• Spine · Dec 2011

    Review

    Diagnosis of altered central pain processing.

    • Michele Curatolo.
    • University Department of Anaesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland. michele.curatolo@insel.ch
    • Spine. 2011 Dec 1;36(25 Suppl):S200-4.

    Study DesignNonsystematic review.ObjectiveTo review the current knowledge on detecting altered central pain processing in individual patients with chronic pain.Summary Of Background DataAlterations in central pain processing are mainly characterized by hyperexcitability of the central nervous system and disturbances in endogenous pain modulation. Although these mechanisms are widely recognized as important determinants of pain and disability, there is need for translation of this knowledge into benefits for patients. To this purpose, the first step is the detection of abnormalities in pain processing in individual patients. Quantitative sensory tests (QST) explore aspects of nociception and pain perception, and are therefore potentially useful for diagnostic purposes.MethodsNonsystematic review of the reliability, validity and reference values of QST for the assessment of altered central pain processing in chronic pain patients.ResultsThe reliability of QST is generally high. However, most studies have been performed on healthy volunteers, and few reliability data in patients are available. Furthermore, little is known on the reliability of measures of endogenous pain modulation. The face validity of QST is acceptable. The construct validity cannot be tested, because there is no gold standard for the detection of altered central pain processing in humans. Reference values of different types of QST for applications in neuropathic and musculoskeletal pain have been determined in large samples of pain-free subjects.ConclusionQST can be used in clinical practice to assess the presence of sensory abnormalities in individual patients. Because information on the reliability and validity of the tests is incomplete, the findings should be interpreted with caution. It is still unclear to what extent disturbances in central pain processing are relevant for the determination of symptoms in individual patients. Furthermore, the therapeutic consequences of these assessments remain undetermined. These are challenges of future translational research.

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