Centralization: Its Prognostic Value in Patients With Referred Symptoms and Sciatica

Skytte, Lene; May, Stephen; Petersen, P.

doi:10.1097/01.brs.0000164119.78463.0c

Cited by 53 publications

(45 citation statements)

References 42 publications

(37 reference statements)

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“…Although outcome measurements after TESIs showed statistically significant change in leg pain and disability, the differences were not deemed clinically relevant by the patients. These findings are in line with Skytte et al [25] who found that patients with peripheralizing response were six times more likely to undergo surgery than centralizers. Interestingly, the patients who were operated showed higher levels of pain and disablity at intake compared to the non-surgery patients.…”

Section: Discussionsupporting

confidence: 82%

“…The good outcomes in the centralizing subgroup are in accordance with studies that report good outcomes for centralizers treated with MDT [9,24,25]. The outcomes of the present study justify some optimism, especially when recognizing that all included patients had peripheralizing pain responses, MRI-verified herniated discs that corresponded to clinical assessment and 91% of the patients had chronic symptoms.…”

Section: Discussionsupporting

confidence: 77%

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Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

Helvoirt

Apeldoorn

Knol

et al. 2016

BMR

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Abstract. STUDY DESIGN: Prospective cohort study. BACKGROUND: Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. OBJECTIVE: The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. METHODS: Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. RESULTS: A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain. H. van Helvoirt et al. / Transforaminal epidural steroid injections influence MDT pain response classificationThese patients underwent surgery and were not further evaluated. Eleven (14%) patients were classified as resolved, 37 (48%) as centralizing with significant less pain, and 12 (16%) as peripheralizing with significant less pain. None of these patients underwent surgery. Resolved and centralizer subgroups had better outcomes in terms of VAS and RMDQ than the non-operated peripheralizers at discharge and at 12 months. The succes rates (GPE) for the resolved, centralizing, and peripheralizing with less pain patients were 100%, 100% and 33% respectively at short term, and 100%, 92% and 50% respectively at long term. CONCLUSION: After TESIs, a peripheralizing pain pattern changed to resolved or centralizing in 62% of the patients. For the non-operated patients, those with a centralising pattern after TESIs reported better pain and disability outcomes than those with peripheralizing pattern at short ...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 77%

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

Helvoirt

Apeldoorn

Knol

et al. 2016

BMR

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“…2 Posterior tilting of the pelvis has been recommended as an exercise for relief of LBP since at least as far back as the 1980s 3,4 and can still occasionally be found in patient education literature and Internet sites. Nor is the concept unique to this exercise; there are many published examples of directional preference-the identification of which positions and movement patterns relieve or aggravate pain-for lumbar flexion, as well as for extension and lateral bending [5][6][7][8][9][10][11] -and use of that information for therapeutic decisions.…”

Section: Introductionmentioning

confidence: 99%

Low Back Pain Response to Pelvic Tilt Position: An Observational Study of Chiropractic Patients

Minicozzi¹,

Russell

Ray

et al. 2016

Journal of Chiropractic Medicine

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Objective: The aim of this study was to look for differences between patients with an increased pain response as compared with those with a decreased pain response. Methods: Data were collected from consecutive new patients with lumbar or lumbopelvic pain in a chiropractic clinic. A pelvic tilt exercise was included in the initial examination, and pain response was noted. Analysis was made of pain and disability severity, as well as symptom location, chronicity, and other characteristics, before and after a course of chiropractic care. Results: Patients with an increased pain response to pelvic tilt (n = 12) had higher levels of pain and disability at baseline than patients without (n = 34). There were no between-group differences in other aspects of their complaints; in age, sex, or body mass; or in the types of care they received (eg, manipulation, stretching, exercise instruction). On the average, both groups of patients showed improvement with chiropractic care, and there was no detectable difference in improvement between groups. Conclusions: This study found that patients experiencing pain in response to a pelvic tilt maneuver may have a poorer precare status than patients with a decreased pain response.

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“…1 Thus, a CEN pain response has consistently been associated with good outcome in patients with acute and chronic LBP, 8,13,20,28,29,[35][36][37][38] reflecting a poorer prognosis when CEN is absent.…”

mentioning

confidence: 99%

“…20,27,28 The objective of this study was to investigate the prognostic value of pain response classification at initial physiotherapy examination in patients with LBP who were sick-listed.…”

mentioning

confidence: 99%

Pain Response Classification Does Not Predict Long-Term Outcome in Patients With Low Back Pain Who Are Sick-Listed

Christiansen¹,

Larsen²,

Jensen³

et al. 2010

J Orthop Sports Phys Ther

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Low back pain (LBP) is a common disorder and one of the most frequent reasons for seeking healthcare. 33 Most LBP episodes are self-limiting, but a small percentage of people with LBP develop recurrent or chronic pain and disability. 31 Recurrent and chronic LBP accounts for a substantial proportion of all absence from work. 5 The longer the sick-listing, the more difficult 4 Head of Department, Department of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, Arhus, Denmark. This study is part of a randomized clinical trial financed by the municipalities of Silkeborg, Favrskov, and Skanderborg, Denmark and the Central Denmark Region. The present part of the study was also supported by a grant from the Research Foundation of Danish Physiotherapists. The study was discussed with The Regional Research Ethics Committee, which determined that formal ethical approval was not required. All participants signed informed consent, and the study was approved by the Danish Data Protection Agency (No. -41-1278 t BaCKGrOund: Recurrent and chronic LBP accounts for a substantial proportion of all absence from work. In predicting outcome in patients with LBP, psychosocial factors are thought to play an important role, while findings from clinical examination seem to be of more limited value. Mechanical evaluation, using repeated end range spinal movements that result in specific pain responses, has been shown to be of some value.t MethOds: The study included 351 patients sick-listed because of LBP with or without sciatica. Prior to clinical examination, the patients completed a comprehensive questionnaire including questions on pain, function, and psychosocial factors. The physiotherapy examination included a standardized mechanical evaluation. Patients were classified into 3 groups according to their pain response: centralization, peripheralization, or no response. Outcomes were obtained by national register data, medical records, and a postal questionnaire at 1 year.t resuLts: At 1-year follow-up, 65% of the patients had returned to work. All pain response groups showed significant and clinically important improvements in both pain and disability. No significant differences were found between pain response groups in any outcome measure. Results remained unchanged after adjustment for potential confounders.t COnCLusiOn: The prognostic value of pain response classification seems limited in patients sick-listed from work because of LBP.t LeVeL OF eVidenCe: Prognosis, level 1b.

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Centralization: Its Prognostic Value in Patients With Referred Symptoms and Sciatica

Abstract: Patients with sciatica and suspected disc herniation who have a centralization response to a mechanical evaluation will have significantly better outcomes. Patients who do not have centralization will be 6 times more likely to undergo surgery.

Cited by 53 publications

References 42 publications

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery

Low Back Pain Response to Pelvic Tilt Position: An Observational Study of Chiropractic Patients

Pain Response Classification Does Not Predict Long-Term Outcome in Patients With Low Back Pain Who Are Sick-Listed

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