Reply to Jensen, O.K. On the Use of Quantitative Sensory Testing to Estimate Central Sensitization in Humans. Comment on “Schuttert et al. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931”
by
, , ,
Ingrid Schuttert
1
,
Hans Timmerman
1,
Kristian K. Petersen
2,
Megan E. McPhee
2
,
Lars Arendt-Nielsen
2,3,
Michiel F. Reneman
4 and
André P. Wolff
1,* 1
Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands
2
Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, DK-9220 Aalborg, Denmark
3
Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, DK-9220 Aalborg, Denmark
4
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(8), 2113; https://doi.org/10.3390/jcm11082113
Submission received: 27 March 2022
/
Accepted: 7 April 2022
/
Published: 11 April 2022
We thank Dr. Jensen for his interest [1] in our systematic review [2]. Dr. Jensen states that we introduce a new phenomenon called human-assumed central sensitization (HACS), though we merely wanted to introduce a new term that, in our opinion, better reflects the current state of science.
Dr. Jensen is correct that no articles on digital tender point (TP) examination were included. No data were found after re-examining the results of the initial search regarding the references given in Dr. Jensen’s comment [2]. Moreover, considering the studies suggested by Dr. Jensen, we feel that they were correctly not included in our systematic review [2] based on the inclusion criteria. One study included patients with fibromyalgia [3], but not patients with chronic low back pain. Four studies were not based on (the assessment of) HACS [4,5,6,7]. Finally, one study [8] mentioned HACS in the discussion to explain the results of the study, but did not assess HACS.
The suggested cut-off points for TP examination [8] are for the women and men separately, which is necessary to account for sex differences that are present in pain [9,10,11,12]. TP may be associated with fibromyalgia [13,14,15], but the association with HACS has not been established. This suggested connection seems to be made based on the altered pain processing, which could also be a result of nociplastic pain [16], the third mechanistic descriptor for chronic pain states. The terms HACS and nociplastic pain overlap but are not synonymous [17]. Furthermore, there are no gold standards to demonstrate the presence of nociplastic pain and HACS in patients with chronic pain.
TP examination could be interesting as an assessment for HACS, but a clear distinction should be made about TP examination being used to identify fibromyalgia or widespread pain and the assessment of HACS. Adding TP examination to the list of indicator tests could probably provide more insight into the presence of HACS. However, more research is needed in patients with chronic low back pain where TP examination is used to assess the underlying pain mechanisms of HACS in combination with other indicator tests, such as the central sensitization inventory and other quantitative sensory testing instruments.
Funding
Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
The authors of the original papers can request all data and related metadata underlying this review’s findings. Data can also be requested from the first author of this systematic review, but data will only be provided with the original data authors consent.
Conflicts of Interest
The authors declare no conflict of interest.
References
- Jensen, O.K. On the Use of Quantitative Sensory Testing to Estimate Central Sensitization in Humans. Comment on Schuttert et al. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931. J. Clin. Med. 2022, 11, 1982. [Google Scholar] [CrossRef]
- Schuttert, I.; Timmerman, H.; Petersen, K.K.; McPhee, M.E.; Arendt-Nielsen, L.; Reneman, M.F.; Wolff, A.P. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931. [Google Scholar] [CrossRef] [PubMed]
- Lundberg, G.; Gerdle, B. Tender point scores and their relations to signs of mobility, symptoms, and disability in female home care personnel and the prevalence of fibromyalgia syndrome. J. Rheumatol. 2002, 29, 603–613. [Google Scholar] [PubMed]
- Weiner, D.K.; Sakamoto, S.; Perera, S.; Breuer, P. Chronic low back pain in older adults: Prevalence, reliability, and validity of physical examination findings. J. Am. Geriatr. Soc. 2006, 54, 11–20. [Google Scholar] [CrossRef] [PubMed]
- Hüppe, A.; Brockow, T.; Raspe, H. Chronische ausgebreitete Schmerzen und Tender Points bei Rückenschmerzen in der Bevölkerung. Z. Rheumatol. 2004, 63, 76–83. [Google Scholar] [CrossRef] [PubMed]
- Jensen, O.K.; Callesen, J.; Nielsen, M.G.; Ellingsen, T. Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement: A validation study. BMJ Open 2013, 3, e002532. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jensen, O.K.; Nielsen, C.V.; Stengaard-Pedersen, K. Low back pain may be caused by disturbed pain regulation: A cross-sectional study in low back pain patients using tender point examination. Eur. J. Pain 2010, 14, 514–522. [Google Scholar] [CrossRef] [PubMed]
- Jensen, O.K.; Nielsen, C.V.; Stengaard-Pedersen, K. Diffuse central sensitization in low back patients: A secondary analysis of cross-sectional data including tender point examination and magnetic resonance imaging of the lumbar spine. Medicine 2020, 99, e22198. [Google Scholar] [CrossRef] [PubMed]
- Bartley, E.J.; Fillingim, R.B. Sex differences in pain: A brief review of clinical and experimental findings. Br. J. Anaesth. 2013, 111, 52–58. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Berkley, K.J. Sex differences in pain. Behav. Brain Sci. 1997, 20, 371–380. [Google Scholar] [CrossRef] [PubMed]
- Sorge, R.E.; Totsch, S.K. Sex differences in pain. J. Neurosci. Res. 2017, 95, 1271–1281. [Google Scholar] [CrossRef] [PubMed]
- Wiesenfeld-Hallin, Z. Sex differences in pain perception. Gend. Med. 2005, 2, 137–145. [Google Scholar] [CrossRef]
- Wolfe, F. The relation between tender points and fibromyalgia symptom variables: Evidence that fibromyalgia is not a discrete disorder in the clinic. Ann. Rheum. Dis. 1997, 56, 268–271. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Croft, P.; Schollum, J.; Silman, A. Population study of tender point counts and pain as evidence of fibromyalgia. BMJ 1994, 309, 696–699. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yunus, M.B. Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes. In Seminars in Arthritis and Rheumatism; Elsevier: Amsterdam, The Netherlands, 2007; Volume 6, pp. 339–356. [Google Scholar]
- Kosek, E.; Cohen, M.; Baron, R.; Gebhart, G.F.; Mico, J.-A.; Rice, A.S.; Rief, W.; Sluka, A.K. Do we need a third mechanistic descriptor for chronic pain states? Pain 2016, 157, 1382–1386. [Google Scholar] [CrossRef] [PubMed]
- Kosek, E.; Clauw, D.; Nijs, J.; Baron, R.; Gilron, I.; Harris, R.E.; Mico, J.-A.; Rice, A.S.; Sterling, M. Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system. Pain 2021, 162, 2629–2634. [Google Scholar] [CrossRef] [PubMed]
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MDPI and ACS Style
Schuttert, I.; Timmerman, H.; Petersen, K.K.; McPhee, M.E.; Arendt-Nielsen, L.; Reneman, M.F.; Wolff, A.P. Reply to Jensen, O.K. On the Use of Quantitative Sensory Testing to Estimate Central Sensitization in Humans. Comment on “Schuttert et al. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931”. J. Clin. Med. 2022, 11, 2113. https://doi.org/10.3390/jcm11082113
AMA Style
Schuttert I, Timmerman H, Petersen KK, McPhee ME, Arendt-Nielsen L, Reneman MF, Wolff AP. Reply to Jensen, O.K. On the Use of Quantitative Sensory Testing to Estimate Central Sensitization in Humans. Comment on “Schuttert et al. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931”. Journal of Clinical Medicine. 2022; 11(8):2113. https://doi.org/10.3390/jcm11082113
Chicago/Turabian StyleSchuttert, Ingrid, Hans Timmerman, Kristian K. Petersen, Megan E. McPhee, Lars Arendt-Nielsen, Michiel F. Reneman, and André P. Wolff. 2022. "Reply to Jensen, O.K. On the Use of Quantitative Sensory Testing to Estimate Central Sensitization in Humans. Comment on “Schuttert et al. The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review. J. Clin. Med. 2021, 10, 5931”" Journal of Clinical Medicine 11, no. 8: 2113. https://doi.org/10.3390/jcm11082113
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