Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Gagnier, Joel J. Department of Epidemiology and Biostatistics and Department of Surgery, Schulich School of Medicine & Dentistry, Western University

2nd Supervisor

Karp, Igor Department of Epidemiology and Biostatistics, Western University

Abstract

Objective: To identify available patient-reported outcome measures (PROMs) used to evaluate central sensitization (CS) manifestations in chronic pain conditions and evaluate the quality of psychometric properties of those instruments.

Methods: A comprehensive search was conducted across multiple databases. Methodological quality and psychometric properties were assessed and summarized using the COSMIN checklist and scoring manual.

Results: A total of fifty-eight studies addressing eight PROMs were identified. The Central Sensitization Inventory (CSI) received the highest overall ratings for most measurement properties among all the instruments, followed by the Pain Sensitivity Questionnaire and Fibromyalgia Survey Questionnaire. Based on pooled data, the test-retest reliability of the CSI was found to be excellent, with an intra-class correlation coefficient of 0.93 (95% CI: 0.91- 0.95) for overall chronic pain conditions.

Conclusion: CSI could be a reliable PROM for chronic pain with CS. More studies should be performed to comprehensively evaluate all measurement properties of the PROMs.

Summary for Lay Audience

Background: Chronic pain is a prevalent public health issue. An underlying pathophysiological mechanism of many chronic pain conditions is central sensitization (CS) in which the central nervous system becomes overly sensitive, leading to persistent pain even without obvious tissue injury. To effectively evaluate treatment outcomes in managing chronic pain with CS, healthcare providers need reliable and valid tools to measure the severity and impact of pain. These tools, known as patient-reported outcome measures (PROMs), are questionnaires that patients fill out to describe their pain experience and outcome of care. However, it’s crucial to assess the quality of a PROM to ensure that it can accurately measure what it intends to measure i.e., validity and produce consistent results i.e., reliability. This study focused on identifying various PROMs used to assess CS manifestations in chronic pain conditions and evaluated those PROMs' quality of measurement properties.

Methods: A comprehensive search was conducted across multiple databases for relevant articles. The methodological quality of studies and psychometric properties of PROMs were assessed and summarized using the COSMIN checklist and scoring manual which is a consensus-based and well-accepted guideline.

Results: A total of fifty-eight studies with eight instruments were identified. Most identified PROMs have limited evidence regarding their psychometric properties. The Central Sensitization Inventory (CSI) received the highest overall ratings for most measurement properties among all the instruments, followed by Pain Sensitivity Questionnaire and Fibromyalgia Survey Questionnaire. Based on pooled data from available studies, the test-retest reliability of the CSI was found to be excellent, with an intra-class correlation coefficient (ICC) of 0.93 (95% CI: 0.91- 0.95) for overall chronic pain, ICC of 0.90 (95% CI: 0.87- 0.93) for chronic musculoskeletal pain and ICC of 0.93 (95% CI: 0.88- 0.99) for chronic neck pain. PSQ also demonstrated excellent test-retest reliability, showing an ICC of 0.86 (95% CI: 0.72- 0.99) for chronic pain conditions.

Conclusion: Although not all properties have been studied, the CSI, which received the highest overall ratings, could serve as a reliable PROM for chronic pain associated with CS. More studies should be performed to comprehensively evaluate all measurement properties of all included instruments.

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