Questionnaire reliably measures nociplastic pain across musculoskeletal conditions
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Key takeaways:
- The Central Aspects of Pain questionnaire was shown to be “a possible measurement tool for nociplastic pain.”
- The questionnaire had “high” reliability with “stable” group-level scores over 4 years.
An eight-item questionnaire, called Central Aspects of Pain, reliably measures nociplastic pain across a variety of chronically painful musculoskeletal conditions, according to data published in Rheumatology.
“Chronic pain is a symptom shared across many musculoskeletal conditions, even when disease management has been optimized,” Daniel F. McWilliams, PhD, of the Pain Center Versus Arthritis at the University of Nottingham, in the United Kingdom, and colleagues wrote. “Measurement of [central nervous system] aspects of pain is a prerequisite for understanding their mechanistic underpinning and their ability to predict future pain and responses to treatment.”
McWilliams and colleagues previously developed a knee pain questionnaire, called Central Aspects of Pain (CAP)-Knee, which “measures a unitary overarching factor [CAPf] that was associated with sensitivity,” they wrote. To draft a similar questionnaire useful across musculoskeletal conditions, the researchers modified CAP-Knee, replacing references to knees with references to joints. The result, called simply the CAP questionnaire, consists of eight self-reported items regarding depression, anxiety, catastrophizing, cognition, sleep, fatigue and a body pain manikin.
The researchers tested the CAP questionnaire in 3,579 patients (median age, 71 years) with joint pain who had been participating in the Investigating Musculoskeletal Health and Wellbeing survey, a community-based study in England’s East Midlands region. The participants — including 1,158 with osteoarthritis, 1,292 with back pain and 177 with fibromyalgia — each completed a questionnaire incorporating CAP between September 2020 and September 2021.
By analyzing pain sites identified on the manikins, the researchers identified a “convergent threshold” for widespread pain across conditions of at least 10 out of 26 potential pain sites. According to the researchers, the questionnaire was found to have “high” reliability, with an intraclass correlation coefficient of 0.89 (95% CI, 0.84-0.92). In addition, although group-level scores were stable through 4 years, but individuals “displayed significant temporal heterogeneity,” the researchers wrote.
“Low item missingness” and high participant-reported satisfaction indicated that the questionnaire was acceptable to participants in both paper and electronic forms, they added.
“We here extend our previous findings in people with knee pain to show that CAPf displays generalizable validity in people with pain at single or multiple index joints,” McWilliams and colleagues wrote.
We report the CAP questionnaire as a possible measurement tool for nociplastic pain,” they added. “Future research should test the mechanistic underpinning of CAP, and its ability to predict future pain and responses to treatment.”
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