Quantitative Sensory Testing Discriminates Central Sensitization Inventory Scores in Participants with Chronic Musculoskeletal Pain: An Exploratory Study (original) (raw)
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The Clinical Journal of Pain, 2011
Objectives: Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (±leg) pain disorders. Methods: This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (±leg) pain were assessed using a standardized assessment protocol. After each assessment, patients' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence/ absence of various clinical criteria. Results: Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios). Discussion: By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
Quantitative Sensory Testing in Chronic Musculoskeletal Pain
Pain medicine (Malden, Mass.), 2016
Background. In recent years, several published articles have demonstrated that quantitative sensory testing (QST) is useful in the analysis of musculoskeletal pain disorders. Based on the evidence from these studies, it is assumed that QST might be a useful tool in the analysis of the pathogenesis, classification, differential diagnosis, and prognosis of chronic musculoskeletal pain. Objectives. The objective of this paper is to discuss measurement properties of QSTand potentials research and clinical applications in musculoskeletal pain. Methods. This is a review of the current knowledge base on QST as it relates to musculoskeletal pain disorders. We based our summary on articles retrieved from Ovid MEDLINE (1946 to present) including EMBASE, AMED, and PsycINFO databases to search for all published literature focused on QST and musculoskeletal pain. Results. QST has been shown to be related to neural sensitivity in musculoskeletal pain. QST measurement properties have been evaluated for multiple sensory evaluation modalities and protocols with no clear superior instrument or test protocol. The research evidence is incomplete, but suggests potential clinical benefits for predicting outcomes and subtyping pain. Threshold detection testing is commonly used to quantify sensory loss or gain, in current practice and has shown moderate reliability. Intensity/magnitude rating can be assessed on a wide range of rating scales and may be more useful for pain rating in a clinical context. Threshold detection-based testing and intensity/magnitude rating-based testing can be combined to determine pain threshold in clinical evaluation. Conclusions. Musculoskeletal pain management may benefit from treatment algorithms that consider mechanism, pain quality, or neurophysiological correlates. Non-invasive QST may be helpful to find sensory array of altered nociceptive process. Due to the diverse etiopathogenetic basis of musculoskeletal pain disorders, a broad range of reliable and valid QST tests may be needed to analyze the various disease entities.
PAIN, 2019
Hypersensitivity due to central pain mechanisms can influence recovery and lead to worse clinical outcomes, but the ability of quantitative sensory testing (QST), an index of sensitisation, to predict outcomes in chronic musculoskeletal disorders remains unclear. We systematically reviewed the evidence for ability of QST to predict pain, disability, and negative affect using searches of CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, and PubMed databases up to April 2018. Title screening, data extraction, and methodological quality assessments were performed independently by 2 reviewers. Associations were reported between baseline QST and outcomes using adjusted (b) and unadjusted (r) correlations. Of the 37 eligible studies (n 5 3860 participants), 32 were prospective cohort studies and 5 randomised controlled trials. Pain was an outcome in 30 studies, disability in 11, and negative affect in 3. Meta-analysis revealed that baseline QST predicted musculoskeletal pain (mean r 5 0.31, 95% confidence interval [CI]: 0.23-0.38, n 5 1057 participants) and disability (mean r 5 0.30, 95% CI: 0.19-0.40, n 5 290 participants). Baseline modalities quantifying central mechanisms such as temporal summation and conditioned pain modulation were associated with follow-up pain (temporal summation: mean r 5 0.37, 95% CI: 0.17-0.54; conditioned pain modulation: mean r 5 0.36, 95% CI: 0.20-0.50), whereas baseline mechanical threshold modalities were predictive of follow-up disability (mean r 5 0.25, 95% CI: 0.03-0.45). Quantitative sensory testing indices of pain hypersensitivity might help develop targeted interventions aiming to improve outcomes across a range of musculoskeletal conditions.
Journal of Clinical Medicine
Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians’ need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain (‘the past’); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain (‘the present’); and (3) highlighting key areas for future implementation and research work in this area (‘the future’). It is explained that the 2021 IASP clinical criteria for nociplastic pain are i...
Manual Therapy, 2011
Central sensitization provides an evidence-based explanation for many cases of 'unexplained' chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. Pain physiology education is indicated when: 1) the clinical picture is characterized and dominated by central sensitization; and 2) maladaptive illness perceptions are present. Both are prerequisites for commencing pain physiology education. Face-to-face sessions of pain physiology education, in conjunction with written educational material, are effective for changing pain cognitions and improving health status in patients with various chronic musculoskeletal pain disorders. These include patients with chronic low back pain, chronic whiplash, fibromyalgia and chronic fatigue syndrome. After biopsychosocial assessment pain physiology education comprises of a first face-to-face session explaining basic pain physiology and contrasting acute nociception versus chronic pain (Session 1). Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.
Use of the painDETECT to discriminate musculoskeletal pain phenotypes
Archives of Physiotherapy, 2022
Background Musculoskeletal pain patients present similar pain characteristics regardless of the clinical diagnosis. PainDETECT questionnaire is useful for screening neuropathic-like symptoms in many musculoskeletal conditions. However, no previous studies compared pain phenotypes of patients with musculoskeletal pain using the painDETECT. Therefore, the current study aimed to compare the pain characteristics of patients with musculoskeletal pain classified according to the painDETECT as nociceptive pain, unclear, and neuropathic-like symptoms. Methods A cross-sectional study was conducted in 308 participants with musculoskeletal pain. Demographic and clinical characteristics of the participants were examined. Neuropathic-like symptoms, pain intensity, pain area, Central Sensitization-related sign and symptoms, functional limitation, and conditioned pain modulation were assessed in patients with musculoskeletal pain. Independent one-way analysis of variance (ANOVA) was used to test f...
Bio Psychosocial Factors and Central Sensitization in Patients with Chronic Musculoskeletal Pain
Chettinad Health City Medical Journal
Introduction: Central sensitization (CS) is a neurological sensitivity phenomenon that causes patients to perceive more pain and broader discomfort. However, the bio psychosocial factors associated with the phenomenon of perception continue to explore and further the current knowledge on CS in patients with chronic musculoskeletal pain. The main purpose of this study was to determine the extent of associative relationship between central nervous system sensitization and bio psychosocial measures in patients with chronic musculoskeletal pain. Settings and Design: An observational cross-sectional study was carried out in a tertiary care hospital’s outpatient unit. Methods and Materials: Two hundred patients with chronic musculoskeletal pain were included in the present cross-sectional study. They completed questionnaires such as Central sensitisation inventory (CSI), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing index (PCI), Insomnia Severity Index (ISI), Widespread Pain In...