Terminology and core components of co-design intervention in chronic pain management: An international Delphi study

Co-design is increasingly used in chronic pain research; however, terminology remains inconsistent, guidance is lacking, and most research is concentrated in high-income countries. This international three-round e-Delphi study aimed to establish consensus on key terminology and core components, and to identify common barriers and strategies for co-design in chronic pain management. The e-Delphi survey was conducted from November 2024 to June 2025. Panel used a five-point Likert scale to rate agreement and importance, with consensus defined 75% thresh-hlod agreement. Open-ended responses on barriers and strategies were analysed using thematic content analysis. A total of 117 panel members participated in Round 1, 98 in Round 2, and 92 in Round 3, representing 30 countries. Though panel members prioritise "co-design" and "collaborative design" as the most appropriate standardised terms to describe the collaboration process in developing and evaluating chronic pain interventions, "co-design" has the highest percentage agreement. Twelve core components of co-designed interventions were identified, including engaging people with lived experience and key interest-holders, addressing biopsychosocial factors, ensuring accessibility and availability, applying evidence-based practices, emphasising person-centredness, conducting needs assessments, supporting goal-oriented care, empowering self-management, promoting interdisciplinary collaboration, ensuring sustainability, incorporating patient-reported outcome measures, and integrating technology. The identified five barriers to co-design were: resource, cultural and contextual; knowledge and educational; interpersonal and professional; and system and policy. Corresponding strategies included enhanced resource allocation, training and education, improved communication, strengthened interdisciplinary collaboration, and supportive policy and organisational structures. These findings provide a clear, consensus-based guide for developing and implementing co-designed chronic pain interventions. PERSPECTIVE: This e-Delphi study established standardised terminology, core components for co-designed chronic pain intervention development, and outlined key barriers and overcoming strategies for them. The findings could enhance research and clinical communication and support embedding co-design principles into clinical service development to improve shared decision-making and patient-centred care.