Comparing Diagnostic Accuracy of Direct Questioning Versus Schematic Evaluation of Chronic Pain Localization

Background: Patients treated for chronic pain may frequently undergo urine drug testing to monitor medication compliance and detect undisclosed prescribed or illicit drug use. Due to the increasing use and abuse of benzodiazepines, this class of medications is often included in drug screening panels. However, immunoassay-based methods lack the requisite sensitivity for detecting benzodiazepine use in this population primarily due to their poor cross-reactivity with several major urinary benzodiazepine metabolites. A High Sensitivity Cloned Enzyme Donor Immunoassay (HS-CEDIA), in which betaglucuronidase is added to the reagent, has been shown to perform better than traditional assays, but its performance in patients treated for chronic pain is not well characterized. Objectives: To determine the diagnostic accuracy of HS-CEDIA, as compared to the Cloned Enzyme Donor Immunoassay (CEDIA) and Kinetic Interaction of Microparticles in Solution (KIMS) screening immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS), for monitoring benzodiazepine use in patients treated for chronic pain. Study Design: A study of the diagnostic accuracy of urine benzodiazepine immunoassays. Setting: The study was conducted at an academic tertiary care hospital with a clinical laboratory that performs urine drug testing for monitoring medication compliance in pain management. Methods: A total of 299 urine specimens from patients treated for chronic pain were screened for the presence of benzodiazepines using the HS-CEDIA, CEDIA, and KIMS assays. The sensitivity and specificity of the screening assays were determined using the LC-MS/MS results as the reference method. Results: Of the 299 urine specimens tested, 141 (47%) confirmed positive for one or more of the benzodiazepines/metabolites by LC-MS/MS. All 3 screens were 100% specific with no false-positive results. The CEDIA and KIMS sensitivities were 55% (78/141) and 47% (66/141), respectively. Despite the relatively higher sensitivity of the HS-CEDIA screening assay (78%; 110/141), primarily due to increased detection of lorazepam, it still missed 22% (31/141) of benzodiazepine-positive urines. The KIMS, CEDIA, and HS-CEDIA assays yielded accuracies of 75%, 79%, and 90%, respectively, in comparison with LC-MS/MS. Limitations: This study was limited by its single-site location and the modest size of the urine samples utilized. Conclusions: While the HS-CEDIA provides higher sensitivity than the KIMS and CEDIA assays, it still missed an unacceptably high percentage of benzodiazepine-positive samples from patients treated for chronic pain. LC-MS/MS quantification with enzymatic sample pretreatment offers superior sensitivity and specificity for monitoring benzodiazepines in patients treated for chronic pain. Key words: High sensitivty immunoassay, benzodiazepine, beta-glucoronidase, pain management, compliance, LC-MS/MS, screening

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Chronic pain diagnosis in refugee torture survivors: A prospective, blinded diagnostic accuracy study

PLoS Medicine ◽

10.1371/journal.pmed.1003108 ◽

2020 ◽

Vol 17 (6) ◽

pp. e1003108

Author(s):

Gunisha Kaur ◽

Roniel Weinberg ◽

Andrew Robert Milewski ◽

Samantha Huynh ◽

Elizabeth Mauer ◽

...

Keyword(s):

Chronic Pain ◽

Diagnostic Accuracy ◽

Torture Survivors ◽

Diagnostic Accuracy Study ◽

Pain Diagnosis ◽

Accuracy Study

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Low Back Pain and Diagnostic Lumbar Facet Joint Nerve Blocks: Assessment of Prevalence, FalsePositive Rates, and a Philosophical Paradigm Shift from an Acute to a Chronic Pain Model

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/519 ◽

2020 ◽

Vol 5;23 (9;5) ◽

pp. 519-529

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Chronic Pain ◽

Pain Relief ◽

Diagnostic Accuracy ◽

False Positive ◽

Facet Joint ◽

Low Back ◽

Lumbar Facet Joint ◽

Nerve Blocks ◽

Pain Model ◽

Lumbar Facet

Background: Lumbar facet joints are a clinically important source of chronic low back pain. There have been extensive diagnostic accuracy studies, along with studies of influence on the diagnostic process, but most of them have utilized the acute pain model. One group of investigators have emphasized the importance of the chronic pain model and longer lasting relief with diagnostic blocks. Objective: To assess the diagnostic accuracy of lumbar facet joint nerve blocks with controlled comparative local anesthetic blocks and concordant pain relief with an updated assessment of the prevalence, false-positive rates, and a description of a philosophical paradigm shift from an acute to a chronic pain model. Study Design: Retrospective study to determine diagnostic accuracy, prevalence and falsepositive rates. Setting: A multidisciplinary, non-university based interventional pain management practice in the United States. Methods: Controlled comparative local anesthetic blocks were performed initially with 1% lidocaine, followed by 0.25% bupivacaine if appropriate response was obtained, in an operating room under fluoroscopic guidance utilizing 0.5 mL of lidocaine or bupivacaine at L3, L4 medial branches and L5 dorsal ramus. All patients non-responsive to lidocaine blocks were considered to be negative for facet joint pain. All patients were assessed after the diagnostic blocks were performed with ≥ 80% pain relief for their ability to perform previously painful movements. Results: The prevalence of lumbar facet joint pain in chronic low back pain was 34.1% (95% CI, 28.8%, 39.8%), with a false-positive rate of 49.8% (95% CI, 42.7%, 56.8%). This study also showed a single block prevalence rate of 67.9% (95% CI, 62.9%, 73.2%). Average duration of pain relief ≥ 80% was 6 days with lidocaine block and total relief of ≥ 50% of 32 days. With bupivacaine, the average duration of pain relief ≥ 80% was 13 days with total relief of ≥ 50% lasting for 55 days. Conclusion: This study demonstrated that the chronic pain model is more accurate and reliable with concordant pain relief. This updated assessment also showed prevalence and false-positive rates of 34.1% and 49.8%. Key words: Chronic spinal pain, lumbar facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, diagnostic accuracy, prevalence, false-positive rate

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Using Tongue, Lip, and Jaw Movement Data to Improve Diagnostic Accuracy of ALS

10.1044/cred-dsa-bts-004 ◽

2014 ◽

Vol 1 (1) ◽

pp. 1

Author(s):

Jordan Green

Keyword(s):

Diagnostic Accuracy ◽

Jaw Movement ◽

Movement Data

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Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

Language Speech and Hearing Services in Schools ◽

10.1044/2020_lshss-20-00043 ◽

2020 ◽

pp. 1-15

Author(s):

Ling-Yu Guo ◽

Phyllis Schneider ◽

William Harrison

Keyword(s):

Diagnostic Accuracy ◽

Psychometric Properties ◽

Language Impairment ◽

Reference Data ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Criterion Validity ◽

Likelihood Ratios ◽

Generation Task ◽

Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

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