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Clinical Assessment of Mechanical Allodynia in Youth With Complex Regional Pain Syndrome: Development and Preliminary Validation of the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense)

  • Author Footnotes
    # Dr. Shulman and Ms. Cybulski are equal contributors.
    Julie Shulman
    Correspondence
    Address reprint requests to Julie Shulman, PT, PhD, DPT, PCS, Physical Therapy Scientist, Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, 9 Hope Avenue, Waltham, MA 02453.
    Footnotes
    # Dr. Shulman and Ms. Cybulski are equal contributors.
    Affiliations
    Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts

    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts
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  • Author Footnotes
    # Dr. Shulman and Ms. Cybulski are equal contributors.
    Anna Cybulski
    Footnotes
    # Dr. Shulman and Ms. Cybulski are equal contributors.
    Affiliations
    Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts

    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts
    Search for articles by this author
  • Edin Randall
    Affiliations
    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts

    Department of Psychiatry & Behavioral Sciences, Harvard Medical School, Boston, Massachusetts
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  • Kimberly F. Greco
    Affiliations
    Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts
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  • Gabrielle Bryant
    Affiliations
    Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts

    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts
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  • Kelsey Jervis
    Affiliations
    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts

    Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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  • Edie Weller
    Affiliations
    Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts
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  • Navil F. Sethna
    Affiliations
    Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts

    Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts

    Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Author Footnotes
    # Dr. Shulman and Ms. Cybulski are equal contributors.
Published:December 29, 2022DOI:https://doi.org/10.1016/j.jpain.2022.12.006

      Highlights

      • Preliminary results support the use of the Pedi-Sense to evaluate mechanical allodynia.
      • Test-retest and interrater reliability of the Pedi-Sense still need to be studied.
      • Participants appeared to report improved allodynia on the Pedi-Sense after IIPT.

      Abstract

      Youth with complex regional pain syndrome (CRPS) commonly experience mechanical allodynia and disability. Assessment of mechanical allodynia is typically binary (present or absent), making it difficult to assess the quality and degree of mechanical allodynia before and after treatment. This study developed and validated the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) to provide an easy way for rehabilitation clinicians to evaluate mechanical allodynia before and after intensive interdisciplinary pain treatment. The 6 Pedi-Sense items demonstrated adequate internal consistency reliability (CR) at admission (CR = .956) and discharge (CR = .973), reasonably fit the hypothesized linear model of stimulus intensity (P < .0001), and significantly loaded onto a single latent factor, mechanical allodynia (P < .0001), at admission and discharge. Pedi-Sense scores significantly correlated with disability (rs = .40; P = .004) and pain catastrophizing (rs = .33; P = .017) at admission. The Pedi-Sense appeared responsive to intervention as participants’ total scores improved by 1.44 points (95% CI: .72, 2.15) after IIPT interventions that included daily tactile desensitization. However, test-retest and interrater reliability and the specific contribution of desensitization treatment to the overall success of multi-modal pain rehabilitation still needs to be evaluated.

      Perspective

      This article presents the development and preliminary validation of a novel clinical assessment of static and dynamic mechanical allodynia. The Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) allows rehabilitation clinicians to easily evaluate mechanical allodynia at the bedside with minimal training and simple equipment to guide desensitization treatment in clinical settings.

      Key words

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