Chronic secondary musculoskeletal pain

Definition

Chronic secondary musculoskeletal pain is chronic pain arising from bone(s), joint(s), muscle(s), vertebral column, tendon(s)or related soft tissue(s). It is a heterogeneous group of chronic pain conditions originating in persistent nociception in joint, bone, muscle, vertebral column, tendon and related soft tissues, with local and systemic etiologies, but also related to deep somatic lesions. If the pain is related to visceral lesions, it should be considered whether a diagnosis of chronic visceral pain is appropriate; if it is related to neuropathic mechanisms, it should be coded under chronic neuropathic pain; and if the pain mechanisms are non-specific, chronic musculoskeletal pain should be coded under chronic primary pain. Chronic secondary musculoskeletal pain can be characterised either by persistent local or systemic inflammatory illness, which may be due to infectious diseases, crystal deposition or auto-immune processes, or attributable to structural changes. Other biomedical causes responsible for musculoskeletal pain may also apply (such as neurologically caused muscle spasms and referred pain from deep tissues). The musculoskeletal origin of the pain (that is, nociception in musculoskeletal tissues) should be highly probable. If the musculoskeletal origin does not appear highly plausible and no neuropathic origin is ascertainable; consider using codes in the section of chronic primary pain. Diagnostic Criteria: Conditions A to C are fulfilled: A) Chronic pain (persistent or recurrent for longer than 3 months) in joint(s), bone(s), muscle(s), vertebral column, tendon(s) or related soft tissue is present. The pain may be spontaneous or movement induced. B) At least one of B1 to B3 is fulfilled: B1) A musculoskeletal disease with inflammation due to infection, auto-immunity, auto-inflammation or metabolic disorders (crystals) is present (demonstrated by appropriate clinical examination or appropriate tests) and causes the local activation of nociceptors. B2) A musculoskeletal disease with structural / biomechanical factors (demonstrated by appropriate clinical examnation or appropriate tests) is present and causes the local activation of nociceptors. B3) A neurological disease (classified elsewhere) is present and causes altered biomechanical function (demonstrated by appropriate clinical examination or appropriate tests) that is responsible for the activation of nociceptors. C) The pain is not better accounted for by another diagnosis of chronic pain.

Coding Note

Exclusions

• Acute pain
• Chronic neuropathic pain
• Chronic primary pain
• Chronic secondary visceral pain

Subcategories (3)