Central Sensitivity Is Associated with Poor Recovery of Pain: Prediction, Cluster, and Decision Tree Analyses

Abstract

The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.

Characterizing clinical progression in patients with musculoskeletal pain by pain severity and central sensitization-related symptoms

“…Third, this study could only examine the longitudinal course of CSS for one month. Some studies can assume that changes in CSS occur for one month 13 . Still, since some studies have found intervention effects over extended periods (3 or 6 months) 27 Therefore, the low number of participants who changed the group classification might be related to the short follow-up period.…”

“…CSI has been shown to be associated with pain severity 11 , and higher CSI scores have been reported to have a poorer prognosis 12 . The CSI score is important not only for the initial score but also for monitoring the amount of change, which is related to the prognostic value of pain 13 . However, CSI is not necessarily associated with pain severity, and there is a subgroup of patients with low pain but severe CSI 14 .…”

Investigation for Factors Affecting Body Perception Disturbance in Patients with Low Back Pain by Mechanism-Based Classification of Pain: A Cross-Sectional Study

“…Tese results may indicate that the factors leading to chronicity are more infuenced by body perception disturbance than by the disease duration itself. Tus, these factors may be used to predict chronicity [28].…”

Associations of Central Sensitization-Related Symptoms with Low Back Pain-Related Factors and Work Status in Caregivers

“…CSSs are an essential factor of pain that have been reported to mediate the relationship between psychological factors and pain [ 13 ]. In addition, patients with pain who do not show improvement in CSSs tend not to show improvement in pain [ 14 ]. Interestingly, CSSs have been reported as an independent factor associated with a substantially lower rate of work retention [ 15 ].…”