• Michael Nicholas, VlaeyenJohan W SJWSResearch Group Health Psychology, University of Leuven, Leuven, Belgium.Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.TRACE, Center for Translational Health Research, KU Leuven-Ziekenhu, Winfried Rief, Antonia Barke, Qasim Aziz, Rafael Benoliel, Milton Cohen, Stefan Evers, Maria Adele Giamberardino, Andreas Goebel, Beatrice Korwisi, Serge Perrot, Peter Svensson, Shuu-Jiun Wang, Rolf-Detlef Treede, and IASP Taskforce for the Classification of Chronic Pain.
• Pain Management Research Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
• Pain. 2019 Jan 1; 160 (1): 28-37.

AbstractThis article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called "chronic secondary pain" where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.

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