Differences in Quantitative Sensory Testing Outcomes Between Patients With Low Back Pain in Primary Care and Pain-free Controls

Abstract

Objectives: Quantitative Sensory Testing (QST) is used to test somatosensory functioning in on people with chronic LBP in secondary/ tertiary health care facilities. Studies using QST-testing on LBP populations in primary care are scarce. Central Sensitization Inventory (CSI) measures central sensitization (CS)-related symptoms and studies investigating the differences between QST-testing and participants with LBP with a positive and negative score on the CSI questionnaire are also rare. This case-control study investigates differences of an extensive QST-measurement between patients with acute, chronic LBP, and pain-free controls (PFCs) in primary care. Secondary aim is to investigate differences of an extensive QST-measurement between "CS" and "no-CS" group.Materials and Methods: Participants with LBP were recruited from November 2016 to October 2019. Demographic and clinical information was collected and a standardized QST protocol was taken. Data analysis involved determining differences between groups.Results: Data of 100 participants with LBP and 50 PFCs were analyzed. Heat pain thresholds, pressure pain threshold, and conditioned pain modulation local and remote were significantly moderately to relatively strongly affected by acute, chronic LBP and PFCs (P < 0.001 to 0.001). Lumbar temporal summation was significantly moderately affected by acute, chronic LBP, and PFCs (P = 0.001). Only pressure pain threshold showed significant difference between "CS" and "no-CS" group (P = 0.001 to 0.002).Discussion: Signs of enhanced nociceptive processing and disturbed top-down nociceptive modulation are apparent in people with acute and chronic LBP in primary care. Results indicate existence of central mechanisms in LBP in primary care.

Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study

“…The underlying mechanisms linking comorbidities to pain in the hands and overall body remains unknown. Based on previous literature [ 8 , 39 , 40 ], altered pain physiology and mechanisms of central sensitization could theoretically explain the observed associations between comorbidities and self-reported pain severity. However, comorbidity burden, back pain and depression showed mostly non-significant associations with measures of central sensitization, questioning the importance of this mechanism behind the observed associations in this study.…”

Explaining persistent physical symptoms to patients in general practice: can tests to measure central sensitisation add value? A mixed-methods study.

“…(43) Their RCT showed, in a population with chronic low back pain in primary care, a signi cant difference between the CS and no-CS groups. (44) The results for temporal summation were more mixed.…”