Topographic mapping of pain sensitivity of the lower back – a comparison of healthy controls and patients with chronic non-specific low back pain

O’Neill, Søren; Larsen, Johanne Brinch; Nim, Casper Glissmann; Arendt-Nielsen, Lars

doi:10.1515/sjpain-2018-0113

Cited by 13 publications

(22 citation statements)

References 62 publications

(63 reference statements)

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“…At baseline, we did not observe any consistent differences in any of the QST measures between groups, indicating that our sample of people with LBP did not show obvious signs of peripheral or central sensitization. This is in contrast with previous work using multiple PPTs over the lumbar region, which showed lower PPTs for people with LBP in a comparable population . The high interindividual differences and the relatively low levels of pain and disability in our sample could explain this.…”

Section: Discussioncontrasting

confidence: 99%

Lack of Exercise‐Induced Hypoalgesia to Repetitive Back Movement in People with Chronic Low Back Pain

et al. 2019

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& AbstractPurpose: To investigate whether people with chronic low back pain (LBP) show dysfunctional exercise-induced hypoalgesia (EIH) in response to repeated contractions of their back muscles during a lifting task. Methods: In this cross-sectional observational study conducted on asymptomatic participants (n = 18) and participants with chronic LBP (n = 21), quantitative sensory testing (QST) was applied extensively over the lumbar region and a remote area before and after a repeated task that involved lifting a 5-kg box for~7 minutes. QST included pressure pain thresholds (PPTs), thermal detection, pain thresholds, and measures of temporal summation. Topographical maps of the percentage change in PPT detected at 16 locations over the lumbar region were generated to explore regional differences and compared between groups. Results: Mean (standard deviation) PPTs measured from 16 sites over the lower back changed significantly in asymptomatic participants (+29.78 kPa [41.4]) following task completion, indicative of EIH, whereas no significant change was observed for the low back pain (LBP) group (À14.87 kPa [61.2]). No changes were detected at the remote site for either group. No changes were revealed for the thermal tests. Temporal summation data revealed decreasing pain sensitivity as the test progressed, but the test response did not change after the exercise for either group. Conclusion(s): Unlike asymptomatic individuals, participants with LBP lacked EIH over the lumbar erector spinae muscles following repeated lifting. Although these results should be considered in relation to the study limitations, particularly the absence of a control group, the findings support impaired EIH in patients with LBP. &

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Section: Discussioncontrasting

confidence: 99%

Lack of Exercise‐Induced Hypoalgesia to Repetitive Back Movement in People with Chronic Low Back Pain

et al. 2019

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“…This neurological mediated reflex could depend upon sensitization of central pain mechanisms. This mechanism occurs as the pain persists 47 and typically the QST scores differs significantly in chronic versus acute pain 48 and versus asymptomatic subjects 49 . There is some evidence to suggest that such widespread hypersensitivity is rapidly reversible 50,51 .…”

Section: Patient Reported Low Back Pain Intensity Whether the Reductmentioning

confidence: 99%

“…It is not evident whether the randomization actually represents the stiffest or most pain sensitive segments. It may be possible that a discrete anatomical distribution of lumbar stiffness exists that ought to be adjusted for, yet for PPT this does not appear to be the case 49 . The indexing was used to avoid a potential overlap between the stiffest and most pain sensitive segment.…”

Section: Patient Reported Low Back Pain Intensity Whether the Reductmentioning

confidence: 99%

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

Nim

Kawchuk

Schiøttz‐Christensen

et al. 2020

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The mechanisms underlying pain relief following spinal manipulative therapy (SMT) are not understood fully although biomechanical and neurophysiological processes have been proposed. As such, we designed this randomized trial to elucidate the contributions of biomechanical and neurophysiological processes. A total of 132 participants with low back pain were randomly assigned to receive SMT at either the lumbar segment measured as the stiffest or the segment measured as having the lowest pain threshold. The primary outcome was patient reported low back pain intensity following treatment. Secondary outcomes were biomechanical stiffness and neurophysiological pressure pain threshold. All outcomes were measured at baseline, after the fourth and final session and at 2-weeks follow-up. Data were analyzed using linear mixed models, and demonstrated that the SMT application site did not influence patient reported low back pain intensity or stiffness. However, a large and significant difference in pressure pain threshold was observed between groups. This study provides support that SMT impacts neurophysiological parameters through a segment-dependent neurological reflex pathway, although this do not seem to be a proxy for improvement. This study was limited by the assumption that the applied treatment was sufficient to impact the primary outcome. Treatment of low back pain. Low back pain (LBP) is now the number one cause for years lived disability worldwide 1. In most cases, a specific pathoanatomical cause of LBP cannot be identified 2. Without a specific therapeutic target, a predictably large and diverse spectrum of interventions are available to clinicians that range from joint mobilization to spinal fusion surgery 3. Given these almost endless possibilities, clinical guidelines rate education and exercise as first line therapy for low back pain often in combination with manual therapy 3. Although, these guideline recommendations are generally clear and unambiguous, it is challenging for clinicians to implement them in practice (e.g. which exercises to recommend, how often, and which patients to offer manual therapy etc.). Spinal manipulative therapy. Spinal manipulative therapy (SMT) is a manual therapy recommended as a second line intervention for LBP in most clinical guidelines 4. However, like other conservative treatments, there is little evidence or consensus regarding the specifics of SMT application such as which patients are likely to respond, which type of SMT should be used, and which dose/frequency of SMT is optimal. While the specific SMT technique does not seem to be important 5-7 , there are at least two theoretical rationales for where to apply SMT: at the site of greatest biomechanical dysfunction or the site of greatest pain sensitivity. As the goal of SMT is to restore normal function to segments with biomechanical dysfunctions 8 , it may be surprising to some that the evidence for identifying such dysfunction is sparse. A narrative review reported that clinicians use a variety of different ways to ...

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“…It is of interest that these perturbations, in a commonly noted mechanical syndrome such as LBP, extend beyond deep muscle mechanical pain sensitivity, i.e., pressure pain, to superficial skin measures, e.g., heat pain. Nevertheless, apparent differences have previously been reported for both these measurements between LBP patients and healthy controls [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional analysis of persistent low back pain, using correlations between lumbar stiffness, pressure pain threshold, and heat pain threshold

et al. 2021

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Introduction Little is known about the underlying biomechanical cause of low back pain (LBP). Recently, technological advances have made it possible to quantify biomechanical and neurophysiological measurements, potentially relevant factors in understanding LBP etiology. However, few studies have explored the relation between these factors. This study aims to quantify the correlation between biomechanical and neurophysiological outcomes in non-specific LBP and examine whether these correlations differ when considered regionally vs. segmentally. Methods This is a secondary cross-sectional analysis of 132 participants with persistent non-specific LBP. Biomechanical data included spinal stiffness (global stiffness) measured by a rolling indenter. Neurophysiological data included pain sensitivity (pressure pain threshold and heat pain threshold) measured by a pressure algometer and a thermode. Correlations were tested using Pearson’s product-moment correlation or Spearman’s rank correlation as appropriate. The association between these outcomes and the segmental level was tested using ANOVA with post-hoc Tukey corrected comparisons. Results A moderate positive correlation was found between spinal stiffness and pressure pain threshold, i.e., high degrees of stiffness were associated with high pressure pain thresholds. The correlation between spinal stiffness and heat pain threshold was poor and not statistically significant. Aside from a statistically significant minor association between the lower and the upper lumbar segments and stiffness, no other segmental relation was shown. Conclusions The moderate correlation between spinal stiffness and mechanical pain sensitivity was the opposite of expected, meaning higher degrees of stiffness was associated with higher pressure pain thresholds. No clinically relevant segmental association existed.

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Topographic mapping of pain sensitivity of the lower back – a comparison of healthy controls and patients with chronic non-specific low back pain

Cited by 13 publications

References 62 publications

Lack of Exercise‐Induced Hypoalgesia to Repetitive Back Movement in People with Chronic Low Back Pain

Lack of Exercise‐Induced Hypoalgesia to Repetitive Back Movement in People with Chronic Low Back Pain

The effect on clinical outcomes when targeting spinal manipulation at stiffness or pain sensitivity: a randomized trial

A cross-sectional analysis of persistent low back pain, using correlations between lumbar stiffness, pressure pain threshold, and heat pain threshold

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