Centralization Phenomenon: Its Usefulness in Evaluating and Treating Referred Pain

Donelson, Ronald; Silva, Gregory; Murphy, Kenneth D.

doi:10.17761/ijyt.6.1.b3587167251j5k14

Cited by 12 publications

(17 citation statements)

References 2 publications

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“…The centralization phenomenon is a common clinical sign observed when patients with low back pain are examined using standardized test movements and sustained postures first described by McKenzie (278). This phenomenon has been evaluated for reliability and validity in multiple contexts (279)(280)(281)(282)(283)(284). Investigators have found that the centralization phenomenon is highly specific to discogenic pain, and is infrequently observed in patients with sacroiliac or facet joint pain.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

Simopoulos

2012

Pain Phys

142

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Background: The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature. Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions. Study Design: A systematic review of diagnostic sacroiliac joint interventions. Methods: Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard. Results: The evidence is good for the diagnosis of sacroiliac joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose sacroiliac joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited. Limitations: The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of sacroiliac joint pain. Conclusions: Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited. Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliac joint dysfunction, provocation manuevers, controlled diagnostic blocks, intraarticular injection, extraarticular injection.

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Section: Discussionmentioning

confidence: 99%

A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

Simopoulos

2012

Pain Phys

142

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“…None of these methods has proven superiority over another, and none provides significant neurogenic claudication improvement. 18,19 If there is a history of lower limb chronic pain, paresthesia, dysesthesia, or neuropathic pain, this treatment can be associated with tricyclic antidepressants and/or anticonvulsants such as gabapentin or pregabalin. Pregabalin is the drug of choice in neuropathic pain, with 40% of patients reporting relief.…”

Section: Lumbar Spinal Stenosis: Conservative Treatmentmentioning

confidence: 99%

“…None of these methods has proven superiority over another, and none provides significant neurogenic claudication improvement. 18 19 …”

Section: Lumbar Spinal Stenosis: Conservative Treatmentmentioning

confidence: 99%

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Estenose degenerativa do canal lombar

Hennemann

Abreu

2020

Rev Bras Ortop (Sao Paulo)

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ResumoA estenose degenerativa do canal vertebral lombar é a causa mais frequente de dor lombar e/ou ciática no paciente idoso; sua epidemiologia, fisiopatogenia, manifestações e testes clínicos são revistos em ampla investigação bibliográfica atual. A importância da relação entre a clínica e o estudo por imagens, principalmente a ressonância magnética (RM), é ressaltada. Antes da indicação do tratamento, é necessário identificar a localização precisa da dor, bem como o diagnóstico diferencial entre a claudicação neurogênica e a vascular. O tratamento conservador associando medicações com as diversas técnicas fisioterápicas resolve o problema na maioria dos casos, já o teste terapêutico com os bloqueios, seja epidural, foraminal ou facetário, é realizado quando as dores não cedem com o tratamento conservador e antes da indicação da cirurgia. Os bloqueios costumam dar melhores resultados no alívio dos sintomas de ciatalgia e menos no quadro de claudicação neurogênica. A descompressão da cauda equina e/ou radicular associada ou não à artrodese é o padrão ouro quando a intervenção cirúrgica é necessária. A artrodese após a descompressão é necessária nos casos com instabilidade segmentar, como na espondilolistese degenerativa. Quando a estenose de canal acontece em múltiplos níveis e vem acompanhada de desvio de eixo, seja coronal e/ou sagital, deve ser realizada, além das descompressões e artrodese, a correção dos desvios de eixo, principalmente o eixo sagital, quando a correção da lordose lombar se impõe com técnicas que corrigem a lordose retificada para valores próximos à incidência pélvica.

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“…As per Werneke et al [11], the centralization of symptoms supports favorable outcomes in patients. Although centralization is considered a predictor of the treatment outcomes in low back pain [11][12][13][14][15][16], limited studies have been conducted on patients with CBPS. It is observed that C5-C6 is the most affected segment in the cervical spine.…”

Section: Introductionmentioning

confidence: 99%

Influence of Tensioner’s Mobilization on the Centralization of Symptoms in Cervicobrachial Pain Syndrome: A Randomized Controlled Trial

Sudhakar¹,

Khan²,

Saraswat³

et al. 2022

Asian Spine J

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This study was designed as a randomized controlled trial. Purpose: The present study aimed to determine the impact of neural mobilization by tensioner's technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS). Overview of Literature: CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms. Methods: Thirty patients aged 18-45 years with a complaint of pain in the neck that had persisted for 2-12 weeks radiating to the arm and fulfilling Elvey's criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke's scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within-and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels. Results: There was a significant difference (p<0.05) within and between the groups for both the measures at the end of the 3rd and 6th sessions. Thus, NMTT may be beneficial in decreasing the peripheralization of symptoms and pain intensity in patients with CBPS. Conclusions: NMTT can be used as an alternative and effective treatment option for patients with CBPS.

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Centralization Phenomenon: Its Usefulness in Evaluating and Treating Referred Pain

Cited by 12 publications

References 2 publications

A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

Estenose degenerativa do canal lombar

Influence of Tensioner’s Mobilization on the Centralization of Symptoms in Cervicobrachial Pain Syndrome: A Randomized Controlled Trial

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