Abstract
It is estimated that millions of people worldwide suffer from chronic pain associated with infectious diseases and their treatment. Notably, numerous pathogens can cause chronic pain in people with current or past infections but the underlying mechanisms of pain development and persistence are only partially known. To help those people, classification systems are important to differentiate chronic pain that is not affected by the infection from chronic pain that started or worsened in relation to the infection. This is especially true because these classification systems often guide treatment selection. Unfortunately, current classification systems do not reflect the complex reality of the myriad chronic pain features known to exist in the context of infectious diseases. In this article, we have therefore presented a framework to initiate discussions between the pain community, infectious disease specialists, and ICD experts to yield a proposal to add chronic pain related to infection as a subgroup to the existing ICD-11 classification of chronic pain. This framework is discussed in the context of HIV-1, HTLV-1, and Mycobacterium leprae, three pathogens that are associated with chronic pain. We discuss diagnostic criteria, provide a definition of chronic pain related to infection suitable for its inclusion into the ICD-11, but also possible limitations. We believe that a classification system that better reflects chronic pain related to infection will improve clinical communication, detection of chronic pain conditions, selection of appropriate pain therapies, facilitate reimbursement by health care systems, raise awareness, and improve research, together better serving the need to treat patients.