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Pain Research and Treatment
Volume 2016, Article ID 5964250, 7 pages
Research Article

Cost-Saving Early Diagnosis of Functional Pain in Nonmalignant Pain: A Noninferiority Study of Diagnostic Accuracy

1University Medical Center of the Johannes Gutenberg University, Mainz, Institute of Medical Biostatistics, Epidemiology, and Informatics, Obere Zahlbacher Straße 69, 55131 Mainz, Germany
2Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
3Heart Failure and Transplantation, Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
4Department of Psychosomatic Medicine, Clinic Barmelweid, 5017 Barmelweid, Switzerland
5Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland

Received 3 December 2015; Revised 20 January 2016; Accepted 1 February 2016

Academic Editor: Donald A. Simone

Copyright © 2016 Rafael J. A. Cámara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. We compared two index screening tests for early diagnosis of functional pain: pressure pain measurement by electronic diagnostic equipment, which is accurate but too specialized for primary health care, versus peg testing, which is cost-saving and more easily manageable but of unknown sensitivity and specificity. Early distinction of functional (altered pain perception; nervous sensitization) from neuropathic or nociceptive pain improves pain management. Methods. Clinicians blinded for the index screening tests assessed the reference standard of this noninferiority diagnostic accuracy study, namely, comprehensive medical history taking with all previous findings and treatment outcomes. All consenting patients referred to a university hospital for nonmalignant musculoskeletal pain participated. The main analysis compared the receiver operating characteristic (ROC) curves of both index screening tests. Results. The area under the ROC curve for peg testing was not inferior to that of electronic equipment: it was at least 95% as large for finger measures (two-sided ) and at least equally as large for ear measures (two-sided ). Conclusions. Routine diagnostic testing by peg, which is accessible for general practitioners, is at least as accurate as specialized equipment. This may shorten time-to-treatment in general practices, thereby improving the prognosis and quality of life.