialist at the University of Miami and co-editor of PPM. The new classification more formally recognizes the psychosocial factors that contribute to the experience of pain – something the pain management community has known and advocated for years.
Dr. Gudin highlighted significant field trials of the updated coding system, published in the February 2022 issue of Pain. German and Swiss researchers trained 177 healthcare professionals in WHO regions on the ICD-11 chronic pain codes approved by the World Health Assembly in 2019 (the same codes that came into effect in January 2022). They assessed 18 ICD-11 diagnosis codes and 12 case vignettes describing chronic pain conditions. The researchers analyzed the accuracy, ambiguity and perceived difficulty of coding, comparing ICD-11 to ICD-10, which came into effect in 2015. Their conclusion: “From a coding perspective, the ICD-11 is superior to ICD-10 in every respect, providing better accuracy, less ambiguity, and other benefits.3
Jeffrey Fudin, PharmD, FCCP, FASHP, FFSMB, President of Remitigate LLC and Co-Editor for PPMagrees that the ICD-11 coding system will significantly change diagnosis and treatment. “The diagnosis reflected in the record will be more complete and accurate, and treatment can be better guided based on causality.”
The stigma surrounding long-term opioid therapy could also be affected, he says. “For example, it might be more obvious from a quick glance that a patient receiving long-term opioid treatment has a diagnosis that cannot be easily treated without opioid treatment. A good example is recurrent pancreatitis, which often requires intermittent or chronic opioid therapy, unlike other visceral pain syndromes. This could help alleviate the stigma associated with long-term opioid therapy.
What the ICD-11 change means for pain practitioners
As pain management physicians and their coders learn the ICD-11 system, Dr. Fudin suggests that “it is important that they take the extra few minutes to accurately select diagnoses and sub- accurate diagnoses so that data mining is accurate and reflects the true patient problem.
For example, he says, “if a patient has a diagnosis of type II diabetes, bilateral lower extremity neuropathy, and a history of colon cancer with chemotherapy treatment, it is important to identify the underlying cause. If the A1C is normal and the patient’s blood sugar is well controlled, it should be obvious from a clinician’s quick glance that the neuropathy is likely due to something else, perhaps neuropathy induced by chemotherapy as a platinum-based treatment.
Approaching the conversation in this way, Dr. Fudin says, “could help focus the conversation when interviewing a patient and lead to a more accurate record.”
What will the new system mean for people with chronic pain disorders? Both clinicians agree that the new coding scheme should contribute to the accuracy of their list of medical problems. More specific pain diagnoses may also facilitate insurance approval and reduce denials for routine and specialty pain care, they add.
For more perspective, check out IASP’s full report on chronic pain.
Last update: February 10, 2022