title: The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.
abstract: Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment.
  
  
  CONCLUSIONS
  The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.
authors.affiliation: Pain Research and Intervention Center of Excellence, Gainesville, Florida. Electronic address: rfilling@ufl.edu.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Fillingim
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bruehl
authors.affiliation: Department of Neurology in the Center for Human Experimental Therapeutics; and Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Dworkin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Department of Oral Medicine, School of Dentistry, University of Washington, Seattle, Washington.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Dworkin
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington.
authors.forename: John D
authors.initials: JD
authors.lastname: Loeser
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Turk
authors.affiliation: Health Scientist VHA, University of Miami, Miller School of Medicine, Miami Project to Cure Paralysis, Miami, Florida.
authors.forename: Eva
authors.initials: E
authors.lastname: Widerstrom-Noga
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, and Director, Women's Health Research Program, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Lesley
authors.initials: L
authors.lastname: Arnold
authors.affiliation: Fibromyalgia Research Unit, Oregon Health & Science University, Portland, Oregon.
authors.forename: Robert
authors.initials: R
authors.lastname: Bennett
authors.affiliation: Brigham & Women's Hospital, Chestnut Hill, Massachusetts.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.affiliation: Department of Neurology, Harvard Medical School, Cambridge, Massachusetts.
authors.forename: Roy
authors.initials: R
authors.lastname: Freeman
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gewandter
authors.affiliation: Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hertz
authors.affiliation: Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Marc
authors.initials: M
authors.lastname: Hochberg
authors.affiliation: Departments of Anesthesiology, Perioperative, and Pain Medicine, Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Elliot
authors.initials: E
authors.lastname: Krane
authors.affiliation: Department of Pharmacology, University of Arizona, Tucson, Arizona.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Mantyh
authors.affiliation: University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, New York.
authors.forename: John
authors.initials: J
authors.lastname: Markman
authors.affiliation: Clinical Epidemiology Unit, Boston, Massachusetts.
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.affiliation: Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Ohrbach
authors.affiliation: Director, Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Paice
authors.affiliation: Department of Pharmacology, University of Arizona, Tucson, Arizona.
authors.forename: Frank
authors.initials: F
authors.lastname: Porreca
authors.affiliation: Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland.
authors.forename: Bob A
authors.initials: BA
authors.lastname: Rappaport
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Oncology, Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.affiliation: Department of Medicine, University of Texas Medical Branch, Galveston, Texas.
authors.forename: G Nicholas
authors.initials: GN
authors.lastname: Verne
authors.affiliation: Department of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Ajay D
authors.initials: AD
authors.lastname: Wasan
authors.affiliation: Department of Anesthesiology and Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ursula
authors.initials: U
authors.lastname: Wesselmann
mesh_terms: D059350:Chronic Pain / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D019317:Evidence-Based Medicine; D006801:Humans; D010147:Pain Measurement / Q000379:methods*; D055818:Public-Private Sector Partnerships; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States; D016885:United States Department of Agriculture
keywords: Taxonomy; biopsychosocial; chronic pain; evidence-based; mechanism-based pain classification; pain classification