The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia.
Centre Interdisciplinaire de recherche en réadaptation et Integration sociale (CIRRIS), Université Laval, Québec, QC, Canada.
Pain. 2021 Apr 1;162(4):1007-1037. doi: 10.1097/j.pain.0000000000002113.
Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
疼痛的机制分类已被广泛提倡，以帮助针对持续的肌肉骨骼疼痛患者量身定制干预措施。国际疼痛研究协会定义了三种疼痛机制类别（PMCs）：伤害感受性疼痛、神经性疼痛和神经病理性疼痛。它们之间的区分仍然具有挑战性。本研究旨在基于为汇聚 PMCs 相关文献而开发的框架，系统地回顾用于区分它们的方法；综合并对这些方法进行主题分析，以确定意见的趋同和分歧；并报告这些方法的验证、心理测量特性以及优缺点。搜索策略确定了讨论用于区分肌肉骨骼系统中基于机制的疼痛类别的方法的文章。评估了用于区分类别的方法的有效性的研究对其质量进行了评估。对 184 篇文章进行了提取和主题分析。数据综合确定了 5 个主题中的 200 种方法：临床检查、定量感觉测试、成像、诊断和实验室测试以及疼痛类型问卷。很少有方法经过验证可用于区分 PMCs。尽管在区分 PMCs 的发现方面存在普遍共识，但也存在一些分歧。通常建议结合特征和方法，而不是单一方法，来区分 PMCs。确定了两个主要局限性：由于混合表现，方法在类别之间的发现存在重叠，并且许多方法被认为可以区分 2 种 PMCs，但不能区分其他 PMCs。本综述的结果为改进区分肌肉骨骼疼痛机制的方法提供了基础。
