Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses.

ABSTRACT: Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.

Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? Protocol for a systematic review.

INTRODUCTION: Central sensitization (CS) was first defined in animal studies to be increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state. Recently, the concept of CS has been adopted in clinical assessments of chronic pain, but its diagnosis in humans has expanded to include the enhancement of a wide range of nociceptive, sensory, and emotional responses. Many poorly understood pain disorders are referred to as "central sensitivity syndrome," a term associated with a broad range of hypervigilant sensory and emotional responses. Diagnosis often involves a review of medical records and an assessment of behaviour, emotional disposition, and overall sensitivity of a patient. Obviously, these assessments are unable to directly capture the responsiveness of nociceptive neurons. The purpose of this review is to ascertain whether self-report questionnaires associated with central sensitization and the diagnosis of central sensitivity syndrome are associated with enhanced nociceptive responses or whether they more validly measure sensitivity in a broader sense (ie, including emotional responses). METHODS: Following the PRISMA guidelines, a detailed search of studies that involve the Central Sensitization Inventory or Pain Sensitivity Questionnaire correlated with either nociceptive sensory tests (quantitative sensory testing) or emotional hypervigilance (anxiety, depression, stress, etc) will be conducted on MEDLINE, PsychINFO, and Web of Science. PERSPECTIVE: The review is expected to synthesize correlations between sensitivity questionnaires and nociceptive or emotional sensitivity to determine whether these questionnaires reflect a broadened understanding of the term "central sensitization."

Attending work with chronic pain is associated with higher levels of psychosocial stress.

Background and Aims: Much is known about the impact of pain in terms of medical costs and missed work. Less is known about its associations when individuals are present for work. This study examines "presenteeism" by analyzing the psychosocial costs of pain in the workplace, using the 2015 European Working Conditions Survey (EWCS). Methods: We conducted cross-sectional analysis of 2384 individuals with chronic pain and 2263 individuals without pain (matched by age and sex) using data from the 2015 EWCS. We compared groups in terms of the following psychosocial factors: supervisor support, job responsibility, team cohesion, discrimination, threats/abuse, job competency, job reward, sexual harassment, stress, and job security. The groups were also compared in terms of days lost due to illness. Results: People with pain were 64% less likely to view their job as rewarding (odds ratio [OR] = 0.61; 95% confidence interval [CI], 0.57-0.65), 47% more likely to be subjected to threats/abuse in the workplace (OR = 0.68; 95% CI, 0.63-0.73), 30% more likely to report poor supervisor support (OR = 0.77; 95% CI, 0.73-0.82), and 28% more likely to perceive discrimination in the workplace (OR = 0.78; 95% CI, 0.71-0.85). People with pain missed approximately nine more days of work per year than respondents without pain. Conclusions: Chronic pain was associated with lower vocational fulfillment and feelings of being ostracized in the workplace. These findings suggest that the presence of pain in the workplace goes well beyond lost productivity due to absenteeism.

Contexte et objectifs: On en sait beaucoup sur l'impact de la douleur en termes de frais médicaux et absences au travail. On en sait moins sur ses associations lorsque des individus sont présents pour travailler. Cette étude examine le « présentéisme ¼ en analysant les coûts psychosociaux de la douleur au travail, à l'aide de l'Enquête européenne sur les conditions de travail 2015 (EECT).Méthodes: Nous avons effectué une analyse transversale de 2 384 personnes souffrant de douleur chronique et 2 263 personnes sans douleur (jumelés par âge et sexe) à l'aide des données de l'EECT 2015. Nous avons comparé les groupes en fonction des facteurs psychosociaux suivants : soutien du superviseur, responsabilité au travail, cohésion de l'équipe, discrimination, menaces ou abus, compétence professionnelle, valorisation professionnelle, harcèlement sexuel, stress et stabilité de l'emploi. Les groupes ont également été comparés en termes de jours perdus pour cause de maladie.Résultats: Les personnes souffrant de douleur étaient 64 % moins susceptibles de considérer leur travail comme enrichissant (rapport de cotes [RC] = 0,61 ; intervalle de confiance [IC] à 95 %, 0,57-0,65), 47 % plus susceptibles d'être soumis à des menaces ou abus dans leur lieu de travail (RC = 0,68; IC à 95 %, 0,63-0,73), 30 % plus susceptibles de déclarer un faible soutien du superviseur (RC = 0,77; IC à 95 %, 0,73-0,82) et 28 % plus susceptibles de percevoir une discrimination sur le lieu de travail (RC = 0,78; IC à 95 %, 0,71-0,85). Les personnes souffrant de douleur ont manqué environ neuf jours de travail de plus par an que les répondants sans douleur.Conclusions: La douleur chronique était associée à un épanouissement professionnel moindre et à un sentiment d'être ostracisé sur le lieu de travail. Ces résultats indiquent que la présence de douleur sur le lieu de travail va bien au-delà de la perte de productivité due à l'absentéisme.

Intrinsic attention to pain is associated with a pronociceptive phenotype.

INTRODUCTION: Evidence suggests that attention to pain is a product of both incoming sensory signals and cognitive evaluation of a stimulus. Intrinsic attention to pain (IAP) is a measure that captures an individual's natural tendency to attend to a painful stimulus and may be important in understanding why pain disrupts cognitive functioning in some individuals more than others. OBJECTIVE: In this study, we explored the extent to which IAP was associated with the modulation of incoming sensory signals characteristic of a pronociceptive phenotype: temporal summation (TS) and conditioned pain modulation (CPM). METHOD: 44 healthy participants (23 female; Mage=23.57, S.D.=5.50) were assessed on IAP, TS and CPM. RESULTS: We found that IAP was positively correlated with TS and CPM. A regression model showed that TS and CPM explained 39% of the variance in IAP scores. Both mechanisms seem to contribute independently to the propensity to attend to pain. CONCLUSION: These findings highlight that modulatory mechanisms at the spinal/supraspinal level exert a strong influence on an individual's ability to disengage from pain.