Tests for central sensitization in general practice: a Delphi study, 2021, den Boer et al

Abstract

Introduction

Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice.

Methods
We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice.

Results
In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale.

Conclusion
In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.

Open access, https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-021-01539-0

 

Paper includes this,
"Nevertheless, there are disadvantages of the CSI [Central Sensitization Inventory]. First, it was developed to measure central sensitivity syndromes (CSS), which is not quite the same as central sensitization. CSS are syndromes like fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. These syndromes share common symptoms and CS is one of the underlying mechanisms in the development of CSS, but not the only one.."

 

Carine den Boer is a Dutch GP who was also involved in the MUS guidelines. I'm not a fan and after this paper even less so.