Chronic pain has been reclassified

Chronic pain has been reclassified in the ICD-11. This became effective in January 2022 after a creative collaboration between the World Health Organization (WHO) and the International Association for the Study of Pain (IASP). 

The new system provides a single diagnostic code for chronic pain (MG30.0 Chronic primary pain). Under the ICD-11, pain is not only recognised as a health condition on its own but also as a symptom that can be secondary to other underlying health issues.

Under the new classification, Chronic pain is defined as primary ( ‘’pain that persists or recurs for more than three months’’ – as it had been previously) or secondary to organic causes.

The new definition of chronic primary pain is an important step forward and is neutral concerning the historically misleading dichotomy between somatic and mental disorders. In addition, it includes essential components of emotional distress and functional disability.

This new development has made it easier to design better Pain Recovery Programs, including our comprehensive Pain Recovery Program at White River Manor.

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The diagnostic entities are listed according to the seven main categories of chronic pain:

1. Chronic primary pain 
2. Chronic cancer-related pain – secondary
3. Chronic postsurgical and chronic post-traumatic pain – secondary
4. Chronic neuropathic pain – secondary
5. Chronic secondary headache or orofacial pain 
6. Chronic secondary visceral pain 
7. Chronic secondary musculoskeletal pain

The four chronic primary pain categories are:

1. Chronic widespread pain 
2. Chronic primary headache or orofacial pain 
3. Chronic primary visceral pain
4. Chronic primary musculoskeletal pain

Chronic widespread pain

• Fibromyalgia
• Complex regional pain syndrome
• (CRPS) CRPS Type 1
• CRPS Type 2

Chronic primary headache or orofacial pain

• Chronic migraine
• Chronic tension-type headache
• Trigeminal autonomic cephalalgias (TACs)
• Chronic primary temporomandibular disorder pains 
• Burning mouth syndrome
• Chronic primary orofacial pain 

Chronic primary visceral pain 

• Chronic primary chest pain syndrome 
• Chronic primary epigastric pain syndrome 
• Irritable bowel syndrome
• Chronic primary abdominal pain syndrome 
• Chronic primary bladder pain syndrome 
• Chronic primary pelvic pain syndrome  
• Chronic pelvic pain in females 
• Chronic pelvic pain in males 

Chronic primary musculoskeletal pain

• Chronic primary low back pain 
• Chronic primary cervical pain 
• Chronic primary thoracic pain 
• Chronic primary limb pain

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Chronic primary pain also has additional specifiers:

• Pain severity
  • 0 – 10
  • No pain
  • Worst pain imaginable

• Pain-related distress
  • Distress Thermometer used.
  • Multifactorial unpleasant emotional experience
    • Cognitive
    • Behavioural
    • Emotional
    • Social
    • Spiritual nature 

• Pain-related interference (disability)
  • ADLs interference (Activities of Daily Living)
    • Mild
    • Moderate 
    • Severe

• Temporal characteristics of the pain
  • Continuous
    • The pain is always present
  • Episodic recurrent
    • There are recurrent pain attacks
    •  With pain-free intervals
  • Continuous pain attack
    • There are recurrent pain attacks
    •  As exacerbations of underlying continuous pain

• Presence of psychosocial factors
  • Cognitive
    • Catastrophizing
    • Excessive worry
  • Emotional
    • Fear
    • Anger
  • Behavioural
    • Avoidance
  • Social factors influenced:
    • Work
    • Relationships

Chronic pain results in negative psychobehavioral consequences such as:

• Demoralisation
• Hopelessness
• Avoidance
• Withdrawal

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White River Manor has partnered with Dr Wayne Kampers, a renowned psychiatrist and pain recovery specialist, to create an exclusive 12-week Pain Recovery Program. Dr Kampers is an expert in chronic primary pain treatment and a pioneer in the field. He and his wife Laura, a Pain Reprocessing Therapist and Mind-Body Coach, will be sharing their decades of experience with White River Manor’s medical team. For more information, see our new pain recovery program.