Chronic Pain Conditions Successfully Classified Using Proposed ICD-11 Criteria

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Researchers successfully classified most participants with chronic pain according to the proposed classification of chronic pain in the ICD-11 and found that participants did not benefit from self-management chronic pain programs.

Researchers were successfully able to classify patients with chronic primary pain (CPP) and chronic secondary pain (CSP), using the proposed new classification criteria for chronic pain in the International Classification of Diseases, Eleventh Revision (ICD-11), according to results of a study published in the European Journal of Pain. They also found that lay-led educational workshops may not be effective for improving pain management in these patients.

The study was a secondary analysis of a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Program (CPSMP), which included 424 patients with chronic pain. Participants in the CPSMP underwent a total of 6 weekly workshops that provided education on pain management in daily life.

The program was led by a layperson who used a structured manual for guidance. The development of weekly action plans, group-based problem solving, management of emotions, and education on the correct use of medication and nutrition were central elements of the program. Patients completed a baseline questionnaire and follow-up questionnaires immediately after and 5 months after the last CPSMP session.

In the final cohort, patients were successfully classified as having CPP (n=164), CSP (n=148), or a mixed pain condition (n=76). This classification system was based on the proposed ICD-11 criteria for chronic pain. Compared with patients with CSP, patients classified with CPP were more often younger (mean age, 58.1 vs 50.4 years, respectively; P <.001), more often women (63.5% vs 79.9%, respectively; P =.001), and had a longer pain duration (7 vs 5 years, respectively; P =.004).

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In addition, participants with CPP had worse outcomes on the 36‐item Medical Outcomes Study Short Form Health Survey Mental Component Summary subscales for vitality (unadjusted difference, −9.6; 95% CI, −13.9 to −5.4; P <.001), social functioning (unadjusted difference, −8.3; 95% CI, −14.0 to −2.6; P =.004), and bodily pain (unadjusted difference, −3.5; 95% CI, −6.7 to −0.4; P =.027).

In the adjusted analysis, individuals with CSP had greater physical comorbidities and a higher total health expenditure (difference, 0.7; 95% CI, 0.5-0.9; P =.008) than patients with CPP. The groups did not appear to benefit from the CPSMP.

Limitations of the study included the reliance on registry data and the use of self-reported pain symptoms in the original trial, as well as the inclusion of only Danish residents.

On the basis of their findings of the CPSMP, the researchers added that “self-management programs for chronic pain — especially when lay-led — seem to have no or limited effect on pain and pain-related disability.”

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Hornemann C, Schröder A, Ørnbøl E, et al. Application of ICD-11 among individuals with chronic pain: A post hoc analysis of the Stanford Self-Management Program [published online September 25, 2019]. Eur J Pain. doi:10.1002/ejp.1486