Low back related leg pain: An investigation of construct validity of a new classification system

Schäfer, Axel; Hall, Toby; Rolke, Roman; Treede, Rolf‐Detlef; Luedtke, Kerstin; Mallwitz, Joachim; Briffa, Kathy

doi:10.3233/bmr-140461

Cited by 14 publications

(7 citation statements)

References 45 publications

(48 reference statements)

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“…In other pain disorders, QST is indicative of poor prognosis, 69 and in low back-related leg pain, membership of subgroups with different sensory characteristics predicts treatment responses. 65 Future investigation should consider whether membership of these subgroups is prognostic and influences management outcomes.…”

Section: ) "mentioning

confidence: 99%

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Rabey

Slater²,

O’Sullivan³

et al. 2015

Pain

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The objectives of this study were to explore the existence of subgroups in a cohort with chronic low back pain (n = 294) based on the results of multimodal sensory testing and profile subgroups on demographic, psychological, lifestyle, and general health factors. Bedside (2-point discrimination, brush, vibration and pinprick perception, temporal summation on repeated monofilament stimulation) and laboratory (mechanical detection threshold, pressure, heat and cold pain thresholds, conditioned pain modulation) sensory testing were examined at wrist and lumbar sites. Data were entered into principal component analysis, and 5 component scores were entered into latent class analysis. Three clusters, with different sensory characteristics, were derived. Cluster 1 (31.9%) was characterised by average to high temperature and pressure pain sensitivity. Cluster 2 (52.0%) was characterised by average to high pressure pain sensitivity. Cluster 3 (16.0%) was characterised by low temperature and pressure pain sensitivity. Temporal summation occurred significantly more frequently in cluster 1. Subgroups were profiled on pain intensity, disability, depression, anxiety, stress, life events, fear avoidance, catastrophizing, perception of the low back region, comorbidities, body mass index, multiple pain sites, sleep, and activity levels. Clusters 1 and 2 had a significantly greater proportion of female participants and higher depression and sleep disturbance scores than cluster 3. The proportion of participants undertaking <300 minutes per week of moderate activity was significantly greater in cluster 1 than in clusters 2 and 3. Low back pain, therefore, does not appear to be homogeneous. Pain mechanisms relating to presentations of each subgroup were postulated. Future research may investigate prognoses and interventions tailored towards these subgroups.

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Section: ) "mentioning

confidence: 99%

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Rabey

Slater²,

O’Sullivan³

et al. 2015

Pain

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show abstract

“…More detailed radiological and neurological assessments may be indicated in some patients, including quantitative sensory testing (QST). QST is used to reveal pathological signs of neuropathic pain and is recognized to be a useful additional diagnostic tool (Freynhagen and Baron, ; Schäfer et al., ). Additionally, neurophysiological investigations utilizing electroneuromyography (i.e.…”

Section: Diagnosis Of Neuropathic Lbpmentioning

confidence: 99%

Neuropathic low back pain in clinical practice

Baron

Binder

Attal

et al. 2016

European Journal of Pain

179

141

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Background and objectiveLow back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments.Databases and data treatmentLiterature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature.ResultsChronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears under‐recognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP.ConclusionsChronic LBP often has an under‐recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment.What does this review add?Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism‐based therapies.Open and retrospective studies suggest that agents like tapentadol and topical analgesics — such as the capsaicin 8% patch and the lidocaine 5% medicated plaster — may be effective options for the treatment of neuropathic low back pain in defined patient groups.

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“…There is a tendency of phenotyping pain patients to characterize them more accurately and facilitate the selection of available treatments [3]. Quantitative sensory testing (QST) is used to evaluate sensory disturbances, and it is applicable in patients with back pain pathology [4]. Standardized and automated QST is a reliable method supplying detailed characteristics of sensory function.…”

Section: Introductionmentioning

confidence: 99%

Sensory Perception in Lumbosacral Radiculopathy with Radicular Pain: Feasibility Study of Multimodal Bedside-Suitable Somatosensory Testing

Vaitkus

Šipylaitė

2021

AML

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Background. Somatosensory testing could be useful in stratifying pain patients and improving pain treatment guidelines. Bedside-suitable techniques are searched for application in daily clinical practice. This study aimed to characterize chronic unilateral lumbosacral radiculopathy (LSR) patients with radicular pain using multimodal bedside-suitable somatosensory testing.Materials and methods. We evaluated 50 chronic unilateral LSR patients with radicular pain (LSR group) and 24 controls (Control group). Sensory testing was performed using a battery of bedside sensory tests (10g monofilament, 200–400 mN brush, Lindblom rollers with controlled 25°C and 40°C temperature, and 40g neurological pin and investigator’s finger pressure). Participants had to rate their sensory perceptions on both legs at multiple test points within L3 to S2 dermatomes. Characteristics of the testing process and sensory disturbances were analyzed.Results. LSR group showed sensory disturbances in 82% of patients. The Control group showed no sensory disturbances. Sensory testing took longer (p < 0.001) in the LSR group (29.3 ± 6.5 minutes per patient) than in the Control group (20.5 ± 5.2). Nine sensory phenotypes were detected in the LSR group according to individual sensory disturbances within 5 superficial tests.Conclusions. The applied multimodal bedside-suitable somatosensory testing battery is suitable for sensory evaluation and characterization of LSR patients. Grouping of allied sensory phenotypes revealed some tendencies in pain intensity characteristics.

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Low back related leg pain: An investigation of construct validity of a new classification system

Cited by 14 publications

References 45 publications

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain

Neuropathic low back pain in clinical practice

Sensory Perception in Lumbosacral Radiculopathy with Radicular Pain: Feasibility Study of Multimodal Bedside-Suitable Somatosensory Testing

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