Abstract
Objectives. We compared two index screening tests for early diagnosis of functional pain: pressure pain measurement by electronic diagnostic equipment, which is accurate but too specialized for primary health care, versus peg testing, which is cost-saving and more easily manageable but of unknown sensitivity and specificity. Early distinction of functional (altered pain perception; nervous sensitization) from neuropathic or nociceptive pain improves pain management. Methods. Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes. All consenting patients referred to a university hospital for nonmalignant musculoskeletal pain participated. The main analysis compared the receiver operating characteristic (ROC) curves of both index screening tests. Results. The area under the ROC curve for peg testing was not inferior to that of electronic equipment: it was at least 95% as large for finger measures (two-sided p = 0.038) and at least equally as large for ear measures (two-sided p = 0.003). Conclusions. Routine diagnostic testing by peg, which is accessible for general practitioners, is at least as accurate as specialized equipment. This may shorten time-to-treatment in general practices, thereby improving the prognosis and quality of life.
Highlights
The lifetime prevalence of chronic nonmalignant musculoskeletal pain varies between 13.5% and 47% in the general population [1]
Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes
We found that finger peg algometry is at least 95% as reliable as finger electronic algometry in distinguishing functional from nociceptive and neuropathic musculoskeletal pain, and we found that ear peg algometry is even good or better than ear electronic algometry
Summary
The lifetime prevalence of chronic nonmalignant musculoskeletal pain varies between 13.5% and 47% in the general population [1]. In one-third of these patients, this pain is “functional,” which is defined as not explainable by lesions or inflammations of tissues or nerves [2, 3]. Functional pain requires specialized multicomponent management involving physical exercise, activating physiotherapy, electrical, thermal, and tactile stimulation, relaxation techniques, psychological support, tricyclic antidepressants, and muscle relaxants [4]. Functional pain may occur as an isolated entity or as the dominant symptom of “central sensitivity syndromes” such as fibromyalgia [5, 6], whereby the functional alteration of the nervous system is probably involved [7, 8]. A delay of eight years on average to classify pain as either functional, nociceptive, or neuropathic increases expenditures and reduces the prognosis and the quality of life of
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