ICD-11

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 associated with structural changes is chronic pain of unknown mechanism(s) that is attributable to anatomical changes in joint(s), bone(s) or tendon(s). The structural change needs to be inferred from clinical examination and/or demonstrable on imaging. The pain may be spontaneous or movement-induced. It is characterised by clinical features such as swelling, allodynia or restricted movement.

Diagnostic Criteria:

Conditions A to D are fulfilled:

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

B) At least one of the following fulfilled: B1) Swelling is present. B2) Allodynia over the part is present.

C) The structural change is inferred from clinical examination or imaging.

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

Chronic secondary musculoskeletal pain associated with structural changes is chronic pain of unknown mechanism(s) that is attributable to anatomical changes in joint(s), bone(s) or tendon(s). The structural change needs to be inferred from clinical examination and/or demonstrable on imaging. The pain may be spontaneous or movement-induced. It is characterized by clinical features such as swelling, allodynia or restriced movement. Chronic secondary musculoskeletal pain associated with structural changes reflects the older classifications of osteoarthrosis (primary and secondary) and spondylosis (when referring to spinal structures), and includes persistent pain following bone fracture especially if there is anatomical deformity (including replacement of bone by tumour), and demonstrable anatomical change in tendons and/or entheses.

This is classification of pain by anatomical change in the candidate structure(s). The presumption is that the structural change, as observed clinically, whether or not supported by imaging, is the origin of the nociception ultimately associated with the experience of pain. This classification does not include any implication about the mechanism of nociception There may be discordance between the degree of structural change observed and the nature and intensity of pain experienced.

Diagnostic Criteria:

Conditions A to D are fulfilled

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

B. At least one of the following fulfilled:

B.1 Swelling is present.

B.2 Allodynia over the part is present.

C. The structural change is inferred from clinical examination or imaging.

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