Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj, Bangkok, Thailand.
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany.
Pain. 2021 Jul 1;162(7):1995-2001. doi: 10.1097/j.pain.0000000000002196.
Pain is a frequent reason for patients to ask for medical services. However, systematic information about the extent and impact of pain, especially in developing countries, has not been available up to now. We evaluated whether the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD) can fill this gap by coding all electronic out-patient medical records of the pain clinic at Siriraj Hospital in Thailand in 2019 (8714 visits), using the ICD-10 and ICD-11 browsers referenced on the WHO websites. The 3 most frequent pain-related codes in ICD-10 were R52.2 "other chronic pain" (29%), M54.5 "low back pain" (18%), and M79.6 "pain in limb" (13%). In ICD-11, the 3 most frequent codes were MG30.31 "chronic secondary musculoskeletal pain associated with structural changes" (28%), MG30.51 "chronic peripheral neuropathic pain" (26%), and MG30.10 "chronic cancer pain" (23%). Thus, using the currently valid ICD-10 system, roughly one-third of patient encounters were coded as "other chronic pain," and the next 2 were specifying the pain region rather than any underlying cause. By contrast, ICD-11 coding of the same patients identified underlying causes (bones and joints, somatosensory nervous system, cancer, or surgery), which provide guidance towards differential patient management. In our pain clinic, most patients suffered from chronic cancer pain, chronic neuropathic pain, and chronic secondary musculoskeletal pain, which were poorly defined or nonexistent in the current ICD-10 coding system. Compared with the ICD-10, the ICD-11 provides more detailed diagnostic categories and is more informative for clinical use, research, and resource allocation for pain-related conditions.
疼痛是患者寻求医疗服务的常见原因。然而，目前还没有关于疼痛的范围和影响的系统信息，特别是在发展中国家。我们评估了第 11 版《国际疾病分类与相关健康问题统计分类》（ICD）是否可以通过使用世界卫生组织网站上引用的 ICD-10 和 ICD-11 浏览器对泰国 Siriraj 医院疼痛诊所 2019 年的所有电子门诊病历（8714 次就诊）进行编码来填补这一空白。ICD-10 中最常见的 3 个与疼痛相关的代码是 R52.2“其他慢性疼痛”（29%）、M54.5“下腰痛”（18%）和 M79.6“肢体疼痛”（13%）。在 ICD-11 中，最常见的 3 个代码是 MG30.31“与结构改变相关的慢性继发性肌肉骨骼疼痛”（28%）、MG30.51“慢性周围神经性疼痛”（26%）和 MG30.10“慢性癌症疼痛”（23%）。因此，使用当前有效的 ICD-10 系统，大约三分之一的患者就诊被编码为“其他慢性疼痛”，接下来的 2 个代码指定了疼痛区域而不是任何潜在的原因。相比之下，相同患者的 ICD-11 编码确定了潜在的原因（骨骼和关节、躯体感觉神经系统、癌症或手术），这为患者的差异化管理提供了指导。在我们的疼痛诊所，大多数患者患有慢性癌症疼痛、慢性神经性疼痛和慢性继发性肌肉骨骼疼痛，而这些疼痛在当前的 ICD-10 编码系统中定义不明确或不存在。与 ICD-10 相比，ICD-11 提供了更详细的诊断类别，对临床使用、研究和疼痛相关疾病的资源分配更具信息性。
