HPE Chronic pain – part two | Page 4

GETTY longitudinally related to health-related quality of life (HRQoL), societal costs, and healthcare costs. Disability, measured using the Oswestry Scale, had a stronger association with all outcomes compared with pain. 9 A complex illness cLBP has many different aetiologies, different clinical signs and symptoms and comorbidities; it may have nociceptive or neuropathic components (some studies show that up to 90% of cLBP patients have a neuropathic component), 10 or a combination of both. It is extremely probable for cLBP that the important outcomes are not represented by a simple measure such as the intensity of the pain. So far, clinical studies often only use pain intensity as the primary outcome parameter, although other parameters and patientreported and relevant outcomes of quality of life and functionality are more relevant and important to be evaluated and monitored. 11,12 Physical functioning outcome measures and assessing dimensions of daily living Physical functioning or functionality can be defined as the “Ability to ambulate, function cognitively, return to work, complete activities of daily living, sleep etc.” 13 Physical functioning and dimensions of daily living are altered in patients with cLBP; the patients experience problems in undertaking certain activities or increased symptoms during or after physical activity. Physical functioning outcome measures are important because they provide data not only on the impact of pain and treatment effects beyond symptom reduction alone, but also on the impact on individuals’ quality of life. IMMPACT (Measurement and Pain Assessment in Clinical Trials) recommended that assessing health-related quality of life (HRQoL), and physical, emotional and social functioning should be included as core outcome domains in every chronic pain clinical trial. 14 Patient-reported outcome measures The US Food and Drug Administration defines patient-reported outcome measures (PROMs) as, “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else”. 15 At least some of these data, especially that reported directly by the patient suffering from cLBP, should be taken into account in the usual clinical practice. The new International Classification of Diseases (ICD-11) acknowledges pain as a disease in its own right and, within it, cLBP, as one of the main causes of pain in general, and almost a disease on its own. 16 The International Classification of Functioning, Disability, and Health (ICF) details physical functioning at the level of specific tasks with an important independent outcome domain. 17,18 The combined use of ICD-11 and ICF is expected to improve research reports on chronic pain by creating a more precise and adequate coding, as well as improved patient management through better diagnostic classification. Increased attention to the functional impact of chronic pain is an important step forward for its management. Useful codes are required in the ICD and ICF but will not be sufficient to improve patient care unless they are regularly used in clinical practice (ICF is difficult to use routinely as it is very long). A lack of therapeutic guidelines in patient care in cLBP contributes to the Physical functioning outcomes measures are important because they provide data on the impact of pain and treatment effects beyond symptom reduction alone 4 | 2020 | hospitalpharmacyeurope.com