Application of the grading system for "nociplastic pain" in chronic primary and chronic secondary pain conditions: a field study.

IF 5.9 1区 医学 Q1 ANESTHESIOLOGY PAIN® Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI:10.1097/j.pain.0000000000003355
Hannah Schmidt, Armin Drusko, Malika Pia Renz, Lea Schlömp, Heike Tost, Sigrid Schuh-Hofer, Jonas Tesarz, Andreas Meyer-Lindenberg, Rolf-Detlef Treede
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Abstract

Abstract: The concept "nociplastic pain" has been developed for patients with features of nociceptive system sensitization that are not explained as nociceptive or neuropathic. Here, we tested how well the recently published grading system differentiates between chronic primary and secondary pain conditions. We recruited patients with fibromyalgia (FMS, n = 41), complex regional pain syndrome (CRPS, n = 11), osteoarthritis (OA, n = 21), or peripheral nerve injury (PNI, n = 8). We used clinical history, pain drawings, quantitative sensory testing (QST), and questionnaires to classify their pains as possibly or probably "nociplastic." All patients with chronic primary pain exhibited widespread/regional pain not explainable by either nociceptive or neuropathic mechanisms. Widespread pain occurred in 12 patients with OA but was identified as nociceptive in 11 of 12. Regional pain occurred in 4 patients with PNI but was identified as neuropathic in 3 of 4. At this step, the grading system had 100% sensitivity and 93% specificity. Clinical evidence for pain hypersensitivity by QST, and history of hypersensitivity and mental comorbidities did not differentiate between chronic primary pain (QST: 36/52 = 69%, history: 43/52 = 83%) and secondary pain conditions (QST: 20/29 = 69%, history: 24/29 83%). Based on these data, specificity remained excellent (93%), but sensitivity dropped substantially (60%) due to lacking evidence for pain hypersensitivity in many patients with FMS. This low sensitivity suggests that the published grading system is not suitable for screening purposes. We suggest structural and content modifications to improve sensitivity, including placement of patient history before clinical examination and addition of a high tender point count as evidence for widespread pain hypersensitivity.

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慢性原发性和慢性继发性疼痛中 "非痉挛性疼痛 "分级系统的应用:一项实地研究。
摘要:"非可塑性疼痛 "这一概念是针对具有痛觉系统敏感化特征但无法解释为痛觉性或神经病理性的患者而提出的。在此,我们测试了最近公布的分级系统在区分慢性原发性疼痛和继发性疼痛方面的效果。我们招募了纤维肌痛(FMS,n = 41)、复杂区域疼痛综合征(CRPS,n = 11)、骨关节炎(OA,n = 21)或周围神经损伤(PNI,n = 8)患者。我们通过临床病史、疼痛图谱、定量感觉测试(QST)和问卷调查,将他们的疼痛分为可能是 "非痉挛性 "疼痛或可能是 "非痉挛性 "疼痛。所有慢性原发性疼痛患者都表现出广泛性/区域性疼痛,无法用痛觉或神经病理性机制来解释。12 名 OA 患者出现了广泛性疼痛,但其中 11 人被确定为痛觉性疼痛。在这一阶段,分级系统的敏感性为 100%,特异性为 93%。临床证据表明,QST、痛觉过敏史和精神合并症并不能区分慢性原发性疼痛(QST:36/52 = 69%,病史:43/52 = 83%)和继发性疼痛(QST:20/29 = 69%,病史:24/29 = 83%)。根据这些数据,特异性仍然很好(93%),但敏感性大幅下降(60%),原因是缺乏证据表明许多 FMS 患者存在痛觉过敏。这种低灵敏度表明,已公布的分级系统不适合用于筛查。我们建议在结构上和内容上进行修改,以提高敏感性,包括将患者病史置于临床检查之前,以及增加高触痛点计数作为广泛痛觉过敏的证据。
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来源期刊
PAIN®
PAIN® 医学-临床神经学
CiteScore
12.50
自引率
8.10%
发文量
242
审稿时长
9 months
期刊介绍: PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
期刊最新文献
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