Methods to measure peripheral and central sensitization using quantitative sensory testing: A focus on individuals with low back pain

Background: Long-term opioid treatment has been used extensively in treatment of chronic low back pain (cLBP) in the last decades. However, there are serious limitations to the long-term efficacy of opioids and related side effects. Objectives: In this study we investigated whether long-term opioid treatment changes pain sensitivity of patients with cLBP. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, university hospital in Germany. Methods: Using quantitative sensory testing (QST), we compared the pain sensitivity of the low back bilaterally among 3 groups: 35 patients with cLBP undergoing a long-term opioid therapy (OP); 35 patients with cLBP administered no opioids (ON), and 28 subjects with neither pain nor opioid intake (HC). Results: OP patients showed significantly higher bilateral thermal detection thresholds to warm stimuli on the back as compared to both ON (P = 0.009 for left low back, P = 0.008 for right low back) and HC subjects (P = 0.004 for left low back, P = 0.003 for right low back). Pain thresholds for cold and heat on the hand were similar in OP and ON groups; both showed, however, significantly reduced heat pain thresholds in comparison with HC participants (P = 0.012 for OP, P = 0.001 for ON). Factors such as age, sex, duration and dose of opioid intake, and self-reported pain intensity, but not depression and pain duration, correlated significantly with QST results. Limitations: Limitations include small numbers of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: The current study demonstrated that chronic opioid intake may only reduce the temperature sensitivity but not pain sensitivity measured by QST which is a useful tool in detecting characteristic changes in pain perception of patients with chronic low back pain after long-term opioid intake. Key words: Pain sensitivity, opioid treatment, chronic low back pain (cLBP), quantitative sensory testing (QST)

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Pseudoradicular and radicular low-back pain – A disease continuum rather than different entities? Answers from quantitative sensory testing

Pain ◽

10.1016/j.pain.2007.05.004 ◽

2008 ◽

Vol 135 (1) ◽

pp. 65-74 ◽

Cited By ~ 95

Author(s):

Rainer Freynhagen ◽

Roman Rolke ◽

Ralf Baron ◽

Thomas R. Tölle ◽

Ann-Kathrein Rutjes ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Quantitative Sensory Testing ◽

Low Back ◽

Sensory Testing

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Does Electroacupuncture Treatment Reduce Pain and Change Quantitative Sensory Testing Responses in Patients with Chronic Nonspecific Low Back Pain? A Randomized Controlled Clinical Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/8586746 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Paula M. S. Leite ◽

Andreza R. C. Mendonça ◽

Leonardo Y. S. Maciel ◽

Maurício L. Poderoso-Neto ◽

Carla C. A. Araujo ◽

...

Keyword(s):

Clinical Trial ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Quantitative Sensory Testing ◽

Low Back ◽

Sensory Testing ◽

Control Groups ◽

Pain Patients ◽

Electroacupuncture Treatment

Chronic nonspecific low back pain is common and one of the most disabling conditions in the world. There is moderate evidence that chronic low back pain patients present altered functional connectivity in areas related to pain processing. Quantitative sensory testing is a way of clinical measure of these alterations. Although there is not enough evidence, there are some reports that electroacupuncture is supposedly more effective in relieving pain than acupuncture because the addition of electric current could optimize the effects of traditional technique. Thus, the objective of this randomized clinical trial was to verify if electroacupuncture treatment reduces pain and changes quantitative sensory testing responses in patients with chronic nonspecific low back pain. Patients were evaluated before and after 10 sessions regarding pain (11-point numerical rating pain scale) and quantitative sensory testing (pressure pain threshold, temporal summation, and conditioned pain modulation). There were 1 treatment group (electroacupuncture (EA)) and three different control groups (CTR 1, CTR 2, and CTR 3). A total of 69 patients participated in the study. No significant differences were found in pain intensity or quantitative sensory testing responses when comparing electroacupuncture group to the three control groups. There was a significant reduction in both resting and movement pain intensity in groups EA, CTR 1, and CTR3. Although ten sessions of electroacupuncture have diminished pain intensity in both resting and movement, it could not change significantly quantitative sensory testing and diminish central sensitization in patients with chronic nonspecific low back pain. The implications of this study involve the fact that, maybe, in chronic nonspecific low back pain, electroacupuncture should be associated with other treatments that target central sensitization.

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