Applying Nociplastic Pain Criteria in Chronic Musculoskeletal Conditions: A Vignette Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2025 Feb 26

PMID 40004711

Authors

Paraskevi Bilika

Jo Nijs

Evdokia Billis

Zacharias Dimitriadis

Achilleas Paliouras

Konstantina Savvoulidou

Nikolaos Strimpakos

Eleni Kapreli

Affiliations

Soon will be listed here.

Abstract

The International Association for the Study of Pain (IASP) recently introduced clinical criteria and a grading system to identify nociplastic pain, marking a pivotal step toward improving diagnostic accuracy. This study aimed to evaluate the reliability and validity of the IASP criteria using clinical vignettes, assessing their effectiveness in identifying nociplastic pain in clinical settings. A reliability and diagnostic accuracy study was conducted using 32 clinical vignettes based on the literature and pre-existing clinical data. The vignettes represented patients with and without the characteristics of nociplastic pain and were reviewed independently by two expert physiotherapists. Inter-rater and intra-rater reliability were evaluated with a 1-month interval between assessments. Criterion validity was analyzed by comparing the IASP criteria against the standardized vignettes as the reference standard. Sensitivity, specificity, and predictive values were calculated to assess diagnostic accuracy. The IASP criteria demonstrated moderate-to-perfect intra-rater agreement (κ = 0.71-1.00, < 0.05) and weak-to-perfect inter-rater agreement (κ = 0.52-1.00, < 0.05). Criterion validity was moderate (κ = 0.68), with strong specificity (89.0%) and moderate sensitivity (69.0%). Positive and negative predictive values were high at 81.8% and 81.0%, respectively, supporting the criteria's accuracy in identifying and excluding nociplastic pain. The IASP criteria for nociplastic pain exhibited satisfactory reliability and criterion validity in this preliminary study, particularly after initial rater familiarization. Future research should evaluate their application in real-world clinical settings, explore concurrent and prognostic validity, and involve a broader range of raters to enhance generalizability.

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