Tschudi-Madsen Hedda, Rødevand Linn N, Bøymo Kaarbø Mette, Granan Lars-Petter
Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
Scand J Pain. 2019 Apr 24;19(2):245-255. doi: 10.1515/sjpain-2018-0097.
Background and aims This study has two main aims: (1) To explore the overlap between classification criteria in patients with Chronic Widespread Pain (CWP) and (2) To explore the use of the Patient Generated Index (PGI) as a quality of life (QoL) measure in this patient group. Methods Patients with Widespread Pain (ICD-11: pain in four or more out of five bodily regions, i.e. the four quadrants and axially) in a tertiary pain outpatient clinic were assessed according to classification criteria for Fibromyalgia [FM, American College of Rheumatology (ACR) criteria of 1990, 2010, 2011 and 2016], Chronic Fatigue Syndrome [CFS, Fukuda, Canada and International Consensus Criteria (ICC)] and Bodily Distress Syndrome (BDS). Furthermore, patients completed the PGI to assess QoL, and electronic questionnaires including demographic variables and standardised patient-reported outcome measures (PROMs). Results All patients (n=33) fulfilled the criteria for musculoskeletal type single-organ BDS, 81.8% met the 2016 modified criteria for FM, 30.3% met the Canada criteria for CFS and 24.2% met the criteria for multi-organ type BDS. There was substantial agreement between the 2016 and the 2011 and 2010 criteria sets for FM compared to the 1990 criteria (κ=0.766 and 0.673 compared to 0.279). Patients generally scored low on the PGI, indicating poor QoL (mean PGI 28.9, SD 19.8, range 0-100). Conclusions Our findings support the use of the term musculoskeletal type single-organ BDS to describe patients with CWP and the 2016 revision of the FM criteria. The PGI provides useful clinical information which is not captured by standardised PROMs. Implications The terminology of CWP has become less ambiguous as the new ICD-11 is closely related to the generalised pain criterion of the modified 2016 FM definition. Studies based on the 1990 classification criteria for FM should not be directly compared to studies based on later criteria set. The PGI may be a supplement to other measurements to portray patients' individual concerns in patients with complex symptom disorders.
背景与目的 本研究有两个主要目的：（1）探究慢性广泛性疼痛（CWP）患者分类标准之间的重叠情况；（2）探究患者生成指数（PGI）作为该患者群体生活质量（QoL）衡量指标的应用。方法 对一家三级疼痛门诊中患有广泛性疼痛（国际疾病分类第11版：五个身体区域中的四个或更多区域疼痛，即四个象限和轴向区域）的患者，根据纤维肌痛的分类标准[FM，1990年、2010年、2011年和2016年美国风湿病学会（ACR）标准]、慢性疲劳综合征[CFS，福田、加拿大和国际共识标准（ICC）]以及身体困扰综合征（BDS）进行评估。此外，患者完成PGI以评估生活质量，并填写包括人口统计学变量和标准化患者报告结局测量（PROMs）的电子问卷。结果 所有患者（n = 33）均符合肌肉骨骼型单器官BDS标准，81.8%符合2016年FM修订标准，30.3%符合CFS的加拿大标准，24.2%符合多器官型BDS标准。与1990年标准相比，2016年与2011年及2010年FM标准集之间存在高度一致性（κ分别为0.766和0.673，而与1990年标准相比为0.279）。患者在PGI上的得分普遍较低，表明生活质量较差（PGI平均分为28.9，标准差为19.8，范围为0 - 100）。结论 我们的研究结果支持使用肌肉骨骼型单器官BDS这一术语来描述CWP患者以及FM标准的2016年修订版。PGI提供了标准化PROMs未涵盖的有用临床信息。启示 随着新的国际疾病分类第11版与2016年FM修订定义中的广泛性疼痛标准密切相关，CWP的术语变得不那么模糊。基于1990年FM分类标准的研究不应直接与基于后来标准集的研究进行比较。PGI可能是其他测量方法的补充，用于描绘复杂症状障碍患者的个体关注点。
