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

Chronic overlapping pain conditions (COPCs) are a group of pain conditions that often co-occur and present with challenging nociplastic pain. Individuals with COPCs describe clinician skepticism and prolonged diagnosis, leading to periods of inadequate pain treatment. The lack of methods to identify nociplastic pain in electronic health records (EHRs) limits large-scale studies of nociplastic pain trajectories and phenotyping that could improve treatment.

To develop and validate the Centralized Pain Score (CPS) as a method for identifying nociplastic pain in EHR data.

In a large deidentified EHR database, the CPS, which sums central sensitization-weighted COPC ICD codes across individual records, was examined. Descriptive statistics were calculated for three groups: a General Population Group (N = 55,340), a group clinically determined to have nociplastic pain (Nociplastic Pain Group, N = 100), and an Age- and Sex-Matched Group (N = 500). T-tests were used to compare differences in CPS between pairs of these three groups. A post hoc content analysis of clinical documentation was conducted to examine the nomenclature of nociplastic pain.

The Nociplastic Pain Group demonstrated a CPS 8.6-fold higher (mean = 3.7, standard deviation [SD] = 2.9) than the General Population (mean = 0.43, SD = 1.0, p < .001) and 7.9-fold higher than the Age- and Sex-Matched Group (CPS mean = 0.47, SD = 1.1, p < .001). Nociplastic pain was most commonly documented as "central pain syndrome."

Clinicians are documenting nociplastic pain and recommending interventions targeting centralized mechanisms. The CPS appears to capture nociplastic pain. The term central pain syndrome was not intended for nociplastic pain, but it is frequently used.

Using the CPS to examine nociplastic pain could improve early detection of nociplastic pain conditions.