Explaining persistent physical symptoms to patients in general practice: can tests to measure central sensitisation add value? A mixed-methods study.

Abstract

Abstract Introduction GPs struggle to explain to patients with persistent physical symptoms (PPS) why their symptoms persist. Providing an explanation of the central sensitisation (CS) mechanism to patients could be helpful, yet GPs do not test for signs of CS in patients. Our aim was to explore whether applying a test for assessing CS is valuable for the explanation. Methods In a prospective study, 25 GPs applied three tests, selected in a Delphi study, to assess CS-related symptoms: 1. the Central Sensitisation Inventory (CSI); 2. an algometer for pressure pain thresholds (PPT); 3. a monofilament for temporal summation. After the test, GP and patient filled in a short questionnaire. Finally, GPs shared their experiences in focus groups and interviews; we interviewed a sample of patients individually. We analysed the questionnaires quantitatively and the focus groups and interviews qualitatively; two researchers analysed the data. Results GPs found that all tests were feasible to perform during consultations; testing took less than 5 minutes in 25% and between 5 and 10 minutes in 60% of the applied tests. In about 50%, an additional consultation was necessary to perform the test. The results of the CSI confirmed CS-related symptoms more often (74%) than the algometer (46%) and monofilament (43%), and many GPs therefore preferred the CSI. Patients had no preference for a particular test; most patients found the tests valuableand the explanation of CS clearer when a test was used. Conclusions In addition to explaining CS to patients with PPS, GPs applied three tests to assess CS: an algometer, a monofilament and the CSI. Testing during the consultation was feasible, although an extra consultation was needed in 50% of the cases. GPs preferred the CSI since its results confirmed symptoms were related to CS more often than the results from the algometer and monofilament.