Multiaxial Classification of Pain - Psychosocial Dimension (MACPainP)

TY - CHAP

T1 - Multiaxial Classification of Pain - Psychosocial Dimension (MACPainP)

T2 - Systematic Approach to Classify Biopsychosocial Aspects of Pain Disorders

AU - Klinger, Regine

AU - Hasenbring, M

AU - Pfingsten, Michael

PY - 2019/7/15

Y1 - 2019/7/15

N2 - The quintessence of every diagnostic process is the diagnosis itself. Ideally, itbelongs to a recognized classification system and can offer a direction for subsequenttherapeutic interventions. Yet, the more complex a syndrome, the greater thedifficulties to find a uniform system of classification. Pain is a very fitting example,and its multidimensionality necessitates us to consider its various constitutingaspects. Pain may differ with regard to the following aspects:• The bodily system that it is assigned to (e.g., central nervous system, muscularsystem).• 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 ofcombinations that cannot always be compared with each other.The International Classification of Disorders, ICD-10, may be the standard systemfor diagnosing pain, but it is not truly suitable for making the distinctions thatare crucial to pain therapy. Most importantly, it does not summarize pain diagnosesunder one umbrella term but rather distributes pain-related diagnoses across allchapters of the ICD. Therefore, the ICD as it is today does not reflect the fact thatpain all too often is a discrete syndrome.A further difficulty in pain classification is the biopsychosocial perspective onpain. Common classification systems only allow for a limited integration of thebiopsychosocial diagnosis of pain, ultimately forcing the diagnostician to choosebetween somatogenic and psychogenic pain diagnoses. This dualistic point of viewcannot 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 theirdaily clinical practice. More than 20 years ago, we started working on a system forpain that would include both the somatic and the psychosocial factors of pain. Atthat time, the only available ICD-10 diagnosis was F54 “bodily condition, in whichthe psychological factors play a role.” This diagnosis, in combination with a somaticdiagnosis from the ICD chapters, only provided a (small) integration of somatic andthe psychosocial factors. F54’s description of pain remained unspecific and offeredmerely few guidelines for therapeutic steps. In the German-speaking world, it wasonly the modification of the ICD-10 (ICD-10 GM (German Modification)) and thenew code F45.41 “chronic pain disorder with somatic and psychological factors”that allowed for the co-occurrence of psychological and somatic factors in painconditions. Yet this diagnosis still could not offer a more differentiated understandingof the psychosocial aspects of pain.In contrast, the MACPainP (Multiaxial Classification of Pain—PsychosocialDimension) places special emphasis on the nuanced description of pain on the psychosociallevel. In addition to the pain-related somatic diagnoses of ICD, MACPainPprovides a systematic differentiation of the psychological influences on pain processes.This nuanced system makes it possible to discern clear indications for subsequenttherapeutic steps.MACPainP, therefore, provides a system in which pain can be recorded and classifiedbiopsychosocially while keeping the diversity and multidimensionality ofpain in mind. Due to its multifaceted descriptions, MACPainP is an ideal option forthose who are looking for an introduction that can offer a quick and in-depth handlingof the biopsychosocial perspective on pain. It also is a system that has beenspecifically 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 inpatientpain centers or day hospitals. In many guidelines for pain diseases, MACPainPcould enrich the diagnostic procedure and offer a basis for interdisciplinaryunderstanding.The upcoming revision of ICD, which is expected to be published in 2018, willinclude a chapter dedicated solely to the classification of pain. This will allow forfurther systematizations of the somatic side of pain. Additionally, the psychologicalside will change in the next edition of the ICD. MACPainP offers an excellent possibilityto get involved with this new pain classification and can serve as an add-onto the differentiation of pain while offering concrete therapy indications.

AB - The quintessence of every diagnostic process is the diagnosis itself. Ideally, itbelongs to a recognized classification system and can offer a direction for subsequenttherapeutic interventions. Yet, the more complex a syndrome, the greater thedifficulties to find a uniform system of classification. Pain is a very fitting example,and its multidimensionality necessitates us to consider its various constitutingaspects. Pain may differ with regard to the following aspects:• The bodily system that it is assigned to (e.g., central nervous system, muscularsystem).• 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 ofcombinations that cannot always be compared with each other.The International Classification of Disorders, ICD-10, may be the standard systemfor diagnosing pain, but it is not truly suitable for making the distinctions thatare crucial to pain therapy. Most importantly, it does not summarize pain diagnosesunder one umbrella term but rather distributes pain-related diagnoses across allchapters of the ICD. Therefore, the ICD as it is today does not reflect the fact thatpain all too often is a discrete syndrome.A further difficulty in pain classification is the biopsychosocial perspective onpain. Common classification systems only allow for a limited integration of thebiopsychosocial diagnosis of pain, ultimately forcing the diagnostician to choosebetween somatogenic and psychogenic pain diagnoses. This dualistic point of viewcannot 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 theirdaily clinical practice. More than 20 years ago, we started working on a system forpain that would include both the somatic and the psychosocial factors of pain. Atthat time, the only available ICD-10 diagnosis was F54 “bodily condition, in whichthe psychological factors play a role.” This diagnosis, in combination with a somaticdiagnosis from the ICD chapters, only provided a (small) integration of somatic andthe psychosocial factors. F54’s description of pain remained unspecific and offeredmerely few guidelines for therapeutic steps. In the German-speaking world, it wasonly the modification of the ICD-10 (ICD-10 GM (German Modification)) and thenew code F45.41 “chronic pain disorder with somatic and psychological factors”that allowed for the co-occurrence of psychological and somatic factors in painconditions. Yet this diagnosis still could not offer a more differentiated understandingof the psychosocial aspects of pain.In contrast, the MACPainP (Multiaxial Classification of Pain—PsychosocialDimension) places special emphasis on the nuanced description of pain on the psychosociallevel. In addition to the pain-related somatic diagnoses of ICD, MACPainPprovides a systematic differentiation of the psychological influences on pain processes.This nuanced system makes it possible to discern clear indications for subsequenttherapeutic steps.MACPainP, therefore, provides a system in which pain can be recorded and classifiedbiopsychosocially while keeping the diversity and multidimensionality ofpain in mind. Due to its multifaceted descriptions, MACPainP is an ideal option forthose who are looking for an introduction that can offer a quick and in-depth handlingof the biopsychosocial perspective on pain. It also is a system that has beenspecifically 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 inpatientpain centers or day hospitals. In many guidelines for pain diseases, MACPainPcould enrich the diagnostic procedure and offer a basis for interdisciplinaryunderstanding.The upcoming revision of ICD, which is expected to be published in 2018, willinclude a chapter dedicated solely to the classification of pain. This will allow forfurther systematizations of the somatic side of pain. Additionally, the psychologicalside will change in the next edition of the ICD. MACPainP offers an excellent possibilityto get involved with this new pain classification and can serve as an add-onto the differentiation of pain while offering concrete therapy indications.

M3 - SCORING: Contribution to collected editions/anthologies

SN - 978-3-030-00424-8

SP - 0

EP - 118

BT - Multiaxial Classification of Pain - Psychosocial Dimension (MACPainP)

PB - Springer Nature

CY - Cham

ER -