ICD-11

Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Chronic pain is pain that persists or recurs for longer than 3 months. Chronic pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome.

Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Often, pain serves as a symptom warning of a medical condition or injury. In these cases, treatment of the underlying medical condition is crucial and may resolve the pain. However, pain may persist despite successful management of the condition that initially caused it, or because the underlying medical condition cannot be treated successfully.

Chronic pain is pain that persists or recurs for longer than 3 months. Such pain often becomes the sole or predominant clinical problem in some patients. As such it may warrant specific diagnostic evaluation, therapy and rehabilitation. Chronic pain is a frequent condition, affecting an estimated 20% of people worldwide. It is multifactorial: biological, psychological and social factors contribute to the pain syndrome.

This code should be used if a pain condition persists or recurs for longer than 3 months.

Chronic secondary musculoskeletal pain is chronic pain arising from bone(s), joint(s), muscle(s), vertebral column, tendon(s) or related soft tissue(s). It is a heterogeneous group of chronic pain conditions originating in persistent nociception in joint, bone, muscle, vertebral column, tendons and related soft tissues, with local and systemic aetiologies, but also related to deep somatic lesions. The pain may be spontaneous or movement-induced.

Chronic secondary musculoskeletal pain is chronic pain arising from bone(s), joint(s), muscle(s), vertebral column, tendon(s)or related soft tissue(s). It is a heterogeneous group of chronic pain conditions originating in persistent nociception in joint, bone, muscle, vertebral column, tendon and related soft tissues, with local and systemic etiologies, but also related to deep somatic lesions. If the pain is related to visceral lesions, it should be considered whether a diagnosis of chronic visceral pain is appropriate; if it is related to neuropathic mechanisms, it should be coded under chronic neuropathic pain; and if the pain mechanisms are non-specific, chronic musculoskeletal pain should be coded under chronic primary pain.

Chronic secondary musculoskeletal pain can be characterised either by persistent local or systemic inflammatory illness, which may be due to infectious diseases, crystal deposition or auto-immune processes, or attributable to structural changes.

Other biomedical causes responsible for musculoskeletal pain may also apply (such as neurologically caused muscle spasms and referred pain from deep tissues).

The musculoskeletal origin of the pain (that is, nociception in musculoskeletal tissues) should be highly probable.

If the musculoskeletal origin does not appear highly plausible and no neuropathic origin is ascertainable; consider using codes in the section of chronic primary pain.

Diagnostic Criteria:

Conditions A to C are fulfilled:

A) Chronic pain (persistent or recurrent for longer than 3 months) in joint(s), bone(s), muscle(s), vertebral column, tendon(s) or related soft tissue is present. The pain may be spontaneous or movement induced.

B) At least one of B1 to B3 is fulfilled:

B1) A musculoskeletal disease with inflammation due to infection, auto-immunity, auto-inflammation or metabolic disorders (crystals) is present (demonstrated by appropriate clinical examination or appropriate tests) and causes the local activation of nociceptors.

B2) A musculoskeletal disease with structural / biomechanical factors (demonstrated by appropriate clinical examnation or appropriate tests) is present and causes the local activation of nociceptors.

B3) A neurological disease (classified elsewhere) is present and causes altered biomechanical function (demonstrated by appropriate clinical examination or appropriate tests) that is responsible for the activation of nociceptors.

C) The pain is not better accounted for by another diagnosis of chronic pain.

If the pain is related to visceral lesions, it should be considered whether a diagnosis of chronic visceral pain is appropriate; if it is related to neuropathic mechanisms, it should be coded under chronic neuropathic pain; and if the pain mechanisms are non-specific, chronic musculoskeletal pain should be coded under chronic primary pain.

Chronic secondary musculoskeletal pain from persistent inflammation is chronic pain due to inflammatory mechanisms in joint(s), bone(s), tendon(s), muscle(s), soft tissue(s) or vertebral column. The pain may be spontaneous or movement-induced. It is characterised by clinical features of inflammation, including increased sensitivity of the part to stimuli.

Chronic secondary musculoskeletal pain from persistent inflammation is chronic pain due to inflammatory mechanisms in joint(s), bone(s), tendon(s) or vertebral column. The pain may be spontaneous or movement-induced. It is characterized by clinical features of inflammation, including increased sensitivity of the part to stimuli. Chronic secondary musculoskeletal pain from persistent inflammation is most common in rheumatological conditions where chronic pain is the main symptom, and where inflammation is the primary pathophysiological mechanism. Chronic secondary musculokeletal pain is one of the most frequent symptoms in auto-immune and auto-inflammatory disorders, mostly driven by systemic or local inflammation.

Classification of chronic secondary musculoskeletal pain from persistent inflammation is linked to the classification of rheumatological disorders, where inflammation is the main pathophysiological mechanism. Inflammation has several determinants and chronic pain related to inflammation can be divided in 3 main sub-categories:

-auto-immune and auto-inflammatory disorders

-crystal deposition diseases

-infection

Diagnostic Criteria:

Conditions A to C are fulfilled:

A. Chronic pain (persistent or recurrent for longer than 3 months) in joint(s), bone(s), tendon(s) or vertebral column is present. The pain may be spontaneous or movement

induced.

B. At least one of B1 to B3 is fulfilled:

B.1 Systemic inflammatory illness is present.

B.2 Local signs of inflammation are present.

B.3 Raised laboratory markers of inflammation are present.

C. The pain is not better accounted for by another diagnosis of chronic pain.