scholarly journals Tests for central sensitization in general practice: a Delphi study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Carine den Boer ◽  
Berend Terluin ◽  
Johannes C. van der Wouden ◽  
Annette H. Blankenstein ◽  
Henriëtte E. van der Horst
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
General Practice ◽  
Delphi Study ◽  
Central Sensitization ◽  
Added Value ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Central Sensitization Inventory

Abstract Introduction Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice. Methods We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice. Results In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale. Conclusion In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.

scholarly journals Exploring the pain in patellofemoral pain: A systematic review and meta-analysis examining signs of central sensitization

2020 ◽  
Author(s):  
Kemery J. Sigmund ◽  
Marie K. Hoeger Bement ◽  
Jennifer E. Earl-Boehm
Keyword(s):  
Systematic Review ◽  
Central Sensitization ◽  
Temporal Summation ◽  
Meta Analysis ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Pain Mapping

Objective: Patellofemoral pain has high recurrence rates and minimal long-term treatment success. Central sensitization refers to dysfunctional pain modulation that occurs when nociceptive neurons become hyper responsive. Research in this area in PFP has been increasingly productive in the past decade. The aim of this review is to determine whether evidence supports manifestations of central sensitization in individuals with PFP. Data sources: MeSH terms for quantitative sensory testing (QST) pressure pain thresholds, conditioned pain modulation, temporal summation, sensitization, hyperalgesia, and anterior knee pain or PFP were searched in PubMed, SportDiscus, CINAHL, Academic Search Complete, and Ebscohost. Study Selection: Peer reviewed studies written in English, published between 2005–2020 which investigated QST and/or pain mapping in a sample with PFP were included in this review. Data Extraction: The initial search yielded 140 articles. After duplicates were removed, 78 article abstracts were reviewed. Full-text review of 21 studies occurred, with 11 studies included in the meta-analysis and eight studies included in the systematic review. Data Synthesis: A random-effects meta-analysis was conducted for four QST variables (local pressure pain thresholds, remote pressure pain thresholds, conditioned pain modulation, temporal summation). Strong evidence supports lower local and remote pressure pain thresholds, impaired conditioned pain modulation, and facilitated temporal summation in individuals with PFP compared to pain-free individuals. Conflicting evidence is presented for heat and cold pain thresholds. Pain mapping demonstrated expanding pain patterns associated with long PFP symptom duration. Conclusions: Signs of central sensitization are present in individuals with PFP, indicating altered pain modulation. PFP etiological and treatment models should reflect the current body of evidence regarding central sensitization. Signs of central sensitization should be monitored clinically and treatments with central effects should be considered as part of a multi-modal plan of care. Registration Number: This review is registered with Prospero (CRD42019127548) Registration URL: https://www.crd.york.ac.uk/PROSPERO Key Points:

scholarly journals Pain perception is altered in patients with medication-overuse headache but can improve after detoxification

2012 ◽  
Vol 3 (3) ◽  
pp. 198-198
Author(s):  
Signe Bruun Munksgaard ◽  
Lars Bendtsen ◽  
Rigmor Højland Jensen
Keyword(s):  
Healthy Volunteers ◽  
Central Sensitization ◽  
Pain Perception ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headaches ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds

Abstract Background Previously, central sensitization has been found in chronic, primary headaches but pain perception in MOH patients has only scarcely been studied. Aim To investigate pain perception before and during detoxification in patients with medication overuse headache (MOH). Methods 35 patients with MOH following structured detoxification programmes were tested before and 2, 6 and 12 months after withdrawal and 40 age and sex matched, healthy volunteers were tested for comparison. We measured cephalic and extra cephalic pressure pain thresholds (PPT) and supra-threshold pressure pain (STPP) as well as extra cephalic pain thresholds, supra-threshold pain and wind-up for electrical stimulation. Results At baseline, cephalic and extra cephalic PPTs were significantly lower in patients with MOH compared with healthy volunteers. Cephalic STPP was significantly higher in MOH patients compared with healthy volunteers but decreased significantly from baseline to the 6-month and 12-month follow-up. Supra-threshold pain for a single electrical stimulus was significantly higher in MOH patients compared with healthy volunteers. In contrast to healthy volunteers, patients with MOH did not exhibit wind-up before withdrawal. After 2 months, MOH patients had regained ability to wind-up and this persisted at 6-month and 12-month follow-up. Conclusions Patients with MOH have altered pain sensation and exhibit both allodynia and hyperalgesia indicating central sensitization. Withdrawal from medication overuse causes significant decrease in central sensitization. The ability to wind-up is altered in MOH patients, probably as a consequence of medication overuse, but it can be regained after withdrawal. These findings emphasize the need for detoxification in MOH.

scholarly journals Assessment of Pressure-Pain Thresholds and Central Sensitization of Pain in Lateral Epicondylalgia

Pain Medicine ◽  
2013 ◽  
Vol 14 (2) ◽  
pp. 297-304 ◽  
Author(s):  
Anders Jespersen ◽  
Kirstine Amris ◽  
Thomas Graven-Nielsen ◽  
Lars Arendt-Nielsen ◽  
Else Marie Bartels ◽  
...  
Keyword(s):  
Central Sensitization ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds ◽  
Lateral Epicondylalgia

scholarly journals Relationship Between Pressure Pain Threshold and Coping Strategies in Patients with Fibromyalgia

1998 ◽  
Vol 3 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Ji-Young Song ◽  
Samuel Noh ◽  
Manfred Harth ◽  
Harold Merskey
Keyword(s):  
Chronic Pain ◽  
Coping Strategies ◽  
Pressure Pain Threshold ◽  
Pain Coping ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Behavioural Activity ◽  
Pressure Pain Thresholds ◽  
Pressure Algometer ◽  
And Coping

OBJECTIVE: To explore the hypothesis that the intensity of pain, pain thresholds and coping mechanisms differ between patients with fibromyalgia and those with rheumatoid arthritis (RA) in order to determine whether pain coping strategies contribute to the understanding of how patients adjust to fibromyalgia.METHODS: Thirty-eight fibromyalgia patients were compared with 15 RA patients regarding severity of pain, pain history, pressure pain thresholds (measured with a pressure algometer) and pain coping strategies (measured with the Coping Strategies Questionnaire [CSQ]).RESULTS: Fibromyalgia patients scored significantly higher than RA patients on severity of pain and had lower pain thresholds at three pairs of nontender sites than the RA group. Fibromyalgia patients were significantly different from RA patients with respect to catastrophizing and increasing behavioural activity, but this differentiation was not maintained with respect to the three main factors of the CSQ. Overall, both the fibromyalgia and RA groups resembled previous chronic pain populations. Depression and anxiety had strong negative correlations with the combined coping scores on the seven subscales (P<0.001).CONCLUSIONS: Patients with fibromyalgia may use some distinctive coping strategies and tend to manage their pain in many of the same ways as other patients with chronic pain.

A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity

2014 ◽  
Vol 5 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Ulrika Heddini ◽  
Ulrika Johannesson ◽  
Alfhild Grönbladh ◽  
Fred Nyberg ◽  
Kent W. Nilsson ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Sensitivity ◽  
Provoked Vestibulodynia ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pain Hypersensitivity ◽  
Pressure Pain Thresholds ◽  
118G Allele ◽  
Μ Opioid Receptor ◽  
A118g Polymorphism

AbstractBackground and aimsProvoked vestibulodynia (PVD) is the most common cause of dyspareunia among young women. The aetiology is largely unknown and treatment is often extensive and longstanding with varying outcomes. Patients display general pain hypersensitivity and there are correlations with other chronic pain syndromes such as fibromyalgia later in life. The A118G polymorphism in the μ-opioid receptor (OPRM1) gene influences endogenous pain regulation and pain sensitivity, but has not been studied in this patient group before. We aimed to investigate a possible association between A118G polymorphism and PVD, with correlation to plasma levels of β-endorphin, and to explore relationships between this polymorphism and pain sensitivity among women with PVD and healthy controls.MethodsThis case-control study included 98 women with PVD and 103 controls. Participants filled out study-specific questionnaires and underwent quantitative sensory testing of pressure pain thresholds on the arm, leg and in the vestibular area. Levels of β-endorphin were analyzed by radioimmunoassay using the EURIA-beta-endorphin kit, and the A118G single-nucleotide polymorphism (SNP; rs1799971) in the OPRM1 gene was analyzed using the TaqMan SNP genotyping assay.ResultsThe 118G allele was more common in controls (44%) than in patients (30%) (p = 0.042). The odds ratio of having PVD was 1.8 in participants carrying the 118A allele compared to participants hetero- or homozygous for the 118G allele (OR = 1.846, CI: 1.03-3.31, p = 0.039). Pressure pain thresholds on the leg were higher for participants carrying the 118G allele (mean 480 kPa, SD 167.5) than for those carrying the 118A allele (mean 419, SD 150.4, p = 0.008). Levels of β-endorphin were higher in patients (mean 17.9 fmol/ml, SD 4.71) than in controls (mean 15.8 fmol/ml, SD 4.03) (p < 0.001).ConclusionWe found an association between the A118G polymorphism in the OPRM1 gene and an increased risk of PVD and increased pain sensitivity among participants carrying the 118A allele. PVD patients were more sensitive to pressure pain and had higher levels of plasma β-endorphin than controls. The results indicate that differences in endogenous pain modulation involving the opioid system could contribute to the pathophysiology of PVD and the general pain hypersensitivity seen in these women.ImplicationsThe data support the conceptualization of PVD as part of a general pain disorder with a possible genetic predisposition. The age of onset of PVD is usually between 18 and 25 years and already at this age general pain hypersensitivity is present but rarely causing disability. We believe that early recognition and treatment, with the risk of further development of chronic pain taken into consideration, might prevent future aggravated pain problems in this patient group.

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