The concept "nociplastic pain" has been developed for patients with features of nociceptive system sensitization that are not explained as nociceptive or neuropathic. Here, we tested how well the recently published grading system differentiates between chronic primary and secondary pain conditions. We recruited patients with fibromyalgia (FMS, n = 41), complex regional pain syndrome (CRPS, n = 11), osteoarthritis (OA, n = 21), or peripheral nerve injury (PNI, n = 8). We used clinical history, pain drawings, quantitative sensory testing (QST), and questionnaires to classify their pains as possibly or probably "nociplastic." All patients with chronic primary pain exhibited widespread/regional pain not explainable by either nociceptive or neuropathic mechanisms. Widespread pain occurred in 12 patients with OA but was identified as nociceptive in 11 of 12. Regional pain occurred in 4 patients with PNI but was identified as neuropathic in 3 of 4. At this step, the grading system had 100% sensitivity and 93% specificity. Clinical evidence for pain hypersensitivity by QST, and history of hypersensitivity and mental comorbidities did not differentiate between chronic primary pain (QST: 36/52 = 69%, history: 43/52 = 83%) and secondary pain conditions (QST: 20/29 = 69%, history: 24/29 83%). Based on these data, specificity remained excellent (93%), but sensitivity dropped substantially (60%) due to lacking evidence for pain hypersensitivity in many patients with FMS. This low sensitivity suggests that the published grading system is not suitable for screening purposes. We suggest structural and content modifications to improve sensitivity, including placement of patient history before clinical examination and addition of a high tender point count as evidence for widespread pain hypersensitivity.

中文翻译：

---

“伤害性疼痛”分级系统在慢性原发性和慢性继发性疼痛中的应用：现场研究。


“伤害性疼痛”这一概念是针对具有伤害性系统敏化特征但不能解释为伤害性或神经性疼痛的患者而开发的。在这里，我们测试了最近发布的分级系统区分慢性原发性和继发性疼痛的效果。我们招募了患有纤维肌痛（FMS，n = 41）、复杂区域疼痛综合征（CRPS，n = 11）、骨关节炎（OA，n = 21）或周围神经损伤（PNI，n = 8）的患者。我们使用临床病史、疼痛图、定量感觉测试（QST）和问卷调查将他们的疼痛分类为可能或很可能是“伤害性疼痛”。所有患有慢性原发性疼痛的患者均表现出无法用伤害性或神经病理性机制解释的广泛/区域疼痛。 12 名 OA 患者出现广泛性疼痛，但 12 名患者中的 11 名被确定为伤害性疼痛。4 名 PNI 患者出现局部疼痛，但 4 名患者中的 3 名被确定为神经性疼痛。在这一步，分级系统的敏感性为 100%，准确度为 93%特异性。通过 QST 得出的疼痛超敏反应的临床证据以及超敏反应史和精神合并症并不能区分慢性原发性疼痛（QST：36/52 = 69%，病史：43/52 = 83%）和继发性疼痛状况（QST：20/ 29 = 69%，历史：24/29 83%）。基于这些数据，特异性仍然很好（93%），但由于缺乏许多 FMS 患者疼痛过敏的证据，敏感性大幅下降（60%）。这种低敏感性表明已发布的分级系统不适合筛选目的。 我们建议修改结构和内容以提高敏感性，包括在临床检查前放置患者病史以及添加高压痛点计数作为广泛疼痛超敏反应的证据。