Diagnostic properties of the paindetect questionnaire for identifying descending inhibitory system deficiency in patients with musculoskeletal pain

Abstract

Introduction: The identification of central sensitization is an essential aspect in the management of patients with chronic pain. Several methods, including self-reported and physiological measurements, were developed. The perception of pain characteristics of patients with central sensitization resembles the description of the pain of patients with neuropathic pain in several cases. However, the ability of the painDETECT questionnaire to identify the presence of central sensitization in patients with musculoskeletal pain has not yet been verified. Objective: To analyze the diagnostic properties of the painDETECT questionnaire for the identification of central sensitization by compromising the descending inhibitory pathway of patients with musculoskeletal pain. Methods: A diagnostic accuracy study was conducted with 311 patients selected from physiotherapy outpatient clinics with musculoskeletal pain. Participants completed the painDETECT questionnaire and performed the Cold Pressor Test (CPT), which was used as a measurement criterion for inhibitory system deficiency. Four painDETECT cut-off points were analyzed, two associated with the presence of scattered pain. Sensitivity, specificity, positive and negative predictive values, accuracy were calculated in addition to the ROC curve analysis. Results: A total of 61 (19.61%) patients had impairment of the descending inhibitory pathway in cold pressor test. Patients with a scored above 19 combined with painDETECT scattered pain have a higher level of diagnostic accuracy with sensitivity of 22.64% (95% CI 12.28 - 36.21), specificity 81.18% ( 95% CI 75.83 - 85.78), 71.10% accuracy (95% CI 65.69 - 76.10), positive predictive value was 20.00% (95% CI 12.51 - 30, 42), negative predictive value found was 83.43% (95% CI 81.18 - 85.52), positive likelihood ratio 1.20 (95% CI 0.69 - 2.10) and likelihood ratio negative, 95 (95% CI 0.81 - 1.12). Conclusion: The painDETECT questionnaire is an instrument that can be used to confirm descending inhibitory system deficiency in patients with musculoskeletal pain, but it is not recommended as a screening tool for this condition.