1. Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain
- Author
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Felipe José Jandre dos Reis, Juliana Valentim Bittencourt, Bruno M. Silva, Ana Carolina de Melo Magalhães Amaral, Pedro Teixeira Vidinha Rodrigues, Leandro Alberto Calazans Nogueira, Leticia Amaral Corrêa, Pain in Motion, and Physiotherapy, Human Physiology and Anatomy
- Subjects
Musculoskeletal pain ,medicine.medical_specialty ,medicine.medical_treatment ,Physical examination ,Chronic pain ,Likelihood ratios in diagnostic testing ,Diffuse noxious inhibitory control ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Threshold of pain ,Medicine ,Central nervous system sensitization ,lcsh:Miscellaneous systems and treatments ,General Environmental Science ,Pain mechanisms ,Rehabilitation ,medicine.diagnostic_test ,business.industry ,Cold pressor test ,medicine.disease ,lcsh:RZ409.7-999 ,Pain management ,Pain threshold ,Physical therapy ,General Earth and Planetary Sciences ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
BackgroundThe identification of central sensitization (CS) is an important aspect in the management of patients with chronic musculoskeletal pain. Several methods have been developed, including clinical indicators and psychophysical measures. However, whether clinical indicators coincide with the psychophysical test of CS-related sign and symptoms is still unknown. Therefore, the present study aimed to analyze the diagnostic accuracy of the clinical indicators in identifying CS-related sign and symptoms in patients with musculoskeletal pain.MethodsOne-hundred consecutive patients with musculoskeletal pain were included. Clinical indicators (index method) based on a combination of patient self-report pain characteristics and physical examination were used to identify the phenotype of patients with musculoskeletal pain and the predominance of the CS-related sign and symptoms. Conditioned pain modulation (CPM) was assessed by the Cold Pressor Test (reference standard), which is a psychophysical test used to detect impairment of CPM. Measurements of the diagnostic accuracy were performed.ResultsTwenty-seven patients presented predominance of CS-related sign and symptoms in the assessment of the clinical indicators, and 20 had impairment of CPM. Clinical indicators showed high accuracy (75.0%; 95% confidence interval = 65.3 to 83.1), high specificity (80.0%; 95% confidence interval = 69.6 to 88.1), high negative predictive value (87.7%; 95% confidence interval = 81.2 to 92.1), and a relevant positive likelihood ratio (2.8, 95% confidence interval = 1.5 to 5.0) when compared to the Cold Pressor Test.ConclusionClinical indicators demonstrated a valuable tool for detecting the impaired CPM, which is a remarkable feature of the CS-related sign and symptoms. Clinicians are encouraged to use the clinical indicators in the management of patients with musculoskeletal pain.
- Published
- 2021