麻豆传媒

ORLANDO -- Central sensitization improved with treatment in an interdisciplinary chronic pain rehabilitation program, according to a preliminary analysis presented here.

In a retrospective analysis of 49 patients treated at the Cleveland Clinic's multidisciplinary pain program, pain scores as measured by the Central Sensitization Inventory (CSI) improved significantly after patients went through the program (mean 54.7 to 40.5, P<0.05), reported , of the Cleveland Clinic, and colleagues.

"Their scores went from pain experienced in untreated fibromyalgia to that of a low back pain population," Jimenez said during a presentation at the American Academy of Pain Medicine meeting. "Keep in mind that these findings are preliminary, in patients with a lot of comorbidities, and it's very messy given the selection bias. The sickest of the sick come to our clinic. As promising as this is, it may be as good as it gets. But it seems like a positive first finding."

Central sensitization involves abnormal and intense enhancement of pain in the central nervous system, and is characterized by hyperalgesia and allodynia. It's involved in many conditions, including fibromyalgia, depression, anxiety, migraines, and chronic low back pain, Jimenez explained.

The CSI is a new scale developed to capture central sensitization, and higher severity on the CSI is correlated with certain pain diagnoses and outcomes, he said.

The clinic's interdisciplinary chronic pain rehabilitation program is a biopsychosocial model that includes medical management, behavioral therapy, and other treatments such as biofeedback, frequently reserved for the most refractory pain cases. Studies have shown it to improve outcomes for these patients, with benefits sustained for up to a year.

But the impact of the program on CSI scores hasn't yet been tested. So Jimenez's group conducted a retrospective analysis of 49 patients in the program who had CSI scores before and after their treatment. Their mean age was 48, 77% were female, 61% were married, and the vast majority (87%) were white.

Jimenez acknowledged that the significant improvement seen in CSI scores after going through the program was limited, particularly because it's a "self-reported instrument, so there are a lot of handicaps with that."

"As well as the potential for multiple confounders, what contributes to the change in score?" he said. "Is it that we improve their depression? Is it that they're less hypervigilant of their symptoms? Is it something else that was the active ingredient?"

"I would argue it's probably a mix of all those things, but the point is we can't definitively say which component is leading to this change," he added.

Jimenez noted that their group is actively collecting data and hope to have double the number of patient outcomes to report on soon.

Other future directions include correlating CSI scores with other program outcomes in order to corroborate self-reported measures. His group is also conducting very involved somatosensory testing, another method to show outcomes of the program.

, of Stanford University in Stanford, Calif., who wasn't involved in the study, noted that objective outcomes are critical to secure reimbursement by insurers for such programs.

"It would be great to demonstrate a persistently low score as justification for insurers to pay for these rehabilitation programs, because we all know that's one of the biggest barriers to treating patients," he said. "It's care we all know [patients] need, but they can't access. The payers need to know" about the outcomes.