Table 1 The 51 elements of the PDDM model and their concordance with the result of the comprehensive review
Domain 1: Nociceptive pain drivers | ||
Nominal elements included in each domain/category | Results from the items generation step | |
Category A: Responders to LBP classification system | Instrument/tool or procedures (physical exam), or questions (anamnesis / self-reported) | Type of assessment |
• 1/ Specific mechanical pattern | • Treatment-Based Classification system (Alrwaily et al., 2016)a | PE |
Category B: Non-responders to LBP classification system | ||
• 2/ LBP without any specific mechanical pattern | • Treatment-Based Classification system (negative result) | PE |
• 3/ Nociceptive pain related to identifiable structural stability deficit (post fracture, post- surgery) | • Anamnesis for medical background/Tests for anatomical structures (Petersen et al., 2017)a | A/P |
• 4/ Presence of signs/symptoms of an active inflammatory process | • Specific signs and symptoms (InformedHealth.org (PubMed))a | A |
Domain 2: Nervous system dysfunction drivers | ||
Category A: Peripheral sources of nervous system dysfunctions | ||
• 5/ Radicular pain pattern | • Specific symptoms: anamnesis or self-reported (Mulvey et al., 2014)a | A |
• 6/ Tingling/paresthesia or burning/shooting pain | • Specific symptoms: anamnesis or self-reported (Mulvey et al., 2014)a | A |
• 7/ Signs of radiculopathy | • Specific symptoms: signs (van der Windt et al., 2010)a | A/PE |
• 8/ Signs of myelopathy | • Specific signs (Issack et al., 2012)a | PE |
Category B: Nervous system hypersensitivity | ||
• 9/ Evidence of increased neural mechanosensitivity | • Prone Knee Bend test (Alexander & Varacallo, 2021)a, Slump test (Urban & MacNeil, 2015)a, Straight Leg Raise test (Scaia et al., 2012)a | PE |
• 10/ Evidence of hyperalgesia | • Clinical signs and potential tests (Mücke et al., 2016)a | PE |
• 11/ Evidence of allodynia | • Clinical signs and potential tests (Mücke et al., 2016)a | PE |
• 12/ Evidence of disproportionate pain intensity in relation to injury | • Brief Pain Inventory (pain severity) (Poquet & Lin, 2016)a | Q |
• 13/ Hypersensitivity of senses non-related to the MSK system | • Central Sensitization Inventory-25 items (Q7–20) (Scerbo et al., 2017)a | Q |
• 14/ Evidence of sympathetic nervous system dysfunctions | • Specific signs (Liao et al., 2016)a | PE |
• 15/ Symptoms of dysesthesia | • Clinical signs and potential tests (Mücke et al., 2016)a | PE |
• 16/ Evidence of widespread pain location | • Central Sensitization Inventory-25 items (Q9) OR Central Sensitization Inventory-9 items (Q3) (Nishigami et al., 2018)a | Q |
• 17/ Sleep disturbances secondary to painful symptoms | • Central Sensitization Inventory-25 items (Q1–12–17-22) OR Central Sensitization Inventory-9 items (Q1–5) OR Brief Pain Inventory (Q9) | Q |
Domain 3: Comorbidity factors | ||
Category A: Physical comorbidities | ||
• 18/ Co-occurring painful MSK pathologies (known/identified) o Osteoarthritis, rheumatoid arthritis, spondylarthritis, et o Any other painful MSK pathology triggering pain | • Self-reported comorbidities (Hartvigsen et al., 2013)a | A |
• 19/ Identified/known co-occurring disorders related to pain sensitization such as: o Chronic fatigue, migraines, irritable bowel syndrome, fibromyalgia | • Self-reported comorbidities (Hestbaek et al., 2003; Rundell et al., 2017)a OR Central Sensitization Inventory −25 items (Part B) | A/Q |
Category B: Mental-health comorbidities | ||
• 20/ Mental health disorders (within the DSM-5) o Depressive disorders | • Beck Depression Inventory-II (Harris & D’Eon, 2008)a | Q |
o Anxiety disorders | • Central sensitization inventory −25 items (Q3–15) OR GAD-7 scale (Plummer et al., 2016)a | Q |
o Personality disorders | • Standardised Assessment of Personnality – Abbreviated scale (Germans et al., 2012)a | Q |
o History of substance-use disorder | • Anamnesis | A |
• 21/ Post-traumatic stress disorders (PTSD) | • Post-Traumatic Stress Disorder-8 Scale (Andersen et al., 2017)a | Q |
• 22/ Sleep disorders | • Central Sensitization Inventory −25 items (part B) OR (Insomnia Severity Index (Alsaadi et al., 2013)a AND/OR Fatigue Severity Scale (Takasaki & Treleaven, 2013)a) | Q |
Domain 4: Cognitive-emotional drivers | ||
Category A: Maladaptive cognitions and emotions | ||
• STart Back Screening Tool: This tool does not cover element of this category. However, its prognostic capacity (prediction of disability at 6 months) based on psychosocial factors (mainly cognitive-emotional) is relevant for clinicians (Beneciuk 2013, Hill 2008)a | Q | |
• 23/ Pain catastrophizing | • Pain Catastrophizing Scale (Osman 2000)a | Q |
• 24/ Pain-related anxiety | • Pain Anxiety Symptoms Scale-20 (Coons 2004)a | Q |
• 25/ Negative mood | • Central Sensitization Inventory-25 items (Q16) OR Beck Depression Inventory-II | Q |
• 26/ Fear of movement / kinesiophobia | • Tampa Scale of Kinesiophobia-17 items (Roelofs 2011)a | Q |
• 27/ Pain-related fears | • Fear Avoidance Components Scale (Neblett 2016)a | Q |
• 28/ Poor self-efficacity | • Chronic Disease Self-Efficacy Scales (Brady 2011)a | Q |
• 29/ High illness perception | • Brief Illness Perception Questionnaire (Hallegraef 2013)a | Q |
• 30/ Pain expectations | • Brief Illness Perception Questionnaire | Q |
• 31/ Negative/low expectation of recovery | • Brief Illness Perception Questionnaire | Q |
• 32/ Low pain coping | • Chronic Pain Coping Inventory (Jensen 2003)a | Q |
• 33/ Poor knowledge relating to pain science | • Revised Neurophysiology of Pain (Catley 2013)a OR Fear Avoidance Beliefs Questionnaire (Swinkles 2003)a | Q |
• 34/ Perceived injustice | • Injustice Experience Questionnaire (Sullivan 2008)a | Q |
• 35/ Perception that medical treatments are still necessary or uncomplete | • Brief Illness Perception Questionnaire | Q |
Category B: Maladaptive pain behaviors | ||
• 36/ Facial expressions | • List of observable pain behaviors (Naye 2021)a | A/PE |
• 37/ Verbal/paraverbal pain expressions | • If clinicians want a quantified assessment of this category: | |
• 38/ Guarded postures | o Avoidance behaviors: BAT-Back (Holzapfel 2016)a | PE |
• 39/ Bending/rubbing the back after performing an activity | o Endurance behaviors: Avoidance Endurance Questionnaire (Hasenbring 2009)a | Q |
• 40/ Completely avoiding to perform a task | ||
• 41/ Discordance between reported behaviors (by the patient) and observed behaviors (by the therapist) | ||
Domain 5: Contextual drivers | ||
Category A: Occupational context | ||
• Örebro Musculoskeletal Pain Screening Questionnaire-short form: This tool does not cover element of this category. However, its prognostic capacity (prediction of return to work at 6 months) based on psychosocial factors are relevant for clinicians (Fuhro 2016). | Q | |
• 42/ Low return-to-work expectations | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) (Marhold 2002)a | A/Q |
• 43/ Low job satisfaction | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 2) | A/Q |
• 44/ Perception of heavy work | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) | A/Q |
• 45/ High job stress | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) | A/Q |
• 46/ High occupational demands | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) | A/Q |
• 47/ Low job flexibility | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) | A/Q |
• 48/ Employer’s policies regarding return-to-work are limited or restrictive | • Anamnesis OR Obstacles to Return-to-Work Questionnaire (Part 3) | A/Q |
Category B: Social context | ||
• 49/ Poor attitudes of employer, family or health care professionals | • Anamnesis | A |
• 50/ Low or non-access to care | • Anamnesis | A |
• 51/ Communication barriers | • Anamnesis | A |