Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding

Antonia Barke,Stephan A Schug,Audun Stubhaug,Hans-Raimund Casser,Winfried Rief,Takahiro Ushida,Egil A Fors,Thomas Wetterling,Rolf-Detlef Treede,Beatrice Korwisi,Christian Geber

doi:10.1186/s12889-018-6135-9

Abstract

BackgroundA task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. The objective was to test whether the proposed categories were exhaustive and mutually exclusive. In addition, the perceived utility of the diagnoses and the raters’ subjective diagnostic certainty were to be assessed.MethodsFive independent pain centers in three continents coded 507 consecutive patients. The raters received the definitions for the main diagnostic categories of the proposed classification and were asked to allocate diagnostic categories to each patient. In addition, they were asked to indicate how useful they judged the diagnosis to be from 0 (not at all) to 3 (completely) and how confident they were in their category allocation.ResultsThe two largest groups of patients were coded as either chronic primary pain or chronic secondary musculoskeletal pain. Of the 507 patients coded, 3.0% had chronic pain not fitting any of the proposed categories (97% exhaustiveness), 20.1% received more than one diagnosis. After adjusting for double coding due to technical reasons, 2.0% of cases remained (98% uniqueness). The mean perceived utility was 1.9 ± 1.0, the mean diagnostic confidence was 2.0 ± 1.0.ConclusionsThe categories proved exhaustive with few cases being classified as unspecified chronic pain, and they showed themselves to be mutually exclusive. The categories were regarded as useful with particularly high ratings for the newly introduced categories (chronic cancer-related pain among others). The confidence in allocating the diagnoses was good although no training regarding the ICD-11 categories had been possible at this stage of the development.

Highlights

A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the International Classification of Diseases (ICD)-11 consisting of seven major categories
Responding to this need, the IASP established a task force consisting of pain experts from around the world to develop a pragmatic classification of chronic pain for the inclusion into the eleventh revision of the ICD
The raters were clinicians experienced with regard to chronic pain, but without any formal training with respect to the ICD-11, because such training was unavailable at that stage in the development

Summary

Introduction

A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. Barke et al BMC Public Health (2018) 18:1239 conditions for research, so the ICD diagnoses inform research agendas. Adequate diagnoses are essential for treatment choices [12, 13]. Responding to this need, the IASP established a task force consisting of pain experts from around the world to develop a pragmatic classification of chronic pain for the inclusion into the eleventh revision of the ICD. The task force has presented a pragmatic, research-based classification proposal, which comprises seven categories of chronic pain conditions [2, 3]: 1. The task force has presented a pragmatic, research-based classification proposal, which comprises seven categories of chronic pain conditions [2, 3]: 1. Chronic primary pain (e.g. irritable bowel syndrome, ‘non-specific’ chronic low back pain, fibromyalgia) [14]

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Conclusion