Clinical indicators of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians

Abstract

The clinical criteria by which clinicians determine mechanisms-based classifications of pain are not known. The aim of this study was to generate expert consensus-derived lists of clinical criteria suggestive of a clinical dominance of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain. A web-based 3 round Delphi survey method was employed as an expert consensus building technique. One hundred and three clinical experts (31 Pain consultants, 72 musculoskeletal physiotherapists) were surveyed. Participants were asked to suggest clinical indicators of three separate categories of pain mechanisms (Round 1), then rate (Round 2) and re-rate their level of agreement/disagreement (Round 3) with those clinical indicators. Consensus was defined by a >or=80% level of agreement. Sixty-two (Response rate, 60%), 60 (58%) and 59 (57%) respondents replied to Rounds 1, 2 and 3 respectively. Twelve 'nociceptive', 14 'peripheral neuropathic' and 17 'central' clinical indicators reached consensus. These expert consensus-derived lists of clinical indicators of 'nociceptive', 'peripheral neuropathic' and 'central' mechanisms of musculoskeletal pain provide some indication of the criteria upon which clinicians may base such mechanistic classifications. Further empirical testing is required in order to evaluate the discriminative validity of these clinical criteria in particular and of mechanisms-based approaches in general.