• Psychosomatic medicine · Jul 2018

    Comparative Study

    Slowly Repeated Evoked Pain as a Marker of Central Sensitization in Fibromyalgia: Diagnostic Accuracy and Reliability in Comparison With Temporal Summation of Pain.

    • Pablo de la Coba, Stephen Bruehl, Carmen María Galvez-Sánchez, and Gustavo A Reyes Del Paso.
    • From the Department of Psychology (Coba, Galvez-Sánchez, Reyes del Paso), University of Jaén, Spain; and Department of Anesthesiology (Bruehl), Vanderbilt University Medical Center, Nashville, Tennessee.
    • Psychosom Med. 2018 Jul 1; 80 (6): 573-580.

    ObjectiveThis study examined the diagnostic accuracy and test-retest reliability of a novel dynamic evoked pain protocol (slowly repeated evoked pain [SREP]) compared with temporal summation of pain (TSP), a standard index of central sensitization.MethodsThirty-five fibromyalgia (FM) patients and 30 rheumatoid arthritis (RA) patients completed, in pseudorandomized order, a standard mechanical TSP protocol (10 stimuli of 1-second duration at the thenar eminence using a 300-g monofilament with 1 second interstimulus interval) and the SREP protocol (9 suprathreshold pressure stimuli of 5-second duration applied to the fingernail with a 30-second interstimulus interval). To evaluate reliability for both protocols, they were repeated in a second session 4-7 days later.ResultsEvidence for significant pain sensitization over trials (increasing pain intensity ratings) was observed for SREP in FM (p < .001) but not in RA (p = .35), whereas significant sensitization was observed in both diagnostic groups for the TSP protocol (p < .008). Compared with TSP, SREP demonstrated higher overall diagnostic accuracy (87.7% versus 64.6%), greater sensitivity (0.89 versus 0.57), and greater specificity (0.87 versus 0.73) in discriminating between FM and RA patients. Test-retest reliability of SREP sensitization was good in FM (intraclass correlations = 0.80), and moderate in RA (intraclass correlations = 0.68).ConclusionsSREP seems to be a dynamic evoked pain index tapping into pain sensitization that allows for greater diagnostic accuracy in identifying FM patients compared with a standard TSP protocol. Further research is needed to study mechanisms underlying SREP and the potential utility of adding SREP to standard pain evaluation protocols.

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