Chronic Pain: Classification

Graduation of chronic pain according to von Korff et al.

Grade Description
0 No pain (no pain in the past six months)
I Pain with low pain-related functional impairment and low intensity (pain intensity <50 and less than 3 points of pain-related impairment)
II Pain with low pain-related functional impairment and higher intensity: (pain intensity > 50 and less than 3 points of pain-related impairment)
III Moderate pain-related functional impairment (3-4 points of pain-related impairment, regardless of pain intensity)
IV High pain-related functional impairment (5-6 points of pain-related impairment, regardless of pain intensity)

Classification of nociceptive pain versus neuropathic pain.

Nociceptive pain Neuropathic pain
Cause of pain
  • Tissue damage (somatic pain/skin, connective tissue, muscles, bones, and joints, or visceral pain/internal organs)
  • Damage to somatosensory nerve structures.
Pain character/quality
  • Stabbing or throbbing or even bluntly probing, pressure-like pain
Sensitive restrictions
  • Rather uncommon; if present, then no dermatomal distribution, i.e., corresponding to the area of supply of a sensitive nerve
  • Very often
  • Spontaneous pain + evoked pain (due to application of an external stimulus: e.g., touch, heat or cold stimulus).
  • Negative sensory symptoms: reduction or a failure of corresponding somatosensory qualities such as hypesthesia (decreased sensitivity), hypalgesia (decreased pain sensitivity), position sense disorder, pallhypesthesia (reduced vibration sensation), thermhypesthesia (pathologically decreased temperature sensation) or corresponding anesthesia (insensitivity of the nervous system)
  • Positive sensory symptoms: Dysesthesias (painful paresthesias), tingling paresthesias (eg, formication).
Hypersensitivity
  • Rather rare, except in cases of hypersensitivity in the area of injury
  • Present; this is due to painful (exaggerated reaction) or non-painful stimuli (allodynia).
Motor constraints
  • Possible if triggering is pain-related
  • Possible if a motor nerve is involved.
Autonomous symptoms
  • Rather uncommon
  • Color changes, swelling, temperature changes(frequency: about 35-50%).

Classification of neuropathic pain (NPS).

Peripheral neuropathies Diabetic and alcoholic neuropathies, Sudeck’s disease (complex regional pain syndrome, CRPS), nerve bottleneck syndromes, phantom limb pain, postzoster neuralgia, trigeminal neuralgia; neuropathic pain syndromes due to HIV, storage diseases, or deficiency states
Central neuropathies After cerebral infarctions or multiple sclerosis (MS).
Mixed pain syndrome Chronic nonspecific low back pain, low back leg pain, tumor pain, and CRPS