Igari Hiroki, Aono Shuichi, Bu-Omer Hani M, Kishimoto Chie, Nakae Aya, Ushida Takahiro
Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan.
Department of Software Science, Tamagawa University, Machida, Japan.
Front Pain Res (Lausanne). 2024 Nov 18;5:1430870. doi: 10.3389/fpain.2024.1430870. eCollection 2024.
The new ICD-11 code for chronic pain indicates a direction to divide chronic pain into two categories: chronic secondary pain, which has a clear underlying disease, and chronic primary pain, which is associated with significant emotional distress or functional disability and cannot be explained by another chronic condition. Until now, epidemiological studies have been hampered by the lack of a clear classification, but we believe that this new code system will provide a new perspective on the diagnosis and treatment of chronic pain, and we have begun work on this code system.
We studied 2,360 patients at Aichi Medical University, the largest pain center in Japan, and asked them to answer questionnaires on pain severity (NRS), pain-related functional impairment (PDAS, Locomo25), quality of life (EQ-5D), and psychological state and pain cognition (HADS, PCS, PSEQ, AIS) while their attending physicians were giving diagnoses according to ICD-11 and the results of the study were used to determine the coding of pain severity.
The ratio of primary to chronic secondary pain was almost 50%, and the group of patients with MG30.01 classification, which included fibromyalgia, had the highest severity among chronic primary pain. The MG30.01 classification of patients was also found to experience more severe pain compared to other classifications of chronic primary pain patients. The classification of patients with a major psychiatric component was not always clear, and some patients in the secondary category also had a clear psychiatric component, suggesting the need to develop complementary tools to support pain diagnosis.
国际疾病分类第 11 版（ICD - 11）中慢性疼痛的新编码指明了一个方向，即把慢性疼痛分为两类：有明确潜在疾病的慢性继发性疼痛，以及与显著情绪困扰或功能残疾相关且无法用其他慢性疾病解释的慢性原发性疼痛。到目前为止，由于缺乏明确的分类，流行病学研究受到了阻碍，但我们认为这个新的编码系统将为慢性疼痛的诊断和治疗提供新的视角，并且我们已经开始研究这个编码系统。
我们对日本最大的疼痛中心爱知医科大学的 2360 名患者进行了研究，要求他们在主治医生根据 ICD - 11 进行诊断时，回答关于疼痛严重程度（数字评分量表，NRS）、疼痛相关功能损害（疼痛残疾评定量表，PDAS；Locomo25）、生活质量（EQ - 5D）以及心理状态和疼痛认知（医院焦虑抑郁量表，HADS；疼痛灾难化量表，PCS；疼痛自我效能问卷，PSEQ；疼痛强度量表，AIS）的问卷，研究结果用于确定疼痛严重程度的编码。
原发性慢性疼痛与慢性继发性疼痛的比例接近 50%，包括纤维肌痛在内的 MG30.01 分类组在慢性原发性疼痛中严重程度最高。还发现 MG30.01 分类的患者与其他慢性原发性疼痛分类的患者相比，经历的疼痛更严重。有主要精神成分的患者分类并不总是明确的，并且继发性类别中的一些患者也有明确的精神成分，表示需要开发辅助工具来支持疼痛诊断。
