Central sensitization in chronic lumbar spine pain – possibilities of therapeutic interventions

Patients with chronic low back pain are a heterogeneous group. Therapeutic management of these patients should address the underlying mechanism of pain, which can be revealed after performing diagnostic tests. The management of patients with the predominant central sensitization component of includes multimodal therapy consisting of pharmacological and non-pharmacological treatment. An important element is also the identification and exclusion of the most important pathophysiological factors affecting the maintenance of central sensitization mechanisms in each patient. The paper describes pharmacological and non-pharmacological therapeutic options in patients with central sensitization component, considering that these methods may differ significantly in the patients. It should be stated that despite the individualized, multimodal therapy based on pain mechanisms, in some patients substantial pain relief may not be achieved.

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Central sensitization in chronic lumbar spine pain – pathophysiology and diagnostics

Ból ◽

10.5604/01.3001.0014.3421 ◽

2020 ◽

Vol 21 (1) ◽

pp. 1-9

Author(s):

Barabara Kosińska ◽

Paweł Turczyn ◽

Krzysztof Wesołowski ◽

Beata Tarnacka ◽

Małgorzata Malec-Milewska

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Central Sensitization ◽

Clinical Problem ◽

Low Back ◽

Spine Pain ◽

High Prevalence ◽

Pain Symptoms ◽

Patients Experience

Chronic low back pain is a substantial clinical problem because of its high prevalence, incidence, complex and heterogeneous symptomatology. The majority of patients experience nociceptive pain only, but in almost 40% of patients neuropathic component may be present. In many patients with low back pain symptoms associated with central sensitization may be present as well and therefore their pain can be classified as nocyplastic. (functional) This paper describes how clinicians can differentiate these types of pain, taking into account that in a given patient several mechanisms may contribute to chronic pain development, and pain results from complex mechanisms. In the second part, therapeutic options are presented for people with symptoms of central sensitization, with emphasis on non-pharmacological methods.

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Low Back Pain: Guidelines for the Clinical Classification of Predominant Neuropathic, Nociceptive, or Central Sensitization Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e333 ◽

2015 ◽

Vol 3;18 (3;5) ◽

pp. E333-E346 ◽

Cited By ~ 34

Author(s):

Jo Nijs

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Expert Opinion ◽

Central Sensitization ◽

Classification Systems ◽

Original Research ◽

Low Back ◽

Pain Mechanisms ◽

Efficient Treatment

Background: Low back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP patients should be classified clinically as either predominantly nociceptive, neuropathic, or central sensitization pain. Objective: To explain how clinicians can differentiate between nociceptive, neuropathic, and central sensitization pain in patients with LBP. Study Design: Narrative review and expert opinion. Setting: Universities, university hospitals and private practices. Methods: Recently, a clinical method for the classification of central sensitization pain versus neuropathic and nociceptive pain was developed. It is based on a body of evidence of original research papers and expert opinion of 18 pain experts from 7 different countries. Here we apply this classification algorithm to the LBP population. Results: The first step implies examining the presence of neuropathic low back pain. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm. Limitations: The classification criteria are substantiated by several original research findings including a Delphi survey, a study of a large group of LBP patients, and validation studies of the Central Sensitization Inventory. Nevertheless, these criteria require validation in clinical settings. Conclusion: The pain classification system for LBP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focussed on pain mechanisms solely. Key words: Chronic pain, neuroscience, diagnosis, clinical reasoning, examination, assessment

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Biobehavioral Factors Affecting Pain and Disability in Low Back Pain: Mechanisms and Assessment

Physical Therapy ◽

10.1093/ptj/75.4.267 ◽

1995 ◽

Vol 75 (4) ◽

pp. 267-280 ◽

Cited By ~ 79

Author(s):

Michael Feuerstein ◽

Paul Beattie

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Pain Mechanisms ◽

Factors Affecting

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The genetic influence of the brain-derived neurotrophic factor Val66Met polymorphism in chronic low back pain

Advances in Rheumatology ◽

10.1186/s42358-021-00183-7 ◽

2021 ◽

Vol 61 (1) ◽

Author(s):

Angela Shiratsu Yamada ◽

Flavia Tasmim Techera Antunes ◽

Camila Ferraz ◽

Alessandra Hubner de Souza ◽

Daniel Simon

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Neurotrophic Factor ◽

Central Sensitization ◽

Low Back ◽

Bdnf Gene ◽

Val66met Polymorphism ◽

Bdnf Val66met Polymorphism ◽

The Brain

Abstract Background The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is a potential biomarker of vulnerability to pain. Thus, the present study aimed to investigate the association of this polymorphism with clinical and biopsychosocial factors in patients with chronic low back pain (CLBP). Methods A total of 107 individuals with CLBP answered questionnaires that were validated and adapted for the Brazilian population, including the Brief Inventory of Pain, the Central Sensitization Inventory, the Roland Morris Disability Questionnaire, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, the Survey of Pain Attitude-Brief, and the Hospital Anxiety and Depression Scale. All of the subjects were genotyped for the BDNF Val66Met polymorphism. Results The sample showed moderate scores of disability, central sensitization, and kinesiophobia, in addition to mild anxiety, hopelessness, and ruminant thoughts. No significant association was observed between the Val66Met polymorphism and the variables analyzed. Besides, there was no relationship between the BDNF Val66Met polymorphism with CSI, catastrophization, or disabilities that were generated by CLBP. Conclusion The results showed that the Val66Met polymorphism of the BDNF gene was not associated with clinical and biopsychosocial characteristics of CLBP in the sample studied.

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Overuse of diagnostic testing in healthcare: a systematic review

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012576 ◽

2021 ◽

pp. bmjqs-2020-012576

Author(s):

Joris L J M Müskens ◽

Rudolf Bertijn Kool ◽

Simone A van Dulmen ◽

Gert P Westert

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Diagnostic Tests ◽

Patient Population ◽

English Language ◽

Diagnostic Testing ◽

Low Back ◽

Preoperative Testing ◽

Healthcare Settings ◽

Major Variation

BackgroundOveruse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting.MethodsPubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens.Results118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation.ConclusionOur findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse.

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Effectiveness of a Multimodal Therapy for Patients with Chronic Low Back Pain Regarding Pre-Admission Healthcare Utilization

PLoS ONE ◽

10.1371/journal.pone.0143139 ◽

2015 ◽

Vol 10 (11) ◽

pp. e0143139 ◽

Cited By ~ 16

Author(s):

Constanze Borys ◽

Johannes Lutz ◽

Bernhard Strauss ◽

Uwe Altmann

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Healthcare Utilization ◽

Chronic Low Back Pain ◽

Multimodal Therapy ◽

Low Back

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Influence of pilates method on the treatment of nonspecific chronic low back pain: a protocol study for a randomized, controlled, blind trial

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2020.18.778 ◽

2020 ◽

Vol 18 ◽

pp. 1-5

Author(s):

Bianca Martins de Souza ◽

Daiane Oliveira da Silva ◽

Lais Paraguai Justo ◽

Leandro Lazzareschi ◽

Daniela Aparecida Biasotto-Gonzalez ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Central Sensitization ◽

Personal Information ◽

Treatment Session ◽

Control Group ◽

Low Back ◽

Pilates Method ◽

Type Of Exercise ◽

And Function

Background: Low back pain is one of the most common musculoskeletal problems among workers. Studies estimate that 90% of the adults will suffer at least one episode of low back pain in life that will lead to the temporary interruption of work. A type of exercise that has gained increasing popularity among individuals with low back pain in the last decade is the Pilates method. Objective: Determine the influence of the Pilates method on improvements in pain, kinesiophobia, central sensitization and function in patients with chronic nonspecific low back pain. Methods: Thirty-four male and female volunteers between 18 and 35 years of age with a complaint of nonspecific low back pain for at least three months will be divided into two groups: Pilates method and control group. An evaluation chart created by the authors will be used to collect data on personal information, history of diseases, alcohol use, smoking, pain intensity (visual analog scale) and medications used. The Tampa Scale for Kinesiophobia, Central Sensitization Questionnaire and Oswestry Disability Index will also be administered. Pilates exercises will be performed three time per week for four weeks and administered by a researcher with adequate training in the method. Reevaluations will be performed after the sixth treatment session in the Pilates group, two weeks after the initial evaluation in the control group, after the 12th session in the Pilates group and after four weeks in the control group. Another reevaluation will be performed three months after treatment. Results: The data will be submitted to statistical analysis and the level of significance will be set to 5%. Conclusion: Based on the results analyzed it will be possible to determine the influence of Pilates Method on improvements in pain, kinesiophobia, central sensitization and function in patients with chronic nonspecific low back pain.

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