ICD-11 & ICF

Since multidisciplinary treatment for chronic pain has been backward in Japan compared with other developed countries for long time, the Ministry of Health, Labour and Welfare (MHLW) encouraged an expert panel to build multidisciplinary pain centers in Japan so that patients with chronic pain can improve pain and functions through multifaceted, comprehensive approaches. As a result, 33 multidisciplinary pain centers have been established in the past decade. MHLW also requested the panel to investigate the effectiveness of the treatment in these centers, so an ideal chronic pain classification is needed to find out what treatment is effective for what kind of chronic pain. Simultaneously, World Health Organization and the IASP have prepared to introduce the ICD-11 chronic pain classification. Therefore, MHLW asked the expert panel to organize a research party of the 33 multidisciplinary pain centers in order to examine characteristics of patients and the effectiveness of the treatment based on the ICD-11 chronic pain classification. The presentation will demonstrate the experience, struggles and problems of adopting the ICD-11 chronic pain classification and the results of the treatment of the pain centers.

For the first time, the newly implemented ICD-11 includes a comprehensive chronic pain classification that was developed by the IASP Task Force for the Classification of Chronic Pain in close cooperation with the World Health Organization (WHO). This classification provides clearly defined and operationalized diagnoses for chronic pain as either a symptom of some chronic disease or as a disease in its own right. Pilot studies have already demonstrated that this classification can be applied in a variety of settings, including primary care and countries with limited resources. In this workshop, we will familiarize attendees with the ICD-11 chronic pain classification and present scientific evidence from different international field studies and from routine use in pain treatment centers in Japan and New Zealand that supports the new diagnoses (e.g., reliability, clinical utility). Furthermore, we will discuss the patient perspective on how the new diagnoses may improve early recognition, access to adequate management and reduction of stigma, as assessed in a large international survey.

Many countries are currently evaluating how to prepare the implementation of this new classification system into their healthcare systems, because since 2019 there are no more updates of its predecessor ICD-10. The first part of this presentation will provide a brief overview of the ICD-11 chronic pain diagnoses: the seven main categories and their sublevels will be presented, and new features of the ICD-11 (e.g., double parenting, complete coding) will be explained. The second part of the presentation will focus on the scientific evidence that supports the classification. First field studies showed the exhaustiveness and clinical utility of the new diagnoses as well as the mutual exclusiveness of the new codes. Furthermore, another field study demonstrated that the ICD-11 chronic pain diagnoses outperform ICD-10 with regard to correct code assignment, difficulty of the code assignment, as well as ambiguity of the diagnoses.

This presentation will give attendees a thorough overview of how the ICD-11 chronic pain classification fits within the larger context of the ICD-11. The second focus of this presentation will be the patient perspective on the new ICD-11 chronic pain diagnoses. Data from an international web-based survey will be presented. Here, patients with self-reported chronic pain rated the new diagnoses after having watched a brief introductory video. Patients rated, among others, whether they expect the new diagnoses to facilitate communication or improve access to adequate pain treatment. Patient endorsement can contribute to a facilitated implementation of the ICD-11 chronic pain classification. Results of more than 1000 patients encourage the use of the new classification system, and offer some hints about aspects to be specifically addressed.

The newly conceptualized classification of chronic pain in the ICD-11 will come into effect in 2022. Over the coming years healthcare providers will gain experiences and will have to deal with challenges of the implementation of this new classification within their institutions. In the context of an international field study, we introduced the ICD-11 pain classification in a pain service of a city hospital in New Zealand. This presentation will introduce the audience to the opportunities and challenges of the implementation in a clinical setting. We will present data from the field study regarding the applicability of the new classification in an interdisciplinary service. The study aimed to examine the quality and clinical utility of the new categories. Our participating clinicians, first trained in the application of the new classification, allocated diagnostic codes to consecutively admitted patients. The diagnostic assessment of the patients was standardized by the use of a classification algorithm, which guided diagnosticians through the new diagnostic criteria of the different pain conditions. Our analyses show the new classification categories to have high clinical utility ratings, high inter-rater agreement, and to be exhaustive and mutually exclusive.