A Systematic Review of Chronic Pain Mechanism Differential Assessment Strategies for Physical Therapy
Roger Allen, PhD, PT
Recently, the International Association for the Study of Pain (IASP) redefined pain, the American Physical Therapy Association proposed pain education guidelines, and a new pain mechanism category (PMC) was defined as “nociplastic pain”. IASP defines three PMCs - nociceptive, neuroplastic, and nociplastic.
Identify current clinical assessment strategies for differentiating between nociceptive, neuropathic, and nociplastic chronic pain, feasible for implementation by physical therapists (PTs).
In 2020, investigators independently searched databases for studies evaluating assessment methods differentiating “nociceptive,” “neuropathic,” “central,” “mixed pain” and “central sensitization,” with follow-up on “nociplastic pain”. A qualitative systematic review was performed utilizing defined inclusion and exclusion criteria, priori criteria for independent evaluation of search result abstracts, blind voting that resulted in inclusion of 91 articles, and a piloted form for data extraction.
PMC assessments were categorized into 4 strategies, recommending combined strategies for meaningful diagnosis. 30% of articles analyzed PMCs per specific pathology, while debating pathology-based pain phenotyping and assessment. PMC nociplastic studies’ agreements included: PMC diagnostic features may be shared, they are not always independent, and may evolve into a blended continuum as chronic pain develops. Studies presented PMC conceptualization, highlighting terminology inconsistencies and understanding amongst researchers, clinicians, and educators.
High quality research is emerging to inform the physical therapy clinician on differential assessment strategies for pain mechanisms in chronic pain patients. The ability for PTs to assess and treat chronic pain is challenged by the current lack of continuity within PMC education, terminology, and difficulty of in vivo research on the subject.
University of Puget Sound
Hovde, Kate SPT; Li, Kenny DPT; Wong, Kylie BS; and Allen, Roger PhD, PT, "A Systematic Review of Chronic Pain Mechanism Differential Assessment Strategies for Physical Therapy" (2022). Physical Therapy Research Symposium. 69.