Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review

Ann Med. 2022 Dec;54(1):1403-1422. doi: 10.1080/07853890.2022.2075560.

Abstract

Introduction: The pathophysiology of fibromyalgia (FM) is related to central sensitisation (CS) to pain. Algometry allows assessing CS based on dynamic evoked pain. However, current algometrýs protocols require optimising, unifying and updating.

Objectives: 1) identify the dynamic pain measures used most frequently to effectively assess CS processes in FM, and 2) consider the future of the algometry assessing CS in these patients.

Methods: Cochrane Collaboration guidelines and PRISMA statements were followed. The protocol was registered in PROSPERO database (ID: CRD42021270135). The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched.

Results: Thirty-four studies were selected, including measures such as temporal summation of pain (TSP), aftersensations (AS), spatial summation of pain (SSP), the noxious flexion reflex (NFR) threshold, conditioned pain modulation (CPM), cutaneous silent period (CuSP), and slowly repeated evoked pain (SREP); and evoked pain combined with neuroimaging. Each measure offered various advantages and limitations. According to ROB, 28 studies were of low quality, 3 of moderate quality, and 3 of high quality.

Conclusions: Several pain indicators have been demonstrated to successfully examine CS involvement in FM in the last years. Algometry, especially when it involves diverse body sites and tissues, might provide further insight into (1) the evaluation of psychological factors known to influence pain experience, (2) new dynamic pain indicators, and (3) the simultaneous use of certain neuroimaging techniques. Further research clarifying the mechanisms underlying some of these measures, and homogenisation and optimisation of the algometrýs protocols, are needed. KEY MESSAGESAlgometry allows for assessing Central Sensitisation by applying dynamic evoked pain.The future of algometry could relapse in its combination with neuroimaging.Recently-emerged pain indicators should be considered for algometrýs new protocols.

Keywords: Algometry; central sensitisation; dolorimetry; evoked pain; fibromyalgia.

Publication types

  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Central Nervous System Sensitization* / physiology
  • Fibromyalgia* / diagnosis
  • Humans
  • Pain / diagnosis
  • Pain / etiology
  • Pain Measurement / methods
  • Pain Threshold / physiology

Grants and funding

This systematic review has been supported by a grant from the Spanish Ministry of Science, Innovation and Universities, co-financed by European Regional Development Funds (ref: RTI2018-095830-B-I00), and a postdoctoral fellowship from Andalusian government co-financed by European Social Funds (Ref: DOC2020-00462).