The Centralized Pain Score: A Method to Identify Nociplastic Pain in Electronic Health Records

Area of Science:

• Pain Medicine
• Medical Informatics
• Computational Health

Background:

• Chronic overlapping pain conditions (COPCs) present challenges due to nociplastic pain and diagnostic delays.
• Lack of EHR methods for nociplastic pain hinders large-scale research and phenotyping.
• Clinician skepticism and inadequate treatment periods are common for COPC patients.

Purpose of the Study:

• To develop and validate the Centralized Pain Score (CPS) for identifying nociplastic pain within electronic health record (EHR) data.
• To establish a quantifiable method for nociplastic pain detection in large patient cohorts.
• To facilitate improved phenotyping and study of nociplastic pain trajectories.

Main Methods:

• Developed the Centralized Pain Score (CPS) by summing central sensitization-weighted COPC ICD codes in EHRs.
• Analyzed CPS in three groups: General Population (N=55,340), Nociplastic Pain Group (N=100), and Age/Sex-Matched Group (N=500).
• Utilized t-tests for group comparisons and post hoc content analysis of clinical documentation for nomenclature.

Main Results:

• The Nociplastic Pain Group showed a significantly higher CPS (mean=3.7) compared to the General Population (mean=0.43, p < .001) and matched group (mean=0.47, p < .001).
• CPS was 8.6-fold higher in the Nociplastic Pain Group versus the General Population.
• Nociplastic pain was frequently documented using the term "central pain syndrome."

Conclusions:

• The CPS effectively captures nociplastic pain, as evidenced by higher scores in the clinically determined group.
• Clinicians document nociplastic pain and target centralized mechanisms, though terminology like "central pain syndrome" is often misapplied.
• The CPS offers a promising tool for improving early detection and management of nociplastic pain conditions.