Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study)

IntroductionPatients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term ‘human assumed central sensitisation’ (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers.Methods and analysisA prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance.Ethics and disseminationThe Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences.Trial registration numberNTR NL6765.

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Health care providers communicate less well with patients with chronic low back pain – A study of encounters at a back pain clinic in Denmark

Pain ◽

10.1016/j.pain.2010.05.024 ◽

2010 ◽

Vol 150 (3) ◽

pp. 458-461 ◽

Cited By ~ 23

Author(s):

Pål Gulbrandsen ◽

Henrik Bjarke Madsen ◽

Jurate Saltyte Benth ◽

Even Lærum

Keyword(s):

Health Care ◽

Low Back Pain ◽

Back Pain ◽

Health Care Providers ◽

Chronic Low Back Pain ◽

Pain Clinic ◽

Low Back ◽

Care Providers

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Chronic Low Back Pain and the Rehabilitation Process: A Multiple Regression Analysis

Journal of Applied Rehabilitation Counseling ◽

10.1891/0047-2220.11.2.90 ◽

1980 ◽

Vol 11 (2) ◽

pp. 90-93

Author(s):

David K. Hollingsworth ◽

Donald Duane Watson

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Multiple Regression ◽

Chronic Low Back Pain ◽

Self Control ◽

Pain Clinic ◽

Low Back ◽

Demographic Information ◽

Rehabilitation Process ◽

Independent Variables

A random sample of 71 chronic low back pain (CLBP) patients was drawn from a Midwest Pain Clinic in 1977. Sociological and demographic information that is obtained early in the rehabilitation process was employed as independent variables of a predictor set in three multiple-regression analyses utilizing the first three clinician scales of the MMPI as dependent measures. An overall significant F ratio was obtained for the Hysteria scale, but not for either the Depression nor the Hypochondriasis scales. The patient's age and sex were the only significant members of the predictor set for all three of the clinician scales. The findings indicate that the rehabilitation of CLBP patients must include issues of social involvement and self control.

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Do diagnostic segmental nerve root blocks in chronic low back pain patients with radiation to the leg lack distinct sensory effects? A preliminary study

British Journal of Anaesthesia ◽

10.1093/bja/aei307 ◽

2006 ◽

Vol 96 (2) ◽

pp. 253-258 ◽

Cited By ~ 7

Author(s):

A.P. Wolff ◽

G.J. Groen ◽

O.H.G. Wilder-Smith ◽

J Richardson ◽

J van Egmond ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Nerve Root ◽

Low Back ◽

Sensory Effects ◽

Segmental Nerve ◽

Nerve Root Blocks ◽

Preliminary Study ◽

Pain Patients

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The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10245931 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5931

Author(s):

Ingrid Schuttert ◽

Hans Timmerman ◽

Kristian K. Petersen ◽

Megan E. McPhee ◽

Lars Arendt-Nielsen ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Quantitative Methods ◽

Assessment Methods ◽

Low Back ◽

Central Sensitisation ◽

Current Systematic Review ◽

Underlying Mechanisms

Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term ‘human assumed central sensitisation’ (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.

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“If You Don’t Keep Going, You’re Gonna Die”: Helplessness and Perseverance Among Older Adults Living With Chronic Low Back Pain

The Gerontologist ◽

10.1093/geront/gnaa150 ◽

2020 ◽

Author(s):

Meredith Stensland

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Lived Experience ◽

Chronic Low Back Pain ◽

Adult Population ◽

Pain Clinic ◽

Low Back ◽

Illness Experiences ◽

Design And Methods

Abstract Background and Objectives Chronic low back pain (CLBP) is the leading cause of disability worldwide and the most common pain complaint among the rapidly growing older adult population. As part of a larger qualitative study examining the lived experience of CLBP among older adults, the objective of the present study is to understand how older pain clinic patients experience helplessness and also how they foster perseverance amid treatment-resistant CLBP. Research Design and Methods Using van Manen’s phenomenological method, semistructured, in-depth, one-on-one interviews were conducted with 21 older pain clinic patients (aged 66–83) living with CLBP. Data were iteratively analyzed via line-by-line thematic coding. Results Findings dually illustrate how participants were living a battle between helplessness and perseverance; the final thematic structure revealed 5 subthemes: (a) Feeling helpless because nothing works; (b) Feeling down and depressed; (c) Distantly wishing for an end; (d) Accepting the reality of my pain; and (e) The pain stays, I keep going. Discussion and Implications This study contributes a vivid illustration of older adults’ CLBP illness experiences that are substantially underpinned by helplessness, depression, and a drive to continue thriving in old age. Practice implications include the need for clinic-based mood and suicide assessment.

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Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031592 ◽

2020 ◽

Vol 10 (3) ◽

pp. e031592 ◽

Cited By ~ 1

Author(s):

Jone Ansuategui Echeita ◽

Henrica R Schiphorst Preuper ◽

Rienk Dekker ◽

Ilse Stuive ◽

Hans Timmerman ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Multiple Regression ◽

Chronic Low Back Pain ◽

Medical Center ◽

Low Back ◽

Cross Sectional ◽

Central Sensitisation ◽

Independent Variable ◽

Symptoms And Signs

IntroductionA relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes.Methods and analysisA cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age.Ethics and disseminationThe study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders.Trial registration numberNTR7167/NL6980.

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