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Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain
- Source :
- Archives of Physiotherapy, Vol 11, Iss 1, Pp 1-8 (2021), Archives of Physiotherapy
- Publication Year :
- 2021
- Publisher :
- BMC, 2021.
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 20570082
- Volume :
- 11
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Archives of Physiotherapy
- Accession number :
- edsair.doi.dedup.....30e63f473b2de6f8ff10a102fd812df5