Predictors of persistent post-surgical pain intensity and interference at 1 year after breast cancer surgery: assessing central sensitization, central sensitivity symptoms, and psychological factors.

BACKGROUND: Persistent post-surgical pain (PPSP) is associated with upper limb dysfunction and decreased quality of life and causes long-term suffering for breast cancer survivors after surgery. However, the predictors of PPSP remain unclear. The purpose of this study was to examine predictors of PPSP intensity and interference at 1 year postoperatively, focusing on treatment-related factors, pre- and postoperative central sensitization (CS), CS-related symptoms (e.g., muscle stiffness, fatigue, sleep disturbances), and psychological factors. METHODS: Eighty-eight women with planned unilateral breast cancer surgery were included in this longitudinal study. CS, CS-related symptoms, and psychological factors were assessed preoperatively, 1 month postoperatively, and 1 year postoperatively. Analysis of covariance was used to compare the groups with and without PPSP, accounting for treatment-related factors. Multiple regression analysis was performed to identify predictors of PPSP intensity and interference at 1 year postoperatively. RESULTS: Even after adjusting for covariates, preoperative and 1-month postoperative Central Sensitization Inventory scores in the PPSP group were significantly higher than scores in the group without PPSP. Multiple regression analysis showed that axillary lymph node dissection (ALND) and 1-month postoperative CS-related symptoms were independent predictors of PPSP intensity and interference at 1 year postoperatively (p < 0.01). CONCLUSION: We found that ALND and 1-month postoperative CS-related symptoms were predictors of PPSP intensity and interference at 1 year postoperatively.

Reliability and validity of the Japanese version of Pain Disability Index.

This study evaluated the reliability and validity of a Japanese version of Pain Disability Index (PDI). Analyses were conducted on a 7-item version (PDI-J) and a 5-item (PDI-5-J version of the PDI). Using a web-based survey system, we recruited 300 individuals with chronic low back pain (lasting ≥3 months) and 300 individuals with chronic daily headache (lasting ≥15 days per month for 3 months) aged 20-64 years. Analyses revealed a one-factor with goodness-of-fit indices assessed by confirmatory factor analysis. For concurrent validity, we calculated Pearson's correlation coefficients among the PDI-J, PDI-5-J, Pain Disability Assessment Scale, Pain numerical rating scale, and revised version of Short-Form McGill Pain Questionnaire. Internal consistency was evaluated by Cronbach's α, and test-retest reliability was assessed with intraclass correlations (ICCs) in 100 of 600 participants a week after the first response. Both Japanese adaptations of the PDI demonstrated good concurrent validity and reliability (Cronbach's α was 0.89 for PDI-J in chronic low back pain or chronic daily headache, and 0.94 and 0.93 for PDI-5-J in chronic low back pain and chronic daily headache, respectively). The PDI-J and PDI-5-J showed were highly correlated (r = 0.98). ICCs were 0.67 and 0.59 for the PDI-J and 0.59 and 0.63 for the PDI-5-J in chronic low back pain and chronic daily headache, respectively. In conclusion, these two PDI versions can be potentially used for evaluating pain-related interference with daily activities among the Japanese general population.

Validation of the Japanese version of the patterns of activity measure-pain in individuals with chronic pain.

BACKGROUND: The Patterns of Activity Measure-Pain (POAM-P) is a self-report questionnaire that measures avoidance, overdoing, and pacing in individuals with chronic pain. We aimed to develop and confirm the psychometric properties of the Japanese version of the POAM-P(POAM-P-J) in Japanese individuals with chronic pain. METHODS: We recruited 147 Japanese individuals with chronic pain (106 women; mean age 64.89 ± 12.13 years). The individuals completed the POAM-P-J, the Brief Pain Inventory (BPI), and the Hospital Anxiety and Depression Scale (HADS). The following psychometric properties of the POAM-P-J were confirmed: structural validity, internal consistency, test-retest reliability, and concurrent validity. RESULTS: We tested factor structure via confirmatory factor analyses (CFA). We chose the 3-factor model with six covariances. The POAM-P-J's internal consistency and test-retest reliability were acceptable to good (α = 0.79-0.86; ICC = 0.72-0.87). The avoidance and overdoing subscales were positively associated with pain severity, pain interference, and anxiety measures (all p < 0.05), but the pacing subscale was not significantly associated with these pain-related measures. CONCLUSIONS: Although the structural validity of the POAM-P-J remains questionable, its internal consistency, test-retest reliability, and concurrent validity were confirmed. The POAM-P-J is useful in both research and clinical practice for evaluating the activity patterns of Japanese patients with chronic pain.

Does a combination of self-reported signs related to central sensitization and pressure pain threshold allow for a more detailed classification of pain-related characteristics in patients with chronic musculoskeletal pain?: A cross-sectional study.

OBJECTIVES: The clinical utility of combining the central sensitization (CS) inventory (CSI) with the pressure pain threshold (PPT) in assessing the effect of central sensitization on pain is unknown. This study aimed to investigate the effects of CSI, PPT, and their interaction on pain and the characteristics of clinical symptoms in patients with chronic musculoskeletal pain grouped according to the CSI score and PPT value. METHOD: A total of 187 participants with chronic musculoskeletal pain were recruited. PPT, brief pain inventory, widespread pain index, pain catastrophizing scale, EuroQol-5 dimension, and CSI were assessed. Multiple regression analyses were performed using pain intensity and interference scores as dependent variables and the CSI score and PPT value as independent variables. Hierarchical cluster analysis was also performed to classify the participants into subgroups according to the CSI score and PPT value. Following the classification, pain-related characteristics and health-related QOL were compared among the subgroups. RESULTS: Multiple regression analyses demonstrated that only the CSI score significantly affected pain intensity and interference. As a result of the cluster analysis, three groups were identified: cluster 1 (n = 61, CSI low/PPT low group), cluster 2 (n = 78, CSI low/PPT high group), and cluster 3 (n = 48, CSI high/PPT low group). The CSI high/PPT low group had a higher incidence of pain-related symptoms than the CSI low group regardless of the PPT value. CONCLUSIONS: Combined CSI and PPT may not fully allow a detailed classification of pain-related characteristics. The CSI may be clinically more useful for assessing the effect of CS on pain-related symptoms.

"But it feels swollen!": the frequency and clinical characteristics of people with knee osteoarthritis who report subjective knee swelling in the absence of objective swelling.

INTRODUCTION: There are complex interactions between pain and perceptions of the painful body part in musculoskeletal disorders, and disruption of various body representations in people with chronic pain. OBJECTIVES: The purpose of this study was to investigate how frequently people with knee osteoarthritis (OA) complain of swelling without objective evidence of swelling, and describe the clinical characteristics of this population. METHODS: Forty-six people with knee OA (68.1 ± 8.8 years) participated in this cross-sectional study. Subjective and objective swelling was evaluated by knee-specific body perception questionnaire and ultrasonography, respectively. Pain intensity, disability, pain-related beliefs, 2-point discrimination threshold, and quadriceps muscle strength were also evaluated. RESULTS: Approximately 1/3 of participants (n = 15) had subjective feelings of knee swelling in the absence of objective swelling (S only). Fifteen participants had both subjective and objective knee swelling (S + O group) and 16 had neither subjective nor objective knee swelling (No S/O group). Participants in the S only group had similar pain or disability as those in the S + O group but had more severe pain or disability than those with in the No S/O group. Those in the S only group also had larger 2-point discrimination distance threshold at the medial knee (impaired tactile acuity) than those in the S + O group and had more dysfunctional pain catastrophizing and pain-related self-efficacy than both other groups. CONCLUSION: Our results suggest that about 30% of people with knee OA perceive swelling of the knee in the absence of any objective swelling and that this is accompanied by severe pain and functional disability. Considering altered body image of the knee may reveal relevant treatment-based subgroups in people with knee OA.

Effect of pain neuroscience education and exercise on presenteeism and pain intensity in health care workers: A randomized controlled trial.

OBJECTIVES: Decreased workforce productivity has a significant economic impact on healthcare systems. Presenteeism, the practice of working at reduced potential, is more harmful than absenteeism. Present workers most often experience musculoskeletal pain that is not mitigated by general exercise or stretching. We aimed to assess whether a regimen of pain neuroscience education (PNE) and exercise tailored to individual healthcare workers could reduce presenteeism and improve productivity. METHODS: An independent investigator randomized 104 medical professionals into two groups (intervention and control). The control group received general feedback after answering a questionnaire, while the intervention group received a 6-month plan of exercises and PNE created by a physical therapist with 10 years of experience. Our primary outcome was the scores of the Japanese version of the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) to investigate presenteeism; and our secondary outcomes were pain intensity, widespread pain index (WPI), and EuroQol 5-dimension (EQ5D-5L). RESULTS: In the intervention group, post intervention, we observed significant improvement in presenteeism, pain intensity, WPI, physical and psychological stress, and EQ5D-5L (P < .05). In the control group, we noted significant improvement only in the physical and psychological stress post intervention (P < .05). The results showed significant between-group differences in presenteeism post-intervention (P < .05). CONCLUSION: We demonstrated that a combination of PNE and exercise decreases presenteeism of healthcare workers. Our findings will help healthcare facilities carry out better employee management and ensure optimal productivity.

Using a postoperative pain trajectory to predict pain at 1 year after total knee arthroplasty.

BACKGROUND: The pain trajectory is an early detection/prediction method for chronic postsurgical pain (CPSP). It is unclear whether a pain trajectory can predict CPSP in patients who have undergone a total knee arthroplasty (TKA). Here we investigated (1) whether CPSP can be predicted in TKA patients, and (2) the values that can be used to predict CPSP. METHODS: We studied 211 postoperative TKA patients. We calculated the pain trajectory (pain curve slope and intercept) using the patients' self-reported pain intensity values at 1, 3, 5, and 7 days post-TKA. Using structural equation modeling (SEM), we performed a multiple regression analysis to investigate appropriate prediction models for the pain trajectory. Classification and regression tree (CHAID) methodology was used to calculate values to predict CPSP by a decision tree model. CPSP (dependent variable) was defined as >30 mm on a visual analog scale for pain intensity at 1 year post-TKA. The predictor variables were pain curve slope, intercept, age, sex, body mass index, and preoperative pain intensity. RESULTS: The pain trajectory was the best fit among the models to predict pain intensity at 1 year post-TKA. When the pain curve slope (pain trajectory) was greater than 2.8, the probability of CPSP at 1 year post-TKA was 33.3%. CONCLUSION: Our results suggest that the pain trajectory could be applied to post-TKA patients and used to calculate clinical values to predict CPSP. Our findings also indicate the possibility that patients with a positive pain curve slope in the first postoperative week may need early intervention to avoid CPSP.

Generalizability of Eccentric Exercise for Patients with Subacromial Pain Syndrome to Real-world Clinical Practice: A Propensity Score-based Analysis.

OBJECTIVES: Subacromial pain syndrome is a common problem in primary care. Although several randomized controlled trials have shown that eccentric exercise is effective in patients with subacromial pain syndrome, its generalizability to real-world clinical practice is unknown. This study aimed to investigate, using propensity score analysis, the generalizability of eccentric exercise for patients with subacromial pain syndrome to real-world daily clinical practice. METHODS: In this study, 78 patients underwent eccentric exercise in addition to traditional exercise, and 77 patients underwent only traditional exercise for 4 weeks. Outcomes measured using a visual analog scale (VAS) and American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment Form (ASES) scores were assessed at baseline and at 4 weeks. RESULTS: In the propensity score-matched analysis, 65 patients in each group were successfully matched (130 of 155 patients, 84% overall). After 4 weeks of exercise, pain intensity was lower in the eccentric exercise group than in the traditional exercise group (VAS -14.5, 95% CI -21.2 to -7.9, P<0.001). No significant difference in the improvement in function was found between the two groups (ASES 4.1, 95% CI -2.0 to 10.2, P=0.18). CONCLUSIONS: Eccentric and traditional exercise in combination could reduce pain in patients with subacromial pain syndrome to a greater extent than traditional exercise alone. These findings have clinical relevance to primary care practitioners who provide conservative treatment for patients with subacromial pain syndrome.

Combination of Pain Location and Pain Duration is Associated with Central Sensitization-Related Symptoms in Patients with Musculoskeletal Disorders: A Cross-Sectional Study.

OBJECTIVES: Increased evidence indicates that pain location affects central sensitization (CS)-related symptoms. In addition, pain location and pain duration may be intricately related to CS-related symptoms. However, these factors have been investigated separately. This study aimed to investigate the association between CS-related symptoms and pain location and/or pain duration in patients with musculoskeletal disorders. METHODS: Six hundred thirty-five participants with musculoskeletal disorders were included in this cross-sectional study. All participants were assessed for pain location, pain duration, central sensitization inventory (CSI), EuroQol-5 dimension, and brief pain inventory. The participants were categorized into 3 groups based on pain location (spinal, limb, and both spinal and limb pain) and into 2 groups based on pain duration (acute and chronic pain). RESULTS: The interaction between pain location and pain duration were not significant on CSI score (P > 0.05). The odds ratio for higher CSI score (≥ 40) in patients with both spinal and limb pain vs. those with spinal or limb pain was 2.64 (P < 0.01) and that in patients with chronic pain vs. those with acute pain was 1.31 (P = 0.52). In addition, the prevalence of higher CSI scores in the combination of chronic and "both spinal and limb" pain was high (23.1%, adjusted residual = 4.48). CONCLUSIONS: Pain location independently influenced CSI scores, and the combination of both spinal and limb pain and chronic pain indicated high CSI scores. The combination of pain location and pain duration is an important clue that points to CS-related symptoms.

Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis.

The aim of this study was to explore the existence of subgroups in a cohort of people with knee osteoarthritis (OA) based upon data from multiple pain-related variables and to profile identified clusters according to levels of pain intensity and knee-related disability. Three hundred and three people with knee OA were recruited. Latent profile analysis was used to confirm the optimal number of knee OA subgroups. Body mass index, radiographic knee OA severity, pain catastrophizing, pain related self-efficacy, and knee specific self-perception, were incorporated into the model. Cluster, demographic and clinical variables were compared between the resulting classes. Four distinct classes were identified. Cluster 1 (28.7%) represented early radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 2 (18.8%) showed advanced radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 3 (34.3%) represented various levels of radiographic OA, and the lowest pain intensity, disability and cognitive and perceptual dysfunction. Cluster 4 (18.1%) represented various levels of radiographic OA, the highest disability and cognitive and perceptual dysfunction. Considering cognitive factors and disturbed body perception may help to explain the phenomenon of the discrepancy between the knee-related disability and the severity of radiographic knee OA.

Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study.

PURPOSE: Central sensitization (CS)-related symptoms and pain catastrophizing contribute to persistent post-mastectomy pain (PPMP). Pain neuroscience education (PNE) is effective in reducing CS-related symptoms and pain catastrophizing in patients with chronic pain. However, to date, no intervention study of PNE has been conducted to patients with PPMP. This study was aimed to examine whether PNE is more effective than biomedical education (BME) for PPMP. METHODS: In this retrospective case-control study, 118 patients were included. We intervened different patients at different times as follows: (1) a BME group (n = 58) of patients who received BME combined with physiotherapy and (2) a PNE group (n = 60) of patients who received PNE combined with physiotherapy. One year after surgery, we assessed pain intensity and interference (brief pain inventory [BPI]), CS-related symptoms (central sensitization inventory [CSI]), and pain catastrophizing (pain catastrophizing scale [PCS]). Propensity score matching was used to reduce or minimize selection bias and confounding biases and to make the number of cases in both groups match 1:1. RESULTS: Propensity score matching generated the BME group (n = 51) and the PNE group (n = 51). The BPI score, CSI score, and PCS score were statistically significantly lower in the PNE group than in the BME group (all, p < 0.05). The effect sizes for the BPI intensity (r = 0.31) were moderate. CONCLUSIONS: PNE resulted in a better outcome of pain management with less functional disability and CS-related symptoms compared to BME after breast surgery.

Development and Psychometric Testing of the Japanese Version of the Fremantle Neck Awareness Questionnaire: A Cross-Sectional Study.

PURPOSE: Contemporary theories of pain suggest that how the body is perceived is central to the emergence of pain. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body-perception specific to the back in people with chronic low back pain. However, there is no comprehensive measure to quantify self-perception of the painful area in Japanese people with neck pain. This study aimed to develop a Japanese version of a self-perception questionnaire specific to the neck and evaluate the validity and reliability of the scale using Rasch analysis. MATERIALS AND METHODS: The Fremantle Neck Awareness Questionnaire (FreNAQ-J) was developed by modifying the FreBAQ-J. One hundred people with chronic neck pain and fifty-six matched healthy controls completed the questionnaire. Rasch analysis was used to evaluate targeting, category order, unidimensionality, person fit, internal consistency, differential item functioning, and differential test functioning in the neck pain population. Validity was investigated by examining the relationship between the FreNAQ-J and clinical status. RESULTS: People with chronic neck pain endorsed FreNAQ-J items with greater frequency than healthy controls. FreNAQ-J did not reject the null hypothesis of fitting the Rasch model, had acceptable internal consistency and good test-retest reliability. Summed FreNAQ-J scores were significantly correlated with pain intensity, disability, pain-related catastrophizing and fear of movement. CONCLUSION: The individual items of the FreNAQ-J can be validly summed to provide a score of self-perception. The FreNAQ-J is the first scale developed for comprehensively evaluating disturbed body perception in Japanese patients with chronic neck pain.

Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain.

BACKGROUND: There is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain. METHODS: The Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis. RESULTS: The FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization. CONCLUSIONS: The FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.

Validation of the Japanese version of the Bath CRPS Body Perception Disturbance Scale for CRPS.

PURPOSE: Body perception disturbance is a common symptom and may be one of the key targets of treatment intervention in complex regional pain syndrome (CRPS). As a comprehensive assessment tool of body perception in patients with CRPS, the Bath Body Perception Disturbance Scale (BPDS) was developed, and its adequate reliability and validity have been reported. However, there is no available Japanese version. Therefore, this study aimed to develop a Japanese version of BPDS (BPDS-J) and to investigate the validity of this scale in Japanese patients with CRPS. METHODS: We developed BPDS-J using a forward-backward method. We then assessed 22 patients with CRPS type 1 of the upper limb using BPDS-J, Brief Pain Inventory (BPI), Tampa Scale for Kinesiophobia (TSK), and a two-point discrimination threshold (TPD) on the middle finger. We investigated the internal consistency of BPDS-J and the correlation between BPDS-J and clinical outcomes as a concurrent validity measure. RESULTS: BPDS-J had good internal consistency (Cronbach's α = 0.73) and was significantly correlated with the TPD ratio (r = 0.65, adjusted p = 0.01) and TSK (r = 0.51, adjusted p = 0.04). CONCLUSIONS: BPDS-J has good internal consistency and concurrent validity for assessing body perception disturbance in Japanese patients with CRPS. Disturbed body perception may be worth evaluating when managing patients with CRPS using BPDS.

Identifying participants with knee osteoarthritis likely to benefit from physical therapy education and exercise: A hypothesis-generating study.

BACKGROUND: The purpose of this investigation was to undertake a hypothesis-generating study to identify candidate variables that characterize people with knee osteoarthritis who are most likely to experience a positive response to exercise. METHODS: One hundred and fifty participants with knee osteoarthritis participated in this observational, longitudinal study. All participants received a standard exercise intervention that consisted of 20-min sessions two to three times a week for three months. The classification and regression tree methodology (CART) was used to develop prediction of positive clinical outcome. Positive pain and disability outcomes (dependent variables) were defined as an improvement in pain intensity by >50% or an improvement of five or more on the Oxford knee score, respectively. The predictor variables considered included age, sex, body mass index, knee osteoarthritis severity (Kellgren/Lawrence grade), pain duration, use of medication, range of knee motion, pain catastrophizing, self-efficacy and knee self-perception. RESULTS: Fifty-five participants (36.6%) were classified as responders for pain intensity and 36.6% were classified as responders for disability. The CART model identified impairments in knee self-perception and knee osteoarthritis severity as the discriminators for pain intensity reduction following exercise. No variables predicted reduction of disability level following exercise. CONCLUSIONS: Such findings suggest that both body perception and osteoarthritis severity may play a role in treatment outcome with exercise. It also raises the possibility that those with higher levels of disrupted body perception may need additional treatment targeted at restoring body perception prior to undertaking exercise. SIGNIFICANCE: Regardless age, sex, body mass index, pain duration, use of medication, knee range of motion, pain catastrophizing and self-efficacy, participants with knee osteoarthritis who report low levels of body perception disruption (a FreKAQ score ≦ 17) and minimal structural changes (KL grade I) demonstrate significantly better outcomes from exercise therapy than other participants.

Performing the hand laterality judgement task does not necessarily require motor imagery.

When people judge the laterality of rotated hand images, that is they perform the laterality judgement task (LJT), they are thought to use motor imagery. However, recent studies have suggested that its completion does not necessarily require the use of motor imagery. In this study, we investigated whether and how many people preferentially use motor imagery to perform the LJT in 37 healthy adults. We assessed the presence of behavioural features associated with motor imagery at the individual level, namely, the linear angle-response time (RT) relationship and the biomechanical constraints effect in the LJT and in the same-different judgement task (SDJT), in which people are not thought to use motor imagery. We found that at most 50% of participants showed both behavioural features in the palmar view condition of the LJT. Moreover, this proportion did not differ from that in the dorsal view condition of the LJT or that in both view conditions of the SDJT. These results demonstrate that a motor imagery-based strategy is not universally and specifically used to perform the LJT. Therefore, previous results of the LJT, in particular, regarding the biomechanical constraints effect, should be reinterpreted in light of our findings.

Cutoff Value for Short Form of Central Sensitization Inventory.

OBJECTIVES: This study aimed to determine the optimal cutoff score of the 9-item short version of the CSI, the CSI-9, by comparing patients with central sensitivity syndrome (CSS) not only to healthy volunteers as with the original version, but also to patients with musculoskeletal (MSK) disorders. METHODS: All participants filled out the CSI, EuroQol 5-dimension, Brief Pain Inventory, and Pain Catastrophizing Scale questionnaires. To identify a clinically relevant cutoff score, receiver operating characteristic analyses were conducted. The area under the curve was used to examine the ability of the CSI-9 to distinguish patients with fibromyalgia (FM) from patients with MSK disorders and healthy individuals. RESULTS: Twenty-six participants with FM, 30 patients with MSK disorders, and 28 healthy individuals were included. We determined 2 cutoff scores: 20 for distinguishing patients with FM from patients with MSK disorders and 17 for distinguishing patients with FM from healthy individuals. These cutoff scores had good sensitivity (patients with MSK disorders, 92.3%; healthy individuals, 96.2%) and specificity (patients with MSK disorders, 93.3%; healthy individuals, 100%). In addition, the patients who scored above the cutoff of 20 points exhibited worse clinical symptoms (higher pain intensity, higher pain interference, higher Pain Catastrophizing Scale scores, and lower EuroQol 5-dimension scores) than those who scored below it. Furthermore, a significantly higher number of subjects who scored more than 20 on the CSI-9 had a history of 2 or more diagnoses of CSS. CONCLUSION: The optimal CSI-9 cutoff score of 20 is beneficial to clinicians in the evaluation of central sensitization-related symptoms. The cutoff score helps to identify patients who need additional treatments, such as pain neuroscience education and cognitive behavioral therapy.

Perceived Body Distortion Rather Than Actual Body Distortion Is Associated With Chronic Low Back Pain in Adults With Cerebral Palsy: A Preliminary Investigation.

OBJECTIVES: The aim of the present study was to investigate whether distorted body perception is a feature of the low back pain (LBP) experience in people with cerebral palsy (CP) and whether any distortions noted are confounded by the presence of motor and postural impairments commonly seen in CP. METHODS: Forty-five individuals participated in this study: 15 adults with CP with LBP (CP_Pain group), 15 adults with CP without LBP (CP_noPain group), and 15 age-matched adults with LBP but no CP (Pain group). Body perception was evaluated using the Fremantle Back Awareness Questionnaire (FreBAQ) and by assessing 2-point discrimination thresholds over the low back. A comprehensive assessment of motor function was also undertaken in the CP population, and postural function was assessed in all 3 groups. RESULTS: Significant differences between the 3 groups were found for FreBAQ scores (P < 0.0001). The TPD threshold in the low back of the CP_Pain group was significantly larger than that of the CP_noPain group (P = 0.01), though we found no difference between the CP_noPain group and the Pain group (P = 0.21). We found no difference in motor or postural function between the 2 CP groups. DISCUSSION: The present results suggest that body image is disrupted in people with CP who experience LBP. The disruptions in perception were similar to those seen in people with LBP and no CP, suggesting that the distortions may be more related to the presence of pain than the presence of CP.

Difference in the impact of central sensitization on pain-related symptoms between patients with chronic low back pain and knee osteoarthritis.

Purpose: The aims of the present study were to investigate whether the association between the Central Sensitization Inventory (CSI) score, pain-related symptoms, pain-related disability, and health-related quality of life differed by disease (chronic low back pain [CLBP] vs knee osteoarthritis [KOA]), and to determine optimal cutoff scores for the CSI reflecting disease-specific characteristics. Patients and methods: A total of 104 patients with CLBP and 50 patients with KOA were recruited. Central sensitization-related symptoms (CSI), EuroQol 5-dimension (EQ-5D), Brief Pain Inventory, widespread pain (Widespread Pain Index [WPI]), pressure pain threshold (PPT), and temporal summation (TS) were assessed and compared between the CLBP and KOA groups. Univariate correlation analysis was performed in each group. The receiver operating characteristic (ROC) curve analysis was performed to identify 1) presence/absence of central sensitization (CS), 2) presence/absence of central sensitivity syndromes (CSSs), and 3) pain intensity and pain interference in each group. Results: The CSI and WPI scores were significantly higher in the CLBP group than in the KOA group. EQ-5D and pain interference scores significantly correlated with the CSI score in both the CLBP and KOA groups. The WPI score, PPT, and TS did not correlate with the CSI score in either the CLBP or KOA group. The suggested cutoff scores were 28 in the CLBP group and 17 in the KOA group to identify presence or absence of CSSs, and 34 in the CLBP group and 18-19 in the KOA group to identify pain severity. Conclusion: The impact of CS on pain could differ between CLBP and KOA and that cutoff scores differ by each parameter we attempted to identify. Therefore, we should use the appropriate cutoff scores for the purposes and consider the difference in the impact of CS on pain by the patient group.

The central sensitization inventory predict pain-related disability for musculoskeletal disorders in the primary care setting.

BACKGROUND: Central sensitization (CS) is found in patients with musculoskeletal disorders and is related to clinical symptoms, including pain-related disability. The Central Sensitization Inventory (CSI) has been developed for patients who are at risk of symptoms related to CS, and CSI severity levels are suggested for clinical interpretation of the CSI score. However, the longitudinal relationship between CSI severity and pain-related disability is unclear in primary care. In this study, we investigated the association between CSI severity levels and the profiles of patients with musculoskeletal disorders as well as the longitudinal relationship between CSI severity levels and pain-related disability in primary care settings. METHODS: A total of 553 patients were assessed using CSI, EuroQol-5 dimension (EQ5D), and Brief Pain Inventory (BPI). Of the 553 patients, 150 patients were reassessed at the 3-month follow-up. Patients were grouped into three severity levels according to baseline CSI score: subclinical, mild, and moderate to higher level. RESULTS: As the CSI severity levels increased, the clinical symptoms tended to worsen on cross-sectional analysis (p < 0.05). Pain-related disability at the 3-month follow-up was significantly higher for patients with moderate to high baseline CSI severity levels than for patients with subclinical baseline CSI levels (p < 0.001). Furthermore, pain-related disability increased according to the CSI severity level, with a medium to large effect size. However, there were no differences in pain duration across the CSI severity levels. CONCLUSIONS: CSI has clinical utility as a prediction tool regardless of pain duration in patients with musculoskeletal disorders in primary care settings. SIGNIFICANCE: Higher CSI severity levels predicted higher pain-related disability for patients with musculoskeletal disorders in a primary care setting. CSI is a clinically useful prediction tool in patients with musculoskeletal disorders.