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The ACTTION-APS Pain Taxonomy Initiative: Response to Henriques et al

  • Roger B. Fillingim
    Correspondence
    Address reprint requests to Roger B. Fillingim, PhD, University of Florida College of Dentistry, Director, UF Pain Research and Intervention Center of Excellence, Clinical and Translational Research Building (CTRB), Room 3216, 2004 Mowry Rd, PO Box 100404, Gainesville, FL 32610-0404.
    Affiliations
    University of Florida College of Dentistry, Director, UF Pain Research and Intervention Center of Excellence, Gainesville, Florida
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  • Robert H. Dworkin
    Affiliations
    Professor of Neurology in the Center for Human Experimental Therapeutics Director, Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), a public-private partnership with the FDA University of Rochester School of Medicine and Dentistry, Rochester, New York
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  • Dennis C. Turk
    Affiliations
    John and Emma Bonica Professor of Anesthesiology & Pain Research Department of Anesthesiology & Pain Medicine University of Washington, Seattle, Washington
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      We are grateful to Dr. Henriques and his colleagues for their generally positive comments regarding the ACTTION-APS Pain Taxonomy (AAPT) initiative and interest in our manuscript describing the approach.
      • Fillingim R.B.
      • Bruehl S.
      • Dworkin R.H.
      • Dworkin S.F.
      • Loeser J.D.
      • Turk D.C.
      • Widerstrom-Noga E.
      • Arnold L.
      • Bennett R.
      • Edwards R.R.
      • Freeman R.
      • Gewandter J.
      • Hertz S.
      • Hochberg M.
      • Krane E.
      • Mantyh P.W.
      • Markman J.
      • Neogi T.
      • Ohrbach R.
      • Paice J.A.
      • Porreca F.
      • Rappaport B.A.
      • Smith S.M.
      • Smith T.J.
      • Sullivan M.D.
      • Verne G.N.
      • Wasan A.D.
      • Wesselmann U.
      The ACTTION-American Pain Society Pain Taxonomy (AAPT): An evidence-based and multidimensional approach to classifying chronic pain conditions.
      We likewise appreciate their thoughtful comments regarding the challenges of applying a multidimensional classification in both clinical and research settings. Here we offer a few remarks to help clarify the rationale for the multidimensional nature of AAPT. Although we are hopeful that AAPT will evolve to enjoy widespread clinical use, we recognize that the initial application of the new taxonomy will inevitably occur in the context of research. Indeed, we hope that AAPT will actually serve to promote new research to validate, extend, and potentially contribute to revision of the classification criteria as they are published. Thus, we opted for a more comprehensive dimensional approach, which would allow (and even encourage) investigators to design studies to address biopsychosocial consequences of painful conditions as well as neurobiological and psychosocial mechanisms, risk factors, and protective factors. Henriques and colleagues note that the multidimensional approach may be difficult to apply in acute pain settings, which is an important consideration. Although the initial focus of AAPT is classification of chronic pain, we intend to extend this initiative to acute pain, which may require modifications to the framework to avoid such difficulties.
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      Linked Article

      • Multidimensional Approach to Classifying Chronic Pain Conditions—Less Is More
        The Journal of PainVol. 15Issue 11
        • Preview
          Our team received with enthusiasm the proposal from the ACTTION-APS Pain Taxonomy (AAPT),1 which claims an evidence-based and multidimensional approach to classifying chronic pain conditions. Attempting to approach an ideal diagnostic system that aims to systematize, organize, and standardize the biopsychosocial assessment of chronic pain patients, a 5-dimension taxonomy was proposed. This perspective drew inspiration from the Diagnostic and Statistical Manual of Mental Disorders (DSM), Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), and International Classification of Headache Disorders diagnostic systems.
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