The following is a summary of “Problem of Pain in Rheumatology: Variations in Case Definitions Derived From Chronic Pain Phenotyping Algorithms Using Electronic Health Records,” published in the December 2023 issue of Rheumatology by Falasinnu et al.
Researchers started a retrospective study to compare and analyze various chronic pain case definitions, estimating potential misclassifications in real-world data for improved diagnostic precision.
They compared the prevalence of various chronic pain case definitions (N = 3042) in patients with autoimmune rheumatic diseases. The prevalence of chronic pain was estimated based on 15 unique combinations of pain scores, diagnostic codes, analgesic medications, and pain interventions.
The results showed varying chronic pain prevalences, lowest in unimodal algorithms—15% with analgesic medications, 18% with pain scores, 21% with pain diagnostic codes, and 22% with pain interventions. Comparatively, a well-validated algorithm yielded 37%. Chronic pain prevalence increased with the number of phenotyping algorithms (bimodal to quadrimodal) in multimodal phenotyping. The highest estimated prevalence (47%) was in the quadrimodal algorithm combining pain scores, diagnostic codes, analgesic medications, and pain interventions. The quadrimodal approach overestimated chronic pain by 10% compared to the well-validated algorithm.
Investigators concluded that chronic pain counts vary wildly with different definitions, and the study reveals biases, paving the way for clearer diagnoses.
Source: jrheum.org/content/early/2023/12/11/jrheum.2023-0416
