The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions

JOURNAL OF PAIN

卷:18

Article

Kent, Michael L.¹  Tighe, Patrick J.²  Belfer, Inna⁴  Brennan, Timothy J.⁵  Bruehl, Stephen⁶  Brummett, Chad M.⁷  Buckenmaier, Chester C.^2,8  Buvanendran, Asokumar⁹  Cohen, Robert I.¹⁰  Desjardins, Paul¹¹  Edwards, David⁶  Fillingim, Roger³  Gewandter, Jennifer¹²  Gordon, Debra B.¹⁴  Hurler, Robert W.¹⁶  Kehlet, Henrik¹⁸  Loeser, John D.^14,15  Mackey, Sean¹⁹  McLean, Samuel A.^20,21  Polomano, Rosemary²²  Rahman, Siamak²³  Raja, Srinivasa²⁴  Rowbotham, Michael²⁵  Suresh, Santhanam²⁶  Schachte, Bernard^27,28  Schreiber, Kristin²⁹  Schumacher, Mark²⁵  Staceyi, Brett³⁰  Stanos, Steven³¹  Todd, Knox³²  Turk, Dennis C.¹⁴  Weisman, Steven J.^17,33  Wu, Christopher²⁴  Carr, Daniel B.³⁴  Dworkin, Robert H.¹³  Terman, Gregory¹⁴ 

[1] Walter Reed Natl Mil Med Ctr, Dept Anesthesiol, Bethesda, MD USA

[2] Univ Florida, Dept Anesthesiol, Gainesville, FL USA

[3] Univ Florida, Dept Community Dent & Behav Sci, Gainesville, FL USA

[4] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA

[5] Univ Iowa, Dept Anesthesiol, Iowa City, IA USA

[6] Vanderbilt Univ, Med Ctr, Dept Anesthesiol, Nashville, TN USA

[7] Univ Michigan Hlth Syst, Dept Anesthesiol, Ann Arbor, MI USA

[8] Uniformed Serv Univ Hlth Sci, Def & Vet Ctr Integrat Pain Management, Bethesda, MD USA

[9] Rush Univ, Med Ctr, Dept Anesthesiol, Chicago, IL 60612 USA

[10] Beth Israel Deaconess Med Ctr, Dept Anesthesiol, Boston, MA 02215 USA

[11] Desjardins Associates LLC, Maplewood, NJ USA

[12] Univ Rochester, Med Ctr, Dept Anesthesiol, Rochester, NY 14642 USA

[13] Univ Rochester, Med Ctr, Sch Med & Dent, Rochester, NY 14642 USA

[14] Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98195 USA

[15] Univ Washington, Dept Neurol Surg, Seattle, WA 98195 USA

[16] Med Coll Wisconsin, Dept Anesthesiol, Milwaukee, WI 53226 USA

[17] Med Coll Wisconsin, Dept Pediat, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA

[18] Univ Copenhagen, Rigshosp, Sect Surg Pathophysiol, Copenhagen, Denmark

[19] Stanford Univ, Dept Anesthesiol Perioperat & Pain Med, Palo Alto, CA 94304 USA

[20] Univ N Carolina, Dept Anesthesiol, Chapel Hill, NC USA

[21] Univ N Carolina, Dept Emergency Med, Chapel Hill, NC USA

[22] Univ Penn, Sch Nursing, Dept Biobehav Sci, Philadelphia, PA 19104 USA

[23] Univ Calif Los Angeles, Dept Anesthesiol, Los Angeles, CA 90024 USA

[24] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA

[25] Univ Calif San Francisco, Dept Anesthesia & Perioperat Care, San Francisco, CA 94143 USA

[26] Northwestern Univ, Feinberg Sch Med, Dept Anesthesiol, Chicago, IL 60611 USA

[27] Yale Sch Publ Hlth, New Haven, CT USA

[28] Schachtel Associates Inc, Jupiter, FL USA

[29] Brigham & Womens Hosp, Dept Anesthesiol & Pain Management, 75 Francis St, Boston, MA 02115 USA

[30] Univ Washington, Med Ctr, Ctr Pain Relief, Seattle, WA 98195 USA

[31] Swedish Hlth Syst, Swedish Pain Serv, Seattle, WA USA

[32] EMLine, Santa Cruz, CA USA

[33] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA

[34] Tufts Univ, Sch Med, Dept Anesthesiol, Boston, MA 02111 USA

关键词: Acute pain;    taxonomy;    ACTTION;    biopsychosocial;    AAAPT;    AAPT;   

DOI  :  10.1016/j.jpain.2017.02.421

来源: Elsevier

【 摘 要 】

Objective. With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (eg, pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. Setting. Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). Methods. As a complement to a taxonomy recently developed for chronic pain, the ACTTION public private partnership with the US Food and Drug Administration, the APS, and the AAPM convened a consensus meeting of experts to develop an acute pain taxonomy using prevailing evidence. Key issues pertaining to the distinct nature of acute pain are presented followed by the agreed-upon taxonomy. The ACTTION-APS-AAPM Acute Pain Taxonomy will include the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Future efforts will consist of working groups utilizing this taxonomy to develop diagnostic criteria for a comprehensive set of acute pain conditions. Perspective. The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) is a multidimensional acute pain classification system designed to classify acute pain along the following dimensions: 1) core criteria, 2) common features, 3) modulating factors, 4) impact/functional consequences, and 5) putative pathophysiologic pain mechanisms. Conclusions. Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPTundertook a similar approach to organizing various acute pain conditions. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of the American Pain Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.00.

【 授权许可】

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