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      Validity of the cold pressor test and pain sensitivity questionnaire via online self-administration

      research-article
      1 , 23andMe Research Team 1 , 2 , * , 2 , 2 , 1 , *
      PLoS ONE
      Public Library of Science

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          Abstract

          To determine the feasibility of complex home-based phenotyping, 1,876 research participants from the customer base of 23andMe completed an online version of a Pain Sensitivity Questionnaire (PSQ) as well as a cold pressor test (CPT) which is used in clinical assessments of pain. Overall our online version of the PSQ performed similarly to the original pen-and-paper version. Construct validity of the PSQ total was demonstrated by internal consistency and consistent discrimination between more and less painful items. Criterion validity was demonstrated by correlation with pain sensitivity as measured by the CPT. Within the same cohort we performed a cold pressor test using a layperson description and household equipment. Comparison with published reports from controlled studies revealed similar distributions of cold pain tolerance times (i.e., time elapsed before removing the hand from the water). Of those who elected to participate in the CPT, a large majority of participants did not report issues with the test procedure or noncompliance with the instructions (97%). We confirmed a large sex difference in CPT thresholds in line with published data, such that women removed their hands from the water at a median of 54.2 seconds, with men lasting for a median time of 82.7 seconds (Kruskal-Wallis statistic, p < 0.0001), but other factors like age or current pain treatment were at most weakly associated, and inconsistently between men and women. We introduce a new paradigm for performing pain testing, called testing@ 123456home , that, in the case of cold nociception, showed comparable results to studies conducted under controlled conditions and supervision of a health care professional.

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          Most cited references28

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          The development and psychometric validation of the central sensitization inventory.

          Central sensitization (CS) has been proposed as a common pathophysiological mechanism to explain related syndromes for which no specific organic cause can be found. The term "central sensitivity syndrome (CSS)" has been proposed to describe these poorly understood disorders related to CS. The goal of this investigation was to develop the Central Sensitization Inventory (CSI), which identifies key symptoms associated with CSSs and quantifies the degree of these symptoms. The utility of the CSI, to differentiate among different types of chronic pain patients who presumably have different levels of CS impairment, was then evaluated. Study 1 demonstrated strong psychometric properties (test-retest reliability = 0.817; Cronbach's alpha = 0.879) of the CSI in a cohort of normative subjects. A factor analysis (including both normative and chronic pain subjects) yielded 4 major factors (all related to somatic and emotional symptoms), accounting for 53.4% of the variance in the dataset. In Study 2, the CSI was administered to 4 groups: fibromyalgia (FM); chronic widespread pain without FM; work-related regional chronic low back pain (CLBP); and normative control group. Analyses revealed that the patients with FM reported the highest CSI scores and the normative population the lowest (P < 0.05). Analyses also demonstrated that the prevalence of previously diagnosed CSSs and related disorders was highest in the FM group and lowest in the normative group (P < 0.001). Taken together, these 2 studies demonstrate the psychometric strength, clinical utility, and the initial construct validity of the CSI in evaluating CS-related clinical symptoms in chronic pain populations.  Published 2011. No claim to original US government works. Pain Practice © 2011 World Institute of Pain.
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            Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire.

            Experimental determination of pain sensitivity has received increasing attention because of emerging clinical applications (including prediction of postoperative pain and treatment response) and scientific implications (e.g. it has been proposed that above-average pain sensitivity is a risk factor for the development of chronic pain disorders). However, the use of experimental pain sensitivity assessment on a broad scale is hampered by its requirements on time, equipment and human resources and the fact that it is painful for the tested subject. Alternatives to experimental pain testing are currently lacking. Here we developed a self-rating instrument for the assessment of pain sensitivity, the Pain Sensitivity Questionnaire (PSQ) that is based on pain intensity ratings of daily life situations and takes 5-10min to complete. Adequate reliability of the PSQ was confirmed in 354 subjects. In a validation study comprising 47 healthy subjects, the results of comprehensive experimental pain testing, including different modalities (heat, cold, pressure, and pinprick) and different measures (pain thresholds, pain intensity ratings), were compared to the results of the PSQ. PSQ scores were significantly correlated to experimental pain intensity ratings (r = 0.56, p < 0.001) but not to pain thresholds (r = 0.03). Prediction of experimental pain intensity ratings by the PSQ was better than by pain-associated psychological factors (pain catastrophizing, depression, anxiety). This shows that the PSQ may be a simple alternative to experimental pain intensity rating procedures in healthy subjects and makes the PSQ a highly promising tool for clinical and experimental pain research.
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              Neural correlates of interindividual differences in the subjective experience of pain.

              Some individuals claim that they are very sensitive to pain, whereas others say that they tolerate pain well. Yet, it is difficult to determine whether such subjective reports reflect true interindividual experiential differences. Using psychophysical ratings to define pain sensitivity and functional magnetic resonance imaging to assess brain activity, we found that highly sensitive individuals exhibited more frequent and more robust pain-induced activation of the primary somatosensory cortex, anterior cingulate cortex, and prefrontal cortex than did insensitive individuals. By identifying objective neural correlates of subjective differences, these findings validate the utility of introspection and subjective reporting as a means of communicating a first-person experience.
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                Author and article information

                Contributors
                Role: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: SupervisionRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: Writing – original draft
                Role: Writing – review & editing
                Role: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 April 2020
                2020
                : 15
                : 4
                : e0231697
                Affiliations
                [1 ] 23andMe Inc., Mountain View, California, United States of America
                [2 ] Grünenthal Innovation, Grünenthal GmbH, Aachen, Germany
                University of Tasmania, AUSTRALIA
                Author notes

                Competing Interests: This research was conducted by 23andMe and Grünenthal GmbH. All authors are employees of these companies. The commercial affiliation of the authors with both companies does not alter their adherence to PLOS ONE policies on sharing data and materials.

                ¶ Membership of the 23andMe Research Team is provided in the Acknowledgments.

                Author information
                http://orcid.org/0000-0001-8301-5934
                Article
                PONE-D-19-24029
                10.1371/journal.pone.0231697
                7162430
                32298348
                608e6a41-742a-4801-abf5-ad17684c94be
                © 2020 McIntyre et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 September 2019
                : 31 March 2020
                Page count
                Figures: 7, Tables: 4, Pages: 16
                Funding
                This research was conducted by 23andMe and Grünenthal GmbH. The funder provided support in the form of salaries for authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Medicine and Health Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                Somatosensory System
                Pain Sensation
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Pain
                Lower Back Pain
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Pain
                Neuropathic Pain
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Pain
                Neuropathic Pain
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Body Limbs
                Arms
                Hands
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Body Limbs
                Arms
                Hands
                Computer and Information Sciences
                Computer Networks
                Internet
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Biology and Life Sciences
                Psychology
                Psychometrics
                Social Sciences
                Psychology
                Psychometrics
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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