den Boer Carine, Krak Zola, Terluin Berend, van der Wouden Johannes C, Blankenstein Annette H, van der Horst Henriëtte E
Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
BMC Prim Care. 2024 Dec 27;25(1):439. doi: 10.1186/s12875-024-02686-w.
General practitioners (GPs) often face challenges in explaining to patients with persistent physical symptoms (PPS) why their symptoms persist. Providing an explanation of the central sensitisation (CS) mechanism to patients could be helpful, yet GPs do not routinely test for signs of CS in these patients. The aim of this study was to explore the value of applying a test to assess CS in enhancing explanations provided to patients.
In this prospective study, 25 GPs applied three tests, selected through a Delphi study, to assess CS-related symptoms: (1) the Central Sensitisation Inventory (CSI); (2) an algometer for measuring pressure pain thresholds (PPT); and (3) a monofilament for assessing temporal summation. Following the tests, both the GP and the patient completed a short questionnaire. Subsequently, GPs shared their experiences in focus groups and interviews, while a sample of patients was interviewed individually. The questionnaires were analysed quantitatively, and the focus groups and interviews were analysed qualitatively.
GPs reported that all tests were feasible to perform during consultations; testing took less than 5 min in 25% of cases and between 5 and 10 min in 60% of cases. In approximately 50% of cases, an additional consultation was required to perform the test. The results of the CSI confirmed CS-related symptoms more frequently (74%) than the algometer (46%) and the monofilament (43%). Consequently, many GPs preferred the CSI. Patients did not show a preference for any specific test; two-third found the tests valuable and approximately 50% reported that the explanation of CS was clearer when a test was used.
Testing during the consultation was feasible, although an additional consultation was required in 50% of the cases. GPs preferred the CSI because its results confirmed CS-related symptoms more frequently than those from the algometer and monofilament.
全科医生（GP）在向患有持续性躯体症状（PPS）的患者解释其症状为何持续存在时常常面临挑战。向患者解释中枢敏化（CS）机制可能会有所帮助，但全科医生通常不会对这些患者进行CS体征的常规检查。本研究的目的是探讨应用一项测试来评估CS在增强向患者提供的解释方面的价值。
在这项前瞻性研究中，25名全科医生应用了通过德尔菲研究选定的三项测试来评估与CS相关的症状：（1）中枢敏化量表（CSI）；（2）用于测量压痛阈值（PPT）的压力痛觉计；（3）用于评估时间总和的单丝。测试后，全科医生和患者都完成了一份简短的问卷。随后，全科医生在焦点小组和访谈中分享了他们的经验，同时对一部分患者进行了单独访谈。对问卷进行了定量分析，对焦点小组和访谈进行了定性分析。
全科医生报告称，所有测试在会诊期间都可行；25%的病例测试用时不到5分钟，60%的病例用时在5至10分钟之间。在大约50%的病例中，需要额外的会诊来进行测试。CSI的结果比压力痛觉计（46%）和单丝（43%）更频繁地证实了与CS相关的症状（74%）。因此，许多全科医生更喜欢CSI。患者对任何特定测试都没有表现出偏好；三分之二的患者认为这些测试有价值，约50%的患者报告说使用测试时对CS的解释更清晰。
会诊期间进行测试是可行的，尽管50%的病例需要额外的会诊。全科医生更喜欢CSI，因为其结果比压力痛觉计和单丝的结果更频繁地证实了与CS相关的症状。
