慢性疼痛:作为一种症状或疾病——国际疼痛学会(IASP)对《国际疾病分类》第 11 版(ICD-11)中慢性疼痛的分类。
Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11).
机构信息
Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany.
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
出版信息
Pain. 2019 Jan;160(1):19-27. doi: 10.1097/j.pain.0000000000001384.
Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.
慢性疼痛是一种主要的痛苦来源。它干扰日常功能,通常伴随着痛苦。然而,在《国际疾病分类》中,慢性疼痛的诊断并没有系统地体现出来。缺乏适当的编码使得准确的流行病学调查变得困难,并阻碍了有关慢性疼痛的卫生政策决策,例如为获得多模式疼痛管理提供充足的资金。在世界卫生组织的合作下,IASP 工作组制定了一个分类系统,该系统适用于广泛的环境,包括疼痛医学、初级保健和资源匮乏的环境。慢性疼痛是指持续或复发超过 3 个月的疼痛。在慢性疼痛综合征中,疼痛可能是唯一或主要的主诉,需要特殊的治疗和护理。在纤维肌痛或非特异性腰痛等疾病中,慢性疼痛本身可能被视为一种疾病;在我们的建议中,我们将这一组称为“慢性原发性疼痛”。在另外 6 个亚组中,疼痛是潜在疾病的继发症状:慢性癌症相关疼痛、慢性神经性疼痛、慢性继发性内脏疼痛、慢性创伤后和手术后疼痛、慢性继发性头痛和口腔颌面部疼痛、慢性继发性肌肉骨骼疼痛。这些疾病被概括为“慢性继发性疼痛”,其中疼痛至少最初可以被视为一种症状。这些编码在即将到来的第 11 版《国际疾病分类》中的实施将导致更好的分类和诊断编码,从而提高对慢性疼痛作为一种独立健康状况的认识。