Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? - a diagnostic accuracy study.
Juliana Valentim Bittencourt, Eduardo Gallas Leivas, Arthur de Sá Ferreira and 1 others
PMID 37723541WHAT IT FOUND
PainDETECT scores below 19 correctly ruled out impaired pain modulation in most people.
However, the questionnaire failed to identify those with the impairment, showing low sensitivity and accuracy. It screens for neuropathic symptoms but does not detect pain modulation deficits.
Key findings
01PainDETECT scores below 19 were highly specific and had a high negative predictive value for ruling out impaired conditioned pain modulation.
02The questionnaire showed low sensitivity and low accuracy for detecting impaired conditioned pain modulation at both cutoff points.
03Participants with unclear or neuropathic-like painDETECT scores had lower pressure pain thresholds than those with nociceptive scores, both before and after cold water immersion.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The cold pressor test and painDETECT questionnaire are not gold standards for diagnosing impaired conditioned pain modulation or neuropathic pain. The study population was heterogeneous, including both acute and chronic pain conditions. The low prevalence of impaired conditioned pain modulation (19.4%) in the sample may have influenced the high negative predictive value. The study did not assess the reliability of the painDETECT for identifying specific central sensitisation phenotypes beyond pain modulation.
Declared interests
The authors declared no conflicts of interest. The study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.
The easy way to misread this
Do not use a high painDETECT score to diagnose impaired conditioned pain modulation. The questionnaire had very low sensitivity (21.6% at the 19-point cutoff), meaning it missed most people who actually had the impairment. It is useful for ruling out the condition when scores are low, but not for confirming it.