The Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain.

Hdl Handle:
http://hdl.handle.net/10147/207704
Title:
The Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain.
Authors:
Smart, Keith M; Blake, Catherine; Staines, Anthony; Doody, Catherine
Affiliation:
St Vincent's University Hospital, Elm Park, Dublin, Ireland. k.smart@ucd.ie
Citation:
Clin J Pain. 2011 Oct;27(8):655-63. doi: 10.1097/AJP.0b013e318215f16a.
Journal:
The Clinical journal of pain
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207704
DOI:
10.1097/AJP.0b013e318215f16a
PubMed ID:
21471812
Abstract:
OBJECTIVES: Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (+/- leg) pain disorders. METHODS: This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (+/- leg) pain were assessed using a standardized assessment protocol. After each assessment, patients' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence/absence of various clinical criteria. RESULTS: Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios). DISCUSSION: By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
Language:
eng
MeSH:
Adult; Aged; Aged, 80 and over; Central Nervous System Sensitization/*physiology; Cross-Sectional Studies; Female; Humans; Logistic Models; Low Back Pain/*physiopathology; Male; Middle Aged; Multivariate Analysis; Musculoskeletal Pain/*classification/*diagnosis; Pain Measurement/methods; Peripheral Nervous System Diseases/*diagnosis/physiopathology; Questionnaires; Reproducibility of Results; Sensitivity and Specificity; Young Adult
ISSN:
1536-5409 (Electronic); 0749-8047 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorSmart, Keith Men_GB
dc.contributor.authorBlake, Catherineen_GB
dc.contributor.authorStaines, Anthonyen_GB
dc.contributor.authorDoody, Catherineen_GB
dc.date.accessioned2012-02-01T10:35:26Z-
dc.date.available2012-02-01T10:35:26Z-
dc.date.issued2012-02-01T10:35:26Z-
dc.identifier.citationClin J Pain. 2011 Oct;27(8):655-63. doi: 10.1097/AJP.0b013e318215f16a.en_GB
dc.identifier.issn1536-5409 (Electronic)en_GB
dc.identifier.issn0749-8047 (Linking)en_GB
dc.identifier.pmid21471812en_GB
dc.identifier.doi10.1097/AJP.0b013e318215f16aen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207704-
dc.description.abstractOBJECTIVES: Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (+/- leg) pain disorders. METHODS: This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (+/- leg) pain were assessed using a standardized assessment protocol. After each assessment, patients' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence/absence of various clinical criteria. RESULTS: Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios). DISCUSSION: By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshCentral Nervous System Sensitization/*physiologyen_GB
dc.subject.meshCross-Sectional Studiesen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLogistic Modelsen_GB
dc.subject.meshLow Back Pain/*physiopathologyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshMultivariate Analysisen_GB
dc.subject.meshMusculoskeletal Pain/*classification/*diagnosisen_GB
dc.subject.meshPain Measurement/methodsen_GB
dc.subject.meshPeripheral Nervous System Diseases/*diagnosis/physiopathologyen_GB
dc.subject.meshQuestionnairesen_GB
dc.subject.meshReproducibility of Resultsen_GB
dc.subject.meshSensitivity and Specificityen_GB
dc.subject.meshYoung Adulten_GB
dc.titleThe Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain.en_GB
dc.contributor.departmentSt Vincent's University Hospital, Elm Park, Dublin, Ireland. k.smart@ucd.ieen_GB
dc.identifier.journalThe Clinical journal of painen_GB
dc.description.provinceLeinster-
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