Chronic Neuropathic Pain Updated Classification by IASP for ICD-11
The consensus statement includes a classification that differentiates neuropathic pain of peripheral or central origin.
A panel of chronic pain experts established by the International Association for the Study of Pain (IASP) updated the classification of chronic neuropathic pain for the International Classification of Diseases, 11th Revision (ICD-11), which was published in Pain.
An interdisciplinary task force assembled by the IASP convened to edit and amend definitions for neuropathic diseases and associated chronic pain conditions. The consensus statement includes a classification that differentiates between neuropathic pain of peripheral or central origin. A total of 9 common conditions associated with recurrent or persistent pain were included in the classification. Pain lasting ≥3 months was considered chronic neuropathic pain “because it provides for clear operationalization in line with widely used research criteria and subject enrollment in analgesic treatment trials,” according to the report authors.
The following chronic neuropathic pain conditions were defined in the ICD-11 as follows:
- Chronic neuropathic pain is defined as spontaneous or evoked pain, with a heightened response to painful (hyperalgesia) or nonpainful (allodynia) stimuli. Chronic neuropathic pain is caused by a disease or lesion of the somatosensory nervous system.
- Trigeminal neuralgia refers to abrupt and recurrent shooting or stabbing pain that is observed in ≥1 divisions of the trigeminal nerve. The pain can be stimulated by innocuous stimuli and is often compared with an electric shock.
- Painful polyneuropathy is defined as chronic pain associated with autoimmune, familial, metabolic, or infectious diseases, following treatment with a neurotoxic drug, or following exposure to environmental or occupational toxins.
- Postherpetic neuralgia is defined as persistent pain lasting ≥3 months after the onset or healing of herpes zoster.
- Painful radiculopathy refers to persistent or recurrent pain resulting from a disease or lesion of the cervical, thoracic, lumbar, or sacral nerve roots. Diagnosis is based on pain in the affected dermatomes.
- Chronic central post-stroke pain is characterized by persistent pain caused by a cerebrovascular lesion, hemorrhage, or infarct of the brain or brainstem. Diagnosis is established, based on a history of stroke and a neuro-anatomically plausible pain distribution.
“Clear definitions combined with a seamless evaluation of the evidence leading to the diagnosis of chronic neuropathic pain will facilitate patient identification for enrolment in clinical trials and promote the translation of research findings into practice,” noted the report authors.
Scholz J, Finnerup NB, Attal N, et al; for the Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019;160(1):53-59.