Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A Delphi expert consensus study

Muath A. Shraim; Kathleen A. Sluka; Michele Sterling; Lars Arendt-Nielsen; Charles Argoff; Karl S. Bagraith; Ralf Baron; Helena Brisby; Daniel B. Carr; Ruth L. Chimenti; Carol A. Courtney; Michele Curatolo; Beth D. Darnall; Jon J. Ford; Thomas Graven-Nielsen; Melissa C. Kolski; Eva Kosek; Richard E. Liebano; Shannon L. Merkle; Romy Parker; Felipe J.J. Reis; Keith Smart; Rob J.E.M. Smeets; Peter Svensson; Bronwyn L. Thompson; Rolf Detlef Treede; Takahiro Ushida; Owen D. Williamson; Paul W. Hodges

doi:10.1097/j.pain.0000000000002577

Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A Delphi expert consensus study

Muath A. Shraim, Kathleen A. Sluka, Michele Sterling, Lars Arendt-Nielsen, Charles Argoff, Karl S. Bagraith, Ralf Baron, Helena Brisby, Daniel B. Carr, Ruth L. Chimenti, Carol A. Courtney, Michele Curatolo, Beth D. Darnall, Jon J. Ford, Thomas Graven-Nielsen, Melissa C. Kolski, Eva Kosek, Richard E. Liebano, Shannon L. Merkle, Romy ParkerFelipe J.J. Reis, Keith Smart, Rob J.E.M. Smeets, Peter Svensson, Bronwyn L. Thompson, Rolf Detlef Treede, Takahiro Ushida, Owen D. Williamson, Paul W. Hodges^*

^*Corresponding author for this work

Physical Therapy and Human Movement Sciences

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination - 134 features, quantitative sensory testing - 34, imaging and diagnostic testing - 14, and pain-type questionnaires - 14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.

Original language	English (US)
Pages (from-to)	1812-1828
Number of pages	17
Journal	Pain
Volume	163
Issue number	9
DOIs	https://doi.org/10.1097/j.pain.0000000000002577
State	Published - Sep 1 2022

Funding

1. This study was supported by a Program Grant (APP1091302) from the National Health and Medical Research Council (NHMRC) of Australia. 2. M.A. Shraim was supported by a postgraduate scholarship from the University of Queensland. 3. P. Hodges was supported by a Fellowship (APP1102905) from the NHMRC. 4. M. Sterling was supported by an unrestricted grant from the Motor Accident Insurance Commission of Queensland. 5. K. Smart was supported by National Institutes of Health Grants R01 AR073187, U24 NS112873, and UH3 AR07638. 6. L. Arendt-Nielsen and T. Graven-Nielsen are part of Center for Neuroplasticity and Pain (CNAP), which is supported by the Danish National Research Foundation (DNRF121). 7. R.L. Chimenti was supported by the National Institute of Arthritis Musculoskeletal and Skin Disease of the National Institutes of Health (NIH) under award number R00AR071517. 8. B.D. Darnall was supported by National Institute on Drug Abuse (NIDA) K24 DA053564-01. 9. R.-D. Treede received support from Deutsche Forschungsgemeinschaft for collaborative research center (SFB 1158). 10. S.L. Merkle: The opinions or assertions contained in this study are the private views of the author(s) and are not to be construed as official or as reflecting the views of the United States Army or the Department of Defense.

Keywords

Clinical examination
Expert consensus
Imaging, Diagnostic tests
Pain mechanisms
Quantitative sensory testing
Questionnaires

ASJC Scopus subject areas

Neurology
Clinical Neurology
Anesthesiology and Pain Medicine

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Shraim, M. A., Sluka, K. A., Sterling, M., Arendt-Nielsen, L., Argoff, C., Bagraith, K. S., Baron, R., Brisby, H., Carr, D. B., Chimenti, R. L., Courtney, C. A., Curatolo, M., Darnall, B. D., Ford, J. J., Graven-Nielsen, T., Kolski, M. C., Kosek, E., Liebano, R. E., Merkle, S. L., ... Hodges, P. W. (2022). Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A Delphi expert consensus study. Pain, 163(9), 1812-1828. https://doi.org/10.1097/j.pain.0000000000002577

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abstract = "Classification of musculoskeletal pain based on underlying pain mechanisms (nociceptive, neuropathic, and nociplastic pain) is challenging. In the absence of a gold standard, verification of features that could aid in discrimination between these mechanisms in clinical practice and research depends on expert consensus. This Delphi expert consensus study aimed to: (1) identify features and assessment findings that are unique to a pain mechanism category or shared between no more than 2 categories and (2) develop a ranked list of candidate features that could potentially discriminate between pain mechanisms. A group of international experts were recruited based on their expertise in the field of pain. The Delphi process involved 2 rounds: round 1 assessed expert opinion on features that are unique to a pain mechanism category or shared between 2 (based on a 40% agreement threshold); and round 2 reviewed features that failed to reach consensus, evaluated additional features, and considered wording changes. Forty-nine international experts representing a wide range of disciplines participated. Consensus was reached for 196 of 292 features presented to the panel (clinical examination - 134 features, quantitative sensory testing - 34, imaging and diagnostic testing - 14, and pain-type questionnaires - 14). From the 196 features, consensus was reached for 76 features as unique to nociceptive (17), neuropathic (37), or nociplastic (22) pain mechanisms and 120 features as shared between pairs of pain mechanism categories (78 for neuropathic and nociplastic pain). This consensus study generated a list of potential candidate features that are likely to aid in discrimination between types of musculoskeletal pain.",

keywords = "Clinical examination, Expert consensus, Imaging, Diagnostic tests, Pain mechanisms, Quantitative sensory testing, Questionnaires",

author = "Shraim, {Muath A.} and Sluka, {Kathleen A.} and Michele Sterling and Lars Arendt-Nielsen and Charles Argoff and Bagraith, {Karl S.} and Ralf Baron and Helena Brisby and Carr, {Daniel B.} and Chimenti, {Ruth L.} and Courtney, {Carol A.} and Michele Curatolo and Darnall, {Beth D.} and Ford, {Jon J.} and Thomas Graven-Nielsen and Kolski, {Melissa C.} and Eva Kosek and Liebano, {Richard E.} and Merkle, {Shannon L.} and Romy Parker and Reis, {Felipe J.J.} and Keith Smart and Smeets, {Rob J.E.M.} and Peter Svensson and Thompson, {Bronwyn L.} and Treede, {Rolf Detlef} and Takahiro Ushida and Williamson, {Owen D.} and Hodges, {Paul W.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.",

year = "2022",

month = sep,

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doi = "10.1097/j.pain.0000000000002577",

language = "English (US)",

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Shraim, MA, Sluka, KA, Sterling, M, Arendt-Nielsen, L, Argoff, C, Bagraith, KS, Baron, R, Brisby, H, Carr, DB, Chimenti, RL, Courtney, CA, Curatolo, M, Darnall, BD, Ford, JJ, Graven-Nielsen, T, Kolski, MC, Kosek, E, Liebano, RE, Merkle, SL, Parker, R, Reis, FJJ, Smart, K, Smeets, RJEM, Svensson, P, Thompson, BL, Treede, RD, Ushida, T, Williamson, OD & Hodges, PW 2022, 'Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A Delphi expert consensus study', Pain, vol. 163, no. 9, pp. 1812-1828. https://doi.org/10.1097/j.pain.0000000000002577

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AU - Shraim, Muath A.

AU - Sluka, Kathleen A.

AU - Sterling, Michele

AU - Arendt-Nielsen, Lars

AU - Argoff, Charles

AU - Bagraith, Karl S.

AU - Baron, Ralf

AU - Brisby, Helena

AU - Carr, Daniel B.

AU - Chimenti, Ruth L.

AU - Courtney, Carol A.

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AU - Darnall, Beth D.

AU - Ford, Jon J.

AU - Graven-Nielsen, Thomas

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AU - Merkle, Shannon L.

AU - Parker, Romy

AU - Reis, Felipe J.J.

AU - Smart, Keith

AU - Smeets, Rob J.E.M.

AU - Svensson, Peter

AU - Thompson, Bronwyn L.

AU - Treede, Rolf Detlef

AU - Ushida, Takahiro

AU - Williamson, Owen D.

AU - Hodges, Paul W.

PY - 2022/9/1

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Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: A Delphi expert consensus study

Abstract

Funding

Keywords

ASJC Scopus subject areas

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