Multiaxial Classification of Pain - Psychosocial Dimension (MACPainP)

The quintessence of every diagnostic process is the diagnosis itself. Ideally, it
belongs to a recognized classification system and can offer a direction for subsequent
therapeutic interventions. Yet, the more complex a syndrome, the greater the
difficulties to find a uniform system of classification. Pain is a very fitting example,
and its multidimensionality necessitates us to consider its various constituting
aspects. Pain may differ with regard to the following aspects:
• The bodily system that it is assigned to (e.g., central nervous system, muscular
system).
• The pattern of appearance (e.g., fluctuating, continuous), duration (e.g., acute,
chronic).
• The etiology (e.g., genetic, posttraumatic, dysfunctional).
The connections between these aspects alone make for innumerable amount of
combinations that cannot always be compared with each other.
The International Classification of Disorders, ICD-10, may be the standard system
for diagnosing pain, but it is not truly suitable for making the distinctions that
are crucial to pain therapy. Most importantly, it does not summarize pain diagnoses
under one umbrella term but rather distributes pain-related diagnoses across all
chapters of the ICD. Therefore, the ICD as it is today does not reflect the fact that
pain all too often is a discrete syndrome.
A further difficulty in pain classification is the biopsychosocial perspective on
pain. Common classification systems only allow for a limited integration of the
biopsychosocial diagnosis of pain, ultimately forcing the diagnostician to choose
between somatogenic and psychogenic pain diagnoses. This dualistic point of view
cannot adequately depict state-of-the-art pain diagnoses.
The MACPainP (Multiaxial Classification of Pain—Psychosocial Dimension)
has been developed to meet the practical challenges that diagnosticians face in their
daily clinical practice. More than 20 years ago, we started working on a system for
pain that would include both the somatic and the psychosocial factors of pain. At
that time, the only available ICD-10 diagnosis was F54 “bodily condition, in which
the psychological factors play a role.” This diagnosis, in combination with a somatic
diagnosis from the ICD chapters, only provided a (small) integration of somatic and
the psychosocial factors. F54’s description of pain remained unspecific and offered
merely few guidelines for therapeutic steps. In the German-speaking world, it was
only the modification of the ICD-10 (ICD-10 GM (German Modification)) and the
new code F45.41 “chronic pain disorder with somatic and psychological factors”
that allowed for the co-occurrence of psychological and somatic factors in pain
conditions. Yet this diagnosis still could not offer a more differentiated understanding
of the psychosocial aspects of pain.
In contrast, the MACPainP (Multiaxial Classification of Pain—Psychosocial
Dimension) places special emphasis on the nuanced description of pain on the psychosocial
level. In addition to the pain-related somatic diagnoses of ICD, MACPainP
provides a systematic differentiation of the psychological influences on pain processes.
This nuanced system makes it possible to discern clear indications for subsequent
therapeutic steps.
MACPainP, therefore, provides a system in which pain can be recorded and classified
biopsychosocially while keeping the diversity and multidimensionality of
pain in mind. Due to its multifaceted descriptions, MACPainP is an ideal option for
those who are looking for an introduction that can offer a quick and in-depth handling
of the biopsychosocial perspective on pain. It also is a system that has been
specifically developed to enrich the work of psychologists and physicians alike.
MACPainP is an excellent diagnostic tool that physicians, psychologist, physiotherapists,
and clinical staff can use in interdisciplinary multimodal out and inpatient
pain centers or day hospitals. In many guidelines for pain diseases, MACPainP
could enrich the diagnostic procedure and offer a basis for interdisciplinary
understanding.
The upcoming revision of ICD, which is expected to be published in 2018, will
include a chapter dedicated solely to the classification of pain. This will allow for
further systematizations of the somatic side of pain. Additionally, the psychological
side will change in the next edition of the ICD. MACPainP offers an excellent possibility
to get involved with this new pain classification and can serve as an add-on
to the differentiation of pain while offering concrete therapy indications.