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Clinical Diagnosis and Treatment of Chronic Pain

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 20788

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Dr. Ferran Cuenca-Martínez

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Guest Editor

Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
Interests: motor imagery; action observation; motor learning
Special Issues, Collections and Topics in MDPI journals

Dr. Luis Suso-Martí

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Guest Editor

Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
Interests: mental practice; chronic pain; pain diagnostic; pain severity
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Chronic pain is a current public health problem, and countries are spending large amounts of money on its management. The approach seems unclear because it meets a multidimensional problem that must be encompassed in the patient-centered model from a biopsychosocial paradigm. Currently, more than 85% of chronic pain problems are non-specific in origin. This indicates that imaging tests do not provide clear information to establish an accurate pathoanatomical diagnosis. The process of pain chronification is complex, and seems to involve different causative factors, including molecular, individual, and social aspects. We need high-quality research to address the issue of chronic pain diagnosis in order to subclassify patients and try to make better diagnoses and, consequently, better treatments—especially more specific treatments in order to improve the quality of life and activities of daily living in patients with chronic pain.

This Special Issue is aimed at researchers investigating the diagnosis of chronic pain processes including imaging and neuroimaging tests, somatosensory assessments, clinical prediction models, reviews dealing with chronic pain diagnosis, pain subclassifications, etc., as well as those dealing with chronic pain treatments after a more precise and updated diagnosis with respect to large groupings of chronic pain populations that continue to be labelled under the word “non-specific”. With this Special Issue we hope to shed light on this important subject where chronic pain itself is already understood as a clinical entity in itself.

Dr. Ferran Cuenca-Martínez
Dr. Luis Suso-Martí
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

chronic pain
pain diagnostics
pain classification
pain management
pain approach
biopsychosocial

Published Papers (9 papers)

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Research

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11 pages, 540 KiB

Open AccessArticle

Oral Glucocorticoid Use and Long-Term Mortality in Patients with Chronic Musculoskeletal Non-Cancer Pain: A Cross-Sectional Cohort Study

by Hey-Ran Choi, In-Ae Song and Tak Kyu Oh

Diagnostics 2023, 13(15), 2521; https://doi.org/10.3390/diagnostics13152521 - 28 Jul 2023

Viewed by 877

Abstract

This study aimed to examine the associated factors of oral glucocorticoid (GC) use in patients with chronic non-cancer pain (CNCP) associated with musculoskeletal diseases (MSDs) in South Korea. Moreover, we examined whether oral GC use was associated with long-term mortality in patients with CNCP. This population-based cohort study used data from the national registration database in South Korea. Using a stratified random sampling technique, we extracted the data from 2.5% of adult patients diagnosed with MSDs in 2010. Patients with CNCP-associated MSDs who were prescribed oral GC regularly for ≥30 days were defined as GC users, while the other patients were considered to be non-GC users. A total of 1,804,019 patients with CNCP were included in the final analysis, and 9038 (0.5%) patients were GC users, while 1,794,981 (95.5%) patients were non-GC users. Some factors (old age, comorbid status, pain medication use, and MSD) were associated with GC use among patients with CNCP. Moreover, in the multivariable time-dependent Cox regression model, GC users showed a 1.45-fold higher 10-year all-cause mortality (hazard ratio: 1.45, 95% confidence interval: 1.36–1.54; p < 0.001) than non-GC users. In South Korea, the 10-year all-cause mortality risk increased in the patients with CNCP using GC. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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13 pages, 293 KiB

Open AccessArticle

Pressure Pain Thresholds and Central Sensitization in Relation to Psychosocial Predictors of Chronicity in Low Back Pain

by Anke Steinmetz, Franziska Hacke and Karl-Stefan Delank

Diagnostics 2023, 13(4), 786; https://doi.org/10.3390/diagnostics13040786 - 19 Feb 2023

Cited by 4 | Viewed by 2169

Abstract

(1) Background: Peripheral, as well as central, sensitization have been described in chronic low back pain (cLBP). The purpose of this study is to investigate the influence of psychosocial factors on the development of central sensitization. (2) Methods: This prospective study investigated local and peripheral pressure pain thresholds and their dependence on psychosocial risk factors in patients with cLBP receiving inpatient multimodal pain therapy. Psychosocial factors were assessed using the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). (3) Results: A total of 90 patients were included in the study, 61 (75.4% women, 24.6% men) of whom had significant psychosocial risk factors. The control group consisted of 29 patients (62.1% women, 37.9% men). At baseline, patients with psychosocial risk factors showed significantly lower local and peripheral pressure pain thresholds, suggesting central sensitization, compared to the control group. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), was also correlated with altered PPTs. After multimodal therapy, all participants reported increased local pain thresholds compared to at admission, independent of psychosocial chronification factors. (4) Conclusions: Psychosocial chronicity factors measured using the ÖMPSQ have a significant influence on pain sensitization in cLBP. A 14-day multimodal pain therapy increased local, but not peripheral, pressure pain thresholds. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

13 pages, 1380 KiB

Open AccessArticle

Osteomyelitis of the Lower Limb: Diagnostic Accuracy of Dual-Energy CT versus MRI

by Giovanni Foti, Chiara Longo, Claudia Sorgato, Eugenio Simone Oliboni, Cristina Mazzi, Leonardo Motta, Giulia Bertoli and Stefania Marocco

Diagnostics 2023, 13(4), 703; https://doi.org/10.3390/diagnostics13040703 - 13 Feb 2023

Cited by 3 | Viewed by 1822

Abstract

Background: MRI is the preferred imaging technique for the identification of osteomyelitis. The key element for diagnosis is the presence of bone marrow edema (BME). Dual-energy CT (DECT) is an alternative tool which is able to identify BME in the lower limb. Purpose: To compare the diagnostic performance of DECT and MRI for osteomyelitis, using clinical, microbiological, and imaging data as reference standards. Materials and Methods: This prospective single-center study enrolled consecutive patients with suspected bone infections undergoing DECT and MRI imaging from December 2020 to June 2022. Four blinded radiologists with various experience levels (range of 3-21 years) evaluated the imaging findings. Osteomyelitis was diagnosed in the presence of BMEs, abscesses, sinus tracts, bone reabsorption, or gaseous elements. The sensitivity, specificity, and AUC values of each method were determined and compared using a multi-reader multi-case analysis. A p value < 0.05 was considered significant. Results: In total, 44 study participants (mean age 62.5 years ± 16.5 [SD], 32 men) were evaluated. Osteomyelitis was diagnosed in 32 participants. For the MRI, the mean sensitivity and specificity were 89.1% and 87.5%, while for the DECT they were 89.0% and 72.9%, respectively. The DECT demonstrated a good diagnostic performance (AUC = 0.88), compared with the MRI (AUC = 0.92) (p = 0.12). When considering each imaging finding alone, the best accuracy was achieved by considering BME (AUC for DECT 0.85 versus AUC of MRI of 0.93, with p = 0.07), followed by the presence of bone erosions (AUC 0.77 for DECT and 0.53 for MRI, with p = 0.02). The inter-reader agreement of the DECT (k = 88) was similar to that of the MRI (k = 90). Conclusion: Dual-energy CT demonstrated a good diagnostic performance in detecting osteomyelitis. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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11 pages, 926 KiB

Open AccessArticle

Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID

by Rodrigo Núñez-Cortés, Cristina Flor-Rufino, Francisco Miguel Martínez-Arnau, Anna Arnal-Gómez, Claudia Espinoza-Bravo, David Hernández-Guillén and Sara Cortés-Amador

Diagnostics 2023, 13(1), 24; https://doi.org/10.3390/diagnostics13010024 - 21 Dec 2022

Cited by 3 | Viewed by 1857

Abstract

Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0–10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0–10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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52 pages, 9428 KiB

Open AccessArticle

Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study

by Ana Serrano-Imedio, Cesar Calvo-Lobo, Coraima Casañas-Martin, Alejandro Garrido-Marin and Daniel Pecos-Martin

Diagnostics 2022, 12(11), 2723; https://doi.org/10.3390/diagnostics12112723 - 07 Nov 2022

Viewed by 6676

Abstract

There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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16 pages, 1193 KiB

Open AccessArticle

Screening Clinical Changes for the Diagnosis of Early Knee Osteoarthritis: A Cross-Sectional Observational Study

by Ana Alabajos-Cea, Luz Herrero-Manley, Luis Suso-Martí, Núria Sempere-Rubio, Ferran Cuenca-Martínez, Vicente Muñoz-Alarcos, Juan Alonso Pérez-Barquero, Enrique Viosca-Herrero and Isabel Vázquez-Arce

Diagnostics 2022, 12(11), 2631; https://doi.org/10.3390/diagnostics12112631 - 30 Oct 2022

Cited by 1 | Viewed by 1388

Abstract

Background: The main objective was to evaluate differences in the clinical, motor, or functional variables in patients with Early Osteoarthritis (EOA) and individuals at risk of developing osteoarthritis (OA). Methods: A cross-sectional study was performed. All the participants were divided into two groups: EOA patients and healthy subjects (HS) at risk of developing OA. The main outcomes were clinical tests, such as those of knee morphology, instability, or proprioception; motor and functional variables, such as knee strength, range of motion, walking speed, and the sit-to-stand test; pain and disability, assessed through the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Knee injury and Osteoarthritis Outcome Score (KOOS) scales; and knee alignment and leg length inequality, assessed via X-ray images. Results: A total of 97 participants were included (54 EOA and 43 HS). Patients with EOA showed a greater presence of knee pain (p < 0.01). In addition, more EOA patients showed instability both in the left (p < 0.01) and right legs (p < 0.05). Regarding the knee alignment variable, significant differences were found (p < 0.04), with more patients with EOA diagnosed as possessing a varus alignment. In addition, EOA patients showed lower knee strength, since statistically significant differences were found regarding flexion and extension strength in the left leg (Mean Difference (MD): 12.92; p = 0.03; d = −0.46 and MD:7.81; p = 0.04; d = −0.39). Differences were found for the sit-to-stand test scores, showing lower results for the EOA group (MD: −1.91; p < 0.01; d = 0.54). Conclusions: The results of this research show statistically significant differences between patients with EOA and HS at risk of developing OA with respect to pain, disability, instability, knee strength, and the sit-to-stand test. Our results suggest that the evaluation of clinical, motor, and functional features could contribute to an early management of knee OA. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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11 pages, 1408 KiB

Open AccessArticle

Network Analysis Reveals That Headache-Related, Psychological and Psycho–Physical Outcomes Represent Different Aspects in Women with Migraine

by César Fernández-de-las-Peñas, Lidiane L. Florencio, Umut Varol, Juan A. Pareja, Carlos Ordás-Bandera and Juan A. Valera-Calero

Diagnostics 2022, 12(10), 2318; https://doi.org/10.3390/diagnostics12102318 - 26 Sep 2022

Cited by 1 | Viewed by 1269

Abstract

Evidence supports that migraine is a complex pain condition with different underlying mechanisms. We aimed to quantify potential associations between demographic, migraine-related, and psychophysical and psychophysical variables in women with migraine. Demographic (age, height, and weight), migraine-related (intensity, frequency, and duration), related-disability (Migraine Disability Assessment Scale, Headache Disability Inventory), psychological (Hospital Anxiety and Depression Scale), and psycho–physical (pressure pain thresholds -PPTs-) variables were collected from a sample of 74 women suffering from migraine. We calculated adjusted correlations between the variables by using a network analysis. Additionally, we also calculated centrality indices to identify the connectivity among the variables within the network and the relevance of each variable in the network. Multiple positive correlations (

ρ

) between PPTs were observed ranging from 0.1654 (C5-C6 and tibialis anterior) to 0.40 (hand and temporalis muscle). The strongest associations within the network were those between migraine attack frequency and diagnosis of chronic migraine (

ρ

= 0.634) and between the HDI-E and HDI-P (

ρ

= 0.545). The node with the highest strength and betweenness centrality was PPT at the second metacarpal, whereas the node with the highest harmonic centrality was PPT at the tibialis anterior muscle. This is the first study applying a network analysis to understand the underlying mechanisms in migraine. The identified network revealed that a model where each subgroup of migraine-related, psychological, and psycho–physical variables showed no interaction between each variable. Current findings could have clinical implications for developing multimodal treatments targeting the identified mechanisms. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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Review

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12 pages, 285 KiB

Open AccessReview

Clinical Diagnosis and Treatment of Chronic Pain

by Sadiq Rahman, Ali Kidwai, Emiliya Rakhamimova, Murad Elias, William Caldwell and Sergio D. Bergese

Diagnostics 2023, 13(24), 3689; https://doi.org/10.3390/diagnostics13243689 - 18 Dec 2023

Viewed by 1545

Abstract

More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

Other

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31 pages, 3933 KiB

Open AccessSystematic Review

Effects of High-Intensity Interval Training (HIIT) on Patients with Musculoskeletal Disorders: A Systematic Review and Meta-Analysis with a Meta-Regression and Mapping Report

by Ferran Cuenca-Martínez, Núria Sempere-Rubio, Clovis Varangot-Reille, Josué Fernández-Carnero, Luis Suso-Martí, Patricio Alba-Quesada and Roy La Touche

Diagnostics 2022, 12(10), 2532; https://doi.org/10.3390/diagnostics12102532 - 19 Oct 2022

Cited by 4 | Viewed by 2302

Abstract

The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO₂ max), disability, and quality of life (QoL). We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect (SMD = −0.73; 95% CI: −1.40–−0.06), and in VO₂ max, with a moderate clinical-effect (SMD = 0.69; 95% CI: 0.42–0.97). However, the meta-analysis showed no statistically significant results for disability (SMD = −0.34; 95% CI: −0.92–0.24) and QoL (SMD = 0.40; 95% CI: −0.80–1.60). We compared HIIT against other exercise models for reducing pain intensity and increasing VO₂ max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO₂ max (R² = 82.99%, p = 0.003). There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO₂ max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO₂ max. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Chronic Pain)

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