Rau Lisa-Marie, Korwisi Beatrice, Barke Antonia, Claus Benedikt B, Frosch Michael, Zernikow Boris, Wager Julia
German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Datteln, Germany.
Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany.
Pain. 2025 Mar 18;166(9):2034-2043. doi: 10.1097/j.pain.0000000000003584.
The 11th revision of the International Classification of Diseases (ICD-11) now includes separate chronic pain diagnoses that may be extended by chronic pain severity specifiers. These specifiers comprise 3 dimensions-pain intensity, pain-related distress, and pain-related interference-rated on an 11-point numerical rating scale referring to the past 7 days. Like the chronic pain diagnoses, these specifiers were originally developed for adults. The current study, therefore, aimed to adapt and validate the 3 ICD-11 chronic pain severity specifiers for pediatric chronic pain patients and evaluate their clinical utility. After adapting the specifiers using feedback from patients and experts, data were collected from N = 319 pediatric chronic pain patients aged 8 to 17 years in a tertiary care setting using 4 assessment methods: patient interview, patient questionnaire, parent-proxy, and healthcare-professional-proxy. Despite all patients having chronic pain, not all reported having experienced pain in the past 7 days. The 3 severity dimensions were interrelated but not unidimensional; both interrater and test-retest reliability were large. While patterns of concurrent and discriminant validity were as expected, correlations with related measures were small. Predictive validity regarding treatment recommendation was small to medium. Most, but not all, suggested severity categories ("none," "mild," "moderate," "severe") were sufficiently distinct within this sample. The chronic pain specifiers provide a quick and easy biopsychosocial description. They should, however, be interpreted with caution in clinical practice, as the psychometric quality is insufficient for making therapeutic or reimbursement-related decisions for individual pediatric patients based solely on these 3 items.
《国际疾病分类》（ICD - 11）的第11次修订版现在包括了单独的慢性疼痛诊断，这些诊断可能会通过慢性疼痛严重程度说明符进行扩展。这些说明符包括三个维度——疼痛强度、与疼痛相关的痛苦和与疼痛相关的干扰——根据过去7天的11点数字评分量表进行评定。与慢性疼痛诊断一样，这些说明符最初是为成年人开发的。因此，本研究旨在对适用于儿科慢性疼痛患者的3个ICD - 11慢性疼痛严重程度说明符进行调整和验证，并评估其临床实用性。在根据患者和专家的反馈对说明符进行调整后，使用4种评估方法从一家三级医疗机构的319名8至17岁的儿科慢性疼痛患者中收集数据：患者访谈、患者问卷、家长代理和医疗专业人员代理。尽管所有患者都患有慢性疼痛，但并非所有人都报告在过去7天内经历过疼痛。这三个严重程度维度相互关联但并非单维的；评分者间信度和重测信度都很高。虽然同时效度和区分效度的模式符合预期，但与相关测量的相关性较小。关于治疗建议的预测效度为小到中等。在这个样本中，大多数（但不是全部）建议的严重程度类别（“无”、“轻度”、“中度”、“重度”）有足够的区别。慢性疼痛说明符提供了一种快速简便的生物心理社会描述。然而，在临床实践中应谨慎解释这些说明符，因为其心理测量质量不足以仅基于这3项内容为个体儿科患者做出治疗或报销相关的决策。
