Abstract
ObjectivesCentral sensitization (CS) is regarded as an important contributing factor for chronification of musculoskeletal pain (MSP). It is crucial to identify CS, as targeted multimodal treatment may be indicated. The primary objective of this study was therefore to explore pain experience of individuals with MSP+CS in order to gain a better understanding of symptoms in relation to CS from a patient perspective. The secondary objective was to investigate whether pain experiences of patients with MSP+CS differ from those of individuals with neuropathic pain (NP).MethodsWe conducted a comparative Group Delphi Study including patients with MSP+CS and neuropathic pain (NP). 13 guiding questions were used to gather information about sensory discriminatory, affective and associated bodily, mental and emotional phenomena related to the pain experience of patients. Descriptions were categorized using qualitative content analysis. Additionally, patients completed several pain related questionnaires.ResultsNine participants with MSP+CS and nine participants with NP participated. The Delphi procedure revealed three main themes: psycho-emotional factors, bodily factors and environmental factors. Descriptions of patients with MSP+CS showed a complex picture, psycho-emotional factors seem to have a considerable impact on pain provocation, aggravation and relief. Impairments associated with mental ability and psyche affected many aspects of daily life. In contrast, descriptions of patients with NP revealed a rather mechanistic and bodily oriented pain experience.DiscussionPatients with MSP+CS reported distinct features in relation to their pain that were not captured with current questionnaires. Insight in patient’s pain experience may help to choose and develop appropriate diagnostic instruments.
Highlights
Musculoskeletal pain (MSP) such as low back, neck or shoulder pain is the most common reason for pain in general and contributes significantly to health related costs in western industrialized countries, second only to cardiovascular diseases [1]
Descriptions of patients with MSP+Central sensitization (CS) showed a complex picture, psychoemotional factors seem to have a considerable impact on pain provocation, aggravation and relief
Patients with MSP+CS are affected by associated phenomena relating to psychological and mental impairments, concentration, vigilance, motivation and communication
Summary
Musculoskeletal pain (MSP) such as low back, neck or shoulder pain is the most common reason for pain in general and contributes significantly to health related costs in western industrialized countries, second only to cardiovascular diseases [1]. Reasons for chronification are multidimensional, as many biopsychosocial mechanisms contribute to the condition in each individual patient. Central sensitization is regarded as the most important pain mechanism contributing to chronification of musculoskeletal pain [5]. Patients with CS possibly should avoid further nociceptive input from pain provoking aggressive interventions or too vigorous physical activities [8]. These could potentially aggravate the problem, as more input could lead to further augmentation of the pain system. Instead, interdisciplinary interventions such as graded activity exposure, cognitive behavioural treatment or pharmacological treatment have been recommended allowing tailored and gradual activation and possibly "desensitisation" [9]
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