Wikipedia:Featured list candidates/List of chronic pain syndromes/archive1

List of chronic pain syndromes

List of chronic pain syndromes (edit | talk | history | protect | delete | links | watch | logs | views)

• Featured list candidates/List of chronic pain syndromes/archive1

Nominator(s): IntentionallyDense (talk) 14:13, 1 October 2024 (UTC)

I am nominating this for featured list because I think it is an important topic and I've put a lot of time into it. I know medical pages can be scary for some but this one is hopefully a bit more straightforward. I have PDFs of all the publications used if needed. I chose to use SFNs to make reviewing easier. I chose not to use tables for this list as it didn't seem appropriate. I tried my hardest to simplify all the medical information but if anything is unclear please let me know. I did struggle a bit with rewording things in a way that wasn't too close to the source but still kept the original meaning so if my wording seems awkward at times please let me know and I will try my hardest to reword things. IntentionallyDense (talk) 14:13, 1 October 2024 (UTC)

@IntentionallyDense: you haven't completed all the steps to nominate this for FL as laid out in WP:FLC. -MPGuy2824 (talk) 09:24, 7 October 2024 (UTC)

Thank you, it makes sense why I haven't gotten any input then. IntentionallyDense (talk) 12:57, 7 October 2024 (UTC)

Draken Bowser

I'm pleased to see this fully IASP/ICD-11-compliant article. I was at a lecture series hosted by the Swedish Pain Society earlier this year, and they seemed quite proud of this new development. I'm no expert on the use of articles in English, so take the following suggestions with a grain of salt:

• or the anatomical system in which it affects.

done. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Two sentences in a row begin The IASP Task Force could that be tweaked?

I changed the second sentence to start off as This task force, does that look better? IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• affecting at least three to four four of five body regions - according to the source.

done. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Body quadrants are defined as the upper, lower, left and right sides of the body. - and my preference would be for an overly careful explanation ("upper left, upper right...").

Changes to Body quadrants are defined as the upper left, upper right, lower left, and lower right quadrants of the body, let me know if that looks better. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Chronic widespread pain cannot be attributed to a nociceptive process in these areas.

done. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Is there any non-technical alternative to "distally" in english? Otherwise we could wikilink it.

It could be changed to outwardly but that sounds odd in my opinion. For now I wikilinked it. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Chronic post traumatic pain is pain that develops are worsens after an injury - needs fixing

changed are to or. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

• Do we need to list all the possible causes of chronic secondary headache or orofacial pain?

The reason I listed all the causes is that I felt that the classification for secondary headache was a little more obscure than say cancer-related pain. If you think it would look better without the causes then I can remove them. FOr now I trimmed it a bit. IntentionallyDense (talk) 21:48, 22 October 2024 (UTC)

Since I'm unfamiliar with the FLC-process, could anyone tell me what the standards for a source review is? I might want to attempt one.

Regards. Draken Bowser (talk) 19:50, 22 October 2024 (UTC)

The source review for FLC's is pretty similiar to that of FAC but pinging Hey man im josh since he has more experience in the area. IntentionallyDense (talk) 21:37, 22 October 2024 (UTC)

Yep, if someone is familiar with source reviews at FAC you can do the exact same thing here and it'd be an excellent source review. Hey man im josh (talk) 12:10, 23 October 2024 (UTC)

Source review

The sources used are all appropriate and compliant with both WP:BESTSOURCES and WP:MEDRS. Spotchecks show that the phrasing has been altered as much as possible to avoid simply parroting the sources, but for technical definitions you can't change the wording more than this and still comply with WP:V. Overall this looks like a pass, and I have but a few pointers:

• I wonder if we can add something about the autonomic dysfunction present in CRPS without getting to technical? It tends to be taught as the hallmark of the disease, alongside pain-out-of-proportion.

I did find this [1] article which states "The autonomic nervous system (ANS) is involved" and "inflammatory changes and autonomic dysregulation". I could change Complex regional pain syndrome is characterized by pain that is distributed regionally, usually starts in an extremity distally, occurs after a trauma, and the pain is disproportionate in severity or duration compared to the expected course of the trauma. to Complex regional pain syndrome is characterized by pain that is distributed regionally, usually starts in an extremity distally, occurs after a trauma, and the pain is disproportionate in severity or duration compared to the expected course of the trauma. CRPS also involves changes to the autonomic nervous system. as that doesn't seem overly technical and still includes the ANS. Let me know what you think. IntentionallyDense (talk) 20:24, 23 October 2024 (UTC)

Yes I think that works, but I don't think we need a new source since that much is covered by the one we've got. I'm wondering if we shouldn't call it "dysfunction" and specify that it is also a local one. /DB

The source I originally used [2] states "Complex regional pain syndrome is further characterized by signs indicating autonomic and inflammatory changes in the affected body region that may vary between patients and over time" I'm thinking of changing Complex regional pain syndrome is characterized by pain that is distributed regionally, usually starts in an extremity distally, occurs after a trauma, and the pain is disproportionate in severity or duration compared to the expected course of the trauma. Complex regional pain syndrome is divided into two types, type 2 requires evidence of peripheral nerve injury, while type 1 does not. to Complex regional pain syndrome is characterized by pain that is distributed regionally, usually starts in an extremity distally, occurs after a trauma, and the pain is disproportionate in severity or duration compared to the expected course of the trauma. The sites affected by complex regional pain syndrome experience autonomic and inflammatory changes. Complex regional pain syndrome is divided into two types, type 2 requires evidence of peripheral nerve injury, while type 1 does not.. Does that wording sound good? IntentionallyDense (talk) 03:42, 25 October 2024 (UTC)

• I note that "other" as a category has been omitted from several pain types, and I must admit I'm not sure exactly what to do with that category either. Maybe we can just state that this residual category exists for many pain types (unless that's already stated somewhere and I missed it)?

In my original draft I did include the other categories but decided to omit them as it just felt odd. I could include something along the lines of "each classification of chronic pain includes an "other" category to account for pain syndromes which do not fall into the current diagnostic criteria" to address this. What do you think? IntentionallyDense (talk) 20:24, 23 October 2024 (UTC)

Sounds lika an excellent solution. /DB

This source [3] states "ICD-11 automatically adds a category “other” at each level to catch any cases that might have been missed" which I think could be worded as "The ICD-11 also has an "other" category, such as "other chronic cancer pain", to include chronic pain that does not fit into other categories but let me know if I should tweak that wording. IntentionallyDense (talk) 03:42, 25 October 2024 (UTC)

Ok, I think the deal here is that we've got a list of categories, but it hasn't been established in the lede that these categories contain neatly defined sub-categories, "other" being the odd one out in each bundle. Using the "such as" example hints at this, but if we talk about it as one of several sub-categories first and then follow up with the example I think that might be better. Draken Bowser (talk) 21:57, 1 November 2024 (UTC)

Does this look better? IntentionallyDense (talk) 04:55, 2 November 2024 (UTC)

• I think we need to state that Chronic postsurgical or posttraumatic pain as a whole, not just posttraumatic pain, includes referred pain from deeper structures to corresponding dermatomes.

I agree but I'm not sure how to include this. The source I used [4] states "The pain has to be localised to the surgical field or area of injury, projected to the innervation territory of a nerve situated in this area or referred to a dermatome or Head’s zone (after surgery/injury to deep somatic and visceral tissues)." which I think may be what you are trying to touch on but I'm not sure. IntentionallyDense (talk) 20:24, 23 October 2024 (UTC)

Yes, and since this is true for both types of pain we need to state so earlier, i.e. under the "Chronic postsurgical or posttraumatic pain"-heading by expanding the sentence that now says The pain is localized to the site of injury or surgery. /DB

I'm struggling on how to word this without sounding overly technical so let me know if you have any ideas. IntentionallyDense (talk) 03:42, 25 October 2024 (UTC)

Best I can do rn is: "..or extends to other areas through damaged nerves or referred pain." Which is a bit of a stretch since the source is not explicit about nerve damage. Draken Bowser (talk) 22:15, 1 November 2024 (UTC)

I currently have The pain is restricted to the surgical field or injury site, projected to the innervation region of a nearby nerve, or referred to a dermatome. which is more technical than I would like but does clarify this a bit. IntentionallyDense (talk) 04:56, 2 November 2024 (UTC)

Draken Bowser (talk) 17:17, 23 October 2024 (UTC)

I'm probably gonna need a few more days to think carefully about possible changes to the current phrasing, but that's a prose issue, which means the source review is a pass. Draken Bowser (talk) 22:19, 29 October 2024 (UTC)

Sounds good, thank you! IntentionallyDense (talk) 23:17, 29 October 2024 (UTC)

Support from Toadspike

• Links are not always linked in the right places. The term "autoimmune" is linked twice, in extremely similar contexts, but the two links point to different articles. "Infection" is linked only on its second appearance. "Rheumatological disorders" should link to Rheumatism (I just created a redirect from the former). Pelvic pain is linked at least twice, but Pelvis doesn't seem to be linked at all. There's a gadget somewhere to check for double linking; maybe the nominator would like try it, and also skim the article again to check that all technical terms are appropriately linked.

I fixed the two cases you pointed out but I'll go back and look for more areas where this could be improved. IntentionallyDense (talk) 02:44, 24 October 2024 (UTC)

• I'm assuming the list is meant to be exhaustive, which seems like a challenging task. May I ask, for instance, why cluster headaches are not listed?

That is because Cluster headaches are a type of Trigeminal autonomic cephalgia which is listed. IntentionallyDense (talk) 22:25, 23 October 2024 (UTC)

Good point :) Toadspike [Talk] 22:30, 23 October 2024 (UTC)

• On a similar note, I doubt the "Chronic postsurgical pain" section can possibly be complete, since I'm pretty sure any surgery can and will result in postsurgical pain. The bulleted list in this section (and other similar ones) should probably be qualified with "Examples include:" or words to that effect.

I mean if you check out the source I used [5] I did include all of the classifications. Of course, any surgery or trauma can cause chronic pain but the classification system is just meant to give names to the most common types. IntentionallyDense (talk) 22:25, 23 October 2024 (UTC)

Thanks. I wonder if it would be possible to make this more clear. Currently the lead says "The ICD-11 category for chronic pain includes the most common types of chronic pain..." and it is implied that the article reflects the ICD-11 categories. Either this LISTCRIT should be explicitly stated in the prose, or the article should be moved to a title like ICD-11 categories of chronic pain. Toadspike [Talk] 22:38, 23 October 2024 (UTC)

I mean I want this list to be a list of chronic pain syndromes not just the ICD-11 categories. I also combined the IASP classification with the ICD classification for this list so that wouldn't really work as a title. The point isn't to list the ICD11 chronic pain syndromes it's just that there is no other accepted classification (unless you can find one). IntentionallyDense (talk) 02:39, 24 October 2024 (UTC)

Suggestion: To clarify the inclusion criteria and why the ICD-11 was chosen as the main source for this list, I suggest changing:

In order to create a classification system for chronic pain, the International Association for the Study of Pain (IASP) collaborated with the World Health Organization (WHO) to form the Task Force for the Classification of Chronic Pain. The IASP Task Force was made up of pain experts. This task force developed a new model to classify chronic pain for the ICD-11.

To something clearer and more upfront on the importance of the ICD-11:

The [current/newest] standard model for classifying chronic pain [is/was created for] the ICD-11. The ICD-11 classification was made by the Task Force for the Classification of Chronic Pain, a group of pain experts formed by the International Association for the Study of Pain (IASP) in collaboration with the World Health Organization.

Feel free to word this better. By the way, since you never use the abbreviation "WHO", you shouldn't mention it. Toadspike [Talk] 14:40, 24 October 2024 (UTC)

• "post cancer" should probably be "post-cancer", unless most reliable sources disagree. Similarly, the spacing within terms like "posttraumatic"/"post traumatic" should be consistent. (I think "post-traumatic" is best.)

I chose to go with that spacing and style because that us what the sources and ICD use which is kind of the main source for this kind of thing. IntentionallyDense (talk) 22:25, 23 October 2024 (UTC)

I have checked the sources cited for the postcancer and posttraumatic sections, neither uses "post cancer" or "post traumatic" with a space. Regardless, you should be consistent between different instances of the same term ("posttraumatic" and "post traumatic" should not both exist in the same Wikipedia article), and I would prefer if you were consistent between different instances of similar terms ("postcancer" and "post traumatic" should not both exist in the same Wikipedia article). Apologies for the pedantry, this should be an easy fix to make the prose look cleaner. Toadspike [Talk] 22:44, 23 October 2024 (UTC)

The post cancer and post traumatic with the space are from the ICD. I’ll take a further look when i’m on my laptop and make those fixes. IntentionallyDense (talk) 00:06, 24 October 2024 (UTC)

The source uses "posttraumatic" and "postcancer" [6] [7] but the icd uses "post traumatic"[8] and "post cancer"[9]. I'm unsure which to use. Do you have a preferance? IntentionallyDense (talk) 02:37, 24 October 2024 (UTC)

The spaced versions ("post traumatic") just seem wrong to me, but try as I might, I cannot find anything in the MOS that says so. I prefer "posttraumatic", but since reliable sources use both, it's up to you. Just be consistent! Toadspike [Talk] 14:27, 24 October 2024 (UTC)

• Although our article on Psychosomatic medicine is quite underdeveloped, it is likely relevant to this topic. In fact, the image in the lead mentions the related idea of Somatization. I'd appreciate if you could look into that and perhaps add something to the prose – otherwise readers might get the impression that all chronic pain has an obvious, known cause :)

I've thought over my response to this a lot so I hope you can understand what I am trying to say here. The reason I didn't go into depth about this is because I don't really go into depth about the mechanisms of pain other than when it is directly relevant (such as with post cancer pain). The section "Chronic widespread pain" states Chronic widespread pain cannot be attributed to a nociceptive process in these areas. which I believe covers your point about not all chronic pain syndromes having a clear cause. Somatization isn't the main mechanism behind chronic pain (in fact through my research I've kinda learnt that there isn't any one main cause) so going into great detail about somatization in particular may look unbalanced. I hope that makes sense. IntentionallyDense (talk) 02:53, 24 October 2024 (UTC)

Having looked through several sources now, I see several mention that a major flaw of ICD-10 was that "Diagnoses did not reflect the biopsychosocial model of pain" – mentioning this issue in the lead might also be worthwhile and is closely related the above comment.

The reason I didn't include this was because I don't want this article to focus too much on the ICD classification (although we may be past that point) however I could add something like "the new classification system tries to approach chronic pain from a biopsychosocial model" (wording would be different) if you think that would be appropriate. IntentionallyDense (talk) 02:53, 24 October 2024 (UTC)

Yes, that would be perfect. Toadspike [Talk] 14:25, 24 October 2024 (UTC)

Alternatively, you could tack it onto the end of: This new classification system emphasized the cause of pain, underlying mechanisms, and body sites. Not sure if this is better though. Toadspike [Talk] 14:31, 24 October 2024 (UTC)

• Image review: I've checked for appropriate licensing and alt text on all images. I believe this FLC passes criterion 5 of the WP:FLCR.

I think that is all from me. If the nominator can address the few remaining points above, I'll be happy to support this nomination. Toadspike [Talk] 22:05, 23 October 2024 (UTC)

Okay I think I have covered all the different point you brought up! IntentionallyDense (talk) 03:57, 25 October 2024 (UTC)

All of my comments have been adequately addressed. I support this FLC! Toadspike [Talk] 09:46, 28 October 2024 (UTC)