gms | German Medical Science

GMDS 2015: 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

06.09. - 09.09.2015, Krefeld

Is early diagnosis of functional musculoskeletal pain possible? A systematic review of the literature

Meeting Abstract

Suche in Medline nach

  • Christian Merz - Inselspital Universitätsspital Bern, Bern, Schweiz
  • Niklaus Egloff - Inselspital Universitätsspital Bern, Bern, Schweiz
  • Rafael Cámara - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

GMDS 2015. 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Krefeld, 06.-09.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocAbstr. 098

doi: 10.3205/15gmds161, urn:nbn:de:0183-15gmds1612

Veröffentlicht: 27. August 2015

© 2015 Merz et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Introduction: The lifetime prevalence of chronic musculoskeletal pain varies between 13.5% and 47% in the general population. In one third of the patients (for instance in fibromyalgia), musculoskeletal pain is functional, namely not explainable by electro-diagnostic, imaging, arthroscopic and surgical, or histological findings. Findings seldom correspond to the localisation of pain, and their treatment, be it conservative or surgical, does not result in a stable amelioration of the pain. This promotes diagnosis by exclusion after extensive investigations and therapeutic try-outs.

Because early diagnosis of functional musculoskeletal pain is likely to improve the treatment and the quality of life, we searched Medline for diagnostic alternatives that do not rely on long years of pain history.

Methods: Diagnostic accuracy studies on the distinction between functional and other musculoskeletal pain in adult humans were the objective of the search. Search filters included records created in PubMed between 01.01.1980 and 30.06.2014 and articles in English, German, Spanish, or French. They excluded distinct subjects such as AIDS or cancer, and unrelated publication types such as case reports and clinical trials:

(functional pain OR "Chronic Pain"[Majr] OR "Fibromyalgia"[Majr] OR “Myofascial Pain Syndromes”[Majr] OR “Somatoform Disorders”[Majr] OR “Fatigue Syndrome, Chronic”[Majr]) AND (accuracy OR “Delayed Diagnosis”[Majr] OR “Diagnosis, Computer-Assisted”[Majr] OR “Diagnosis, Differential”[Majr] OR “Diagnostic Errors”[Majr] OR “Diagnostic Self Evaluation”[Majr] OR “Diagnostic Tests, Routine”[Majr] OR “Physical Examination”[Majr] OR Psychophysics[Majr] OR “Symptom Assessment”[Majr] OR “Visual Analog Scale”[Majr] OR “Early Diagnosis”[Majr] OR “Prodromal Symptoms”[Majr]) AND ("1980/01/01"[CDAT] : "2014/06/30"[CDAT]) AND "humans"[MeSH Terms] AND "adult"[MeSH Terms] AND (German[lang] OR Spanish[lang] OR English[lang] OR French[lang]) AND medline[sb] NOT (AIDS[sb] OR Cancer[sb] OR dietsuppl[sb] OR history[sb] OR tox[sb] OR veterinary[sb]) NOT (Addresses[ptyp] OR Autobiography[ptyp] OR Biography[ptyp] OR “Case Reports”[ptyp] OR “Clinical Trial”[ptyp] OR “Historical Article”[ptyp] OR “In Vitro”[ptyp] OR “Pragmatic Clinical Trial”[ptyp] OR “Randomized Controlled Trial”[ptyp])

By title, abstract, and full text, articles were differentiated into diagnostic accuracy studies, studies on associations with functional musculoskeletal pain, and unrelated articles. Studies without failure of conventional pain treatment as the reference standard were excluded. Failure could be confirmed either during pain history prior to study beginning or in a follow-up. The diagnostic accuracy studies were searched for studies on the distinction of functional from other musculoskeletal pain. The extracted information described if early diagnosis of functional musculoskeletal pain is possible.

Results: Of 1212 items, we classified 893 by title, 262 by abstract, and 57 by full text. Thirty were diagnostic accuracy studies, of which 14 investigated the distinction of functional from other musculoskeletal pain. Of these, 11 studies used pain history or confirmation during follow-up as the reference standard.

Three studies found 34% to 70% correct classifications at early clinical evaluation [1], [2], [3]. Four found 55% to 88% correct classifications for questionnaires after at least three months of “unexplained” pain [4], [5], [6], [7]. One found an area under the receiver operating characteristic curve (AUC) of 96% for pain drawing [8]. Two found 85% correct classifications and AUCs between 78% and 93% for pressure algometry [9], [10]. One found a positive predictive value of 99%, but no negative predictive value, for a semi-structured interview conducted by specialists [11].

Discussion: Early diagnosis of functional musculoskeletal pain is inaccurate. With little evidence, pain drawing is accurate. With more evidence, pressure algometry is sufficiently accurate for screening functional musculoskeletal pain, but not for confirmation of the diagnosis. We recommend its implementation as screening tool in general practices.


Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Rheumatol Oxf Engl. 2003 Feb;42(2):263–7.
Klaus K, Rief W, Brähler E, Martin A, Glaesmer H, Mewes R. The distinction between “medically unexplained” and “medically explained” in the context of somatoform disorders. Int J Behav Med. 2013 Jun;20(2):161–71.
Dagfinrud H, Storheim K, Magnussen LH, Ødegaard T, Hoftaniska I, Larsen LG, et al. The predictive validity of the Örebro Musculoskeletal Pain Questionnaire and the clinicians’ prognostic assessment following manual therapy treatment of patients with LBP and neck pain. Man Ther. 2013 Apr;18(2):124–9.
Perrot S, Bouhassira D, Fermanian J, Cercle d’Etude de la Douleur en Rhumatologie. Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain. 2010 Aug;150(2):250–6.
Arnold LM, Stanford SB, Welge JA, Crofford LJ. Development and testing of the fibromyalgia diagnostic screen for primary care. J Womens Health 2002. 2012 Feb;21(2):231–9.
Oncu J, Iliser R, Kuran B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J Back Musculoskelet Rehabil. 2013;26(4):437–43.
Häuser W, Schild S, Kosseva M, Hayo S, von Wilmowski H, Alten R, et al. [Validation of the German version of the Regional Pain Scale for the diagnosis of fibromyalgia syndrome]. Schmerz Berl Ger. 2010 Jun;24(3):226–35.
Egloff N, Cámara RJA, von Känel R, Klingler N, Marti E, Ferrari M-LG. Pain drawings in somatoform-functional pain. BMC Musculoskelet Disord. 2012;13:257.
Tastekin N, Uzunca K, Sut N, Birtane M, Mercimek OB. Discriminative value of tender points in fibromyalgia syndrome. Pain Med Malden Mass. 2010 Mar;11(3):466–71.
Scudds RA, Rollman GB, Harth M, McCain GA. Pain perception and personality measures as discriminators in the classification of fibrositis. J Rheumatol. 1987 Jun;14(3):563–9.
Schuepbach WMM, Adler RH, Sabbioni MEE. Accuracy of the clinical diagnosis of “psychogenic disorders” in the presence of physical symptoms suggesting a general medical condition: a 5-year follow-up in 162 patients. Psychother Psychosom. 2002 Feb;71(1):11–7.