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 due to diseases of the nervous system is chronic pain localized in joint(s), bone(s), tendon(s) or muscle(s) that is related to peripheral or central neurological disorders classified elsewhere. It includes pain due to altered motor function and altered sensory function. Altered biomechanical function due to the neurological disease is responsible for the activation of nociceptors in musculoskeletal tissue. The pain may be spontaneous or movement-induced.

Chronic secondary musculoskeletal pain due to diseases of the nervous system is chronic pain localized in joint(s), bone(s), tendon(s) or muscle(s) that is related to peripheral or central neurological disorders classified elsewhere. It includes pain due to altered motor function and to altered sensory function. Altered biomechanical function due to the neurological disease is responsible for the activation of nociceptors in musculoskeletal tissue. The pain may be spontaneous or movement-induced.

Chronic secondary musculoskeletal pain associated with a disease of the nervous system includes upper and lower motor neuron disease, extrapyramidal disorders, and chronic pain attributable to altered sensory (including proprioceptive) function.

Diagnostic Criteria:

1. Diagnostic Criteria (Necessary and sufficient criteria)

Conditions A to D are fulfilled:

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

B. Clinical features of a neurological disease (classified elsewhere) are present.

C. Altered biomechanical function (demonstrated by appropriate clinical examination or appropriate tests) due to the neurological problem is responsible for the activation of nociceptors in musculoskeletal tissues.

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