Svensson Peter, May Arne
1 Department of Dentistry and Oral Health - Section of Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark.
2 Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Hamburg, Germany.
Cephalalgia. 2017 Jun;37(7):609-612. doi: 10.1177/0333102417706313. Epub 2017 Apr 12.
It is indisputable that the global scientific advances in headache research, be it bench or bedside, have benefited enormously from the operational diagnostic criteria published in 1988. Today, this classification system is indispensable. The reason for this success is a low inter-rater variability. In general, orofacial pain conditions are less well characterised - with the noticeable exemption of temporomandibular disorder pain. Tremendous work has been put into changing this, and significant progress has been achieved - in particular, in terms of the clinical implications and overriding conceptual models for oro-facial pain. Scientific classifications have only one goal: To provide a scientific agreement about the main features of an object of research and a scientific consensus regarding the name. The main significance is not the fact that a good classification offers a detailed and accurate image of the reality. If we want to overcome the obstacles of different competing classification systems, we need to overcome specialisation borders. The key to success is to understand that such a definition does not mirror all possible clinical facets of a given pain condition but is simply a convention - that is, a consensus on a word used for a pain condition. Simply speaking, a classification creates a common language to be used by more than one profession. It will be crucial to define any given pain condition as precisely and rigid as possible, in order to ensure a homogenous population. Only this ensures a low inter-rater variability, which consequently allows combining and comparing research on a population across different professional settings. This is not easy for chronic facial pain without verifiable morphological cause or structural lesions, as these syndromes are often rather featureless. The new IASP classification of chronic pain is a big step forward to a better characterisation of such conditions, and will trigger future work on a new and operationalised classification of oro-facial pain.
无可争议的是，全球头痛研究领域的科学进展，无论是在实验室还是临床方面，都极大地受益于1988年发布的操作性诊断标准。如今，这一分类系统不可或缺。其成功的原因在于评分者间变异性较低。一般来说，口面部疼痛情况的特征描述不够完善——颞下颌关节紊乱疼痛是明显的例外。为改变这种情况已付出了巨大努力，并取得了显著进展——特别是在口面部疼痛的临床意义和首要概念模型方面。科学分类只有一个目标：就研究对象的主要特征达成科学共识，并就名称达成科学一致。其主要意义并非在于一个好的分类能提供现实的详细准确图景。如果我们想克服不同竞争分类系统的障碍，就需要跨越专业化界限。成功的关键在于明白这样的定义并非反映给定疼痛情况的所有可能临床方面，而仅仅是一种约定——也就是说，是对用于描述疼痛情况的一个词的共识。简单来说，分类创造了一种可供多个专业使用的通用语言。尽可能精确和严格地定义任何给定的疼痛情况至关重要，以确保研究对象的同质性。只有这样才能确保评分者间变异性较低，从而能够在不同专业背景下对研究对象进行合并和比较。对于没有可证实形态学原因或结构病变的慢性面部疼痛来说，这并不容易，因为这些综合征往往缺乏明显特征。国际疼痛研究协会（IASP）对慢性疼痛的新分类是朝着更好地描述此类情况迈出的一大步，并将引发关于口面部疼痛新的可操作分类的未来研究工作。
