Diagnostic accuracy of the clinical indicators to identify central sensitization pain in patients with musculoskeletal pain

• Published in: Archives of physiotherapy Vol. 11; no. 1; p. 2
• Main Authors: Bittencourt, Juliana Valentim, de Melo Magalhães Amaral, Ana Carolina, Rodrigues, Pedro Vidinha, Corrêa, Leticia Amaral, Silva, Bruno Moreira, Reis, Felipe José Jandre, Nogueira, Leandro Alberto Calazans
• Format: Journal Article
• Language: English
• Published: England BioMed Central 11-01-2021; AboutScience Srl
• Subjects: Accuracy; Back pain; Central nervous system sensitization; Chronic pain; Diffuse noxious inhibitory control; Exercise; Genotype & phenotype; Medical diagnosis; Musculoskeletal pain; Pain mechanisms; Pain threshold; Patients; Physical fitness; Professional ethics; Questionnaires; Pain management; Pain threshold; Musculoskeletal pain; Diffuse noxious inhibitory control; Chronic pain; Pain mechanisms; Central nervous system sensitization
• ISSN: 2057-0082; 2057-0082
• DOI: 10.1186/s40945-020-00095-7

The 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.
One-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.
Twenty-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.
Clinical 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.