First EFIC® Symposium Societal Impact of Pain - SIP

Rolf-Detlef Treede
Prof. Dr. med. Rolf-Detlef Treede
President Deutsche Gesellschaft zum Studium des
Schmerzes e.V. (German Pain Society)
Lehrstuhl für Neurophysiologie - Zentrum für
Biomedizin und Medizintechnik Mannheim
Medizinische Fakultät Mannheim der Universität
Heidelberg
Ludolf-Krehl-Str.13-17
D-68167 Mannheim
Germany
Professor Treede is a past member of the Council of
the International Association for the Study of Pain
(IASP), Chair of its Special Interest Group on
Neuropathic Pain (NeuPSIG), and President of its
German chapter (Deutsche Gesellschaft zum Studium
des Schmerzes e.V., DGSS). He sits on numerous
national and international committees, is involved with
a number of task forces – including the IASP Task
Force on Taxonomy – and is a member of the editorial
boards of the journals, Pain and Der Schmerz. He has
authored/co-authored about 200 publications in
journals and books.
Theses on the Ethics of Pain Therapy
1) Freedom from pain is an essential element of
human well-being.
2) Pain therapy is a fundamental human right.
3) Everyone has the same right to adequate pain
relief.
4) Everyone has the right to die without suffering
from pain, if necessary even with the risk of
adverse effects
5) Pain relief should respect the patient's autonomy
6) Pain therapy must not cause harm. Early death in
cancer patients as a result of pain therapy is not
to be considered as harm.
7) Pain relief must not hinder self-determination.
8) Risks of pain therapy may only restrict thera-peutic
measures, if the resulting advantages of pain
therapy are reduced.
9) Chronic pain is to be prevented by effectively
treating acute pain.
DGSS Ethics Charter - Synopsis
The DGSS Ethics Charter is a document offering
ethical orientation in fundamental questions and
special challenges in dealing with pain. It is intended
for all those treating pain, accompanying those
suffering from pain or those who are themselves
affected by pain.
The complete Ethics Charter in German and a short
version in English are available free of charge from:
Geschäftsstelle der DGSS
Obere Rheingasse 3
56154 Boppard
Tel: +49 6742 8001-21
Fax: +49 6742 8001-22
E-Mail info@dgss.org
http://www.dgss.org
Coding chronic pain in the International
Classification of Diseases (ICD 10)
ICD 10 was endorsed by the Forty-third World Health
Assembly in May 1990 and came into use in WHO
Member States as from 1994. The classification is
the latest in a series which has its origins in the
1850s. Not surprisingly, ICD 10 fares better in
representing medical subspecialties (psychiatry in the
F section, orthopaedic surgery in the M section,
neurology in the G section) than interdisciplinary
problems such as chronic pain.
In 2009, the German version of ICD-10 introduced the
diagnosis of “Chronic pain disorder with somatic and
psychological factors” (F45.41) to better reflect the
biopsychosocial character of chronic pain. A
dichotomous classification into psychologically caused
pain (e.g. F62.8 or F45.4) versus biomedically caused
pain (e.g. M54) is inappropriate, because the majority
of patients have elements of both etiologies, as shown
most clearly for low-back pain. The new code F45.41
addresses the relevance of psychological factors for
chronic pain persistence and chronic pain treatment,
even in those conditions with a clear biomedical cause
at the beginning. This new code may be a model for
worldwide implementation in the upcoming ICD11.
Using such a code systematically is expected to have
these practical consequences:
1) Patients with chronic pain, where pain has lost its
warning function, receive a medically recognized
diagnosis.
2) A pain state with such a label will help recognition
as a “legitimate” medical problem.
3) Health care costs for difficult-to-treat cases are
distinguished from those for uncomplicated cases.
4) Once the health care costs for chronic pain
are delineated, the motivation to include
interdisciplinary differential diagnosis and therapy
of pain into medical school curricula may increase.
The first data on the use of F45.41 in Germany are
expected to be available in summer 2010.
Nilges P, Rief W (2010) F45.41 Chronische
Schmerzstörung mit somatischen und psychischen
Faktoren – eine Kodierhilfe. Der Schmerz 24 (2): in
press
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