St Vincent's University Hospital, Elm Park, Dublin, Ireland.
Clin J Pain. 2011 Oct;27(8):655-63. doi: 10.1097/AJP.0b013e318215f16a.
Empirical evidence of discriminative validity is required to justify the use of mechanisms-based classifications of musculoskeletal pain in clinical practice. The purpose of this study was to evaluate the discriminative validity of mechanisms-based classifications of pain by identifying discriminatory clusters of clinical criteria predictive of "nociceptive," "peripheral neuropathic," and "central sensitization" pain in patients with low back (± leg) pain disorders.
This study was a cross-sectional, between-patients design using the extreme-groups method. Four hundred sixty-four patients with low back (± leg) pain were assessed using a standardized assessment protocol. After each assessment, patients' pain was assigned a mechanisms-based classification. Clinicians then completed a clinical criteria checklist indicating the presence/absence of various clinical criteria.
Multivariate analyses using binary logistic regression with Bayesian model averaging identified a discriminative cluster of 7, 3, and 4 symptoms and signs predictive of a dominance of "nociceptive," "peripheral neuropathic," and "central sensitization" pain, respectively. Each cluster was found to have high levels of classification accuracy (sensitivity, specificity, positive/negative predictive values, positive/negative likelihood ratios).
By identifying a discriminatory cluster of symptoms and signs predictive of "nociceptive," "peripheral neuropathic," and "central" pain, this study provides some preliminary discriminative validity evidence for mechanisms-based classifications of musculoskeletal pain. Classification system validation requires the accumulation of validity evidence before their use in clinical practice can be recommended. Further studies are required to evaluate the construct and criterion validity of mechanisms-based classifications of musculoskeletal pain.
为了证明在临床实践中使用基于机制的肌肉骨骼疼痛分类是合理的，需要有辨别效度的实证证据。本研究的目的是通过确定预测“伤害感受性”、“周围神经性”和“中枢敏化”疼痛的临床标准的鉴别聚类，来评估基于机制的疼痛分类的辨别效度，这些患者患有下背部（±腿部）疼痛障碍。
这是一项使用极端分组法的横断面、患者间设计研究。464 名患有下背部（±腿部）疼痛的患者使用标准化评估方案进行评估。每次评估后，根据患者的疼痛情况对其进行基于机制的分类。然后，临床医生完成一份临床标准检查表，表明存在/不存在各种临床标准。
使用具有贝叶斯模型平均的二元逻辑回归的多变量分析，确定了 7、3 和 4 个症状和体征的鉴别聚类，分别预测“伤害感受性”、“周围神经性”和“中枢敏化”疼痛的主导地位。发现每个聚类的分类准确性都很高（灵敏度、特异性、阳性/阴性预测值、阳性/阴性似然比）。
通过确定预测“伤害感受性”、“周围神经性”和“中枢”疼痛的症状和体征的鉴别聚类，本研究为肌肉骨骼疼痛的基于机制的分类提供了一些初步的辨别效度证据。分类系统的验证需要在推荐其在临床实践中使用之前积累有效性证据。需要进一步的研究来评估肌肉骨骼疼痛的基于机制的分类的构念和标准效度。
