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Chang WJ, Humburg P, Jenkins LC, Buscemi V, Gonalez-Alvarez ME, McAuley JH, Liston MB, Schabrun SM. Can assessment of human assumed central sensitisation improve the predictive accuracy of the STarT Back screening tool in acute low back pain? Musculoskelet Sci Pract 2024; 74:103177. [PMID: 39260004 DOI: 10.1016/j.msksp.2024.103177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/05/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The STarT Back Screening Tool (SBT) is recommended to provide risk-stratified care in low back pain (LBP), yet its predictive value is moderate for disability and low for pain severity. Assessment of human assumed central sensitisation (HACS) in conjunction with the SBT may improve its predictive accuracy. OBJECTIVES To examine whether assessment of HACS in acute LBP improves the predictive accuracy of the SBT for LBP recovery at six months in people with acute non-specific LBP. DESIGN A prospective longitudinal study. METHOD Data were drawn from the UPWaRD study. One hundred and twenty people with acute non-specific LBP were recruited from the community. Baseline measures included SBT risk status, nociceptive flexor withdrawal reflex, pressure and heat pain thresholds and conditioned pain modulation. Primary outcome was the presence of LBP (pain numeric rating scale ≥1 and Roland Morris Disability Questionnaire score ≥3) at six-month follow-up. Regression coefficients were penalised using the least absolute shrinkage and selection operator technique to select predictor variables. Internal validation was performed using ten-fold cross-validation. RESULTS/FINDINGS SBT risk status alone did not predict the presence of LBP at six months (area under receiver operating characteristic curve [AUC] = 0.58). Adding measures of HACS to the SBT did not improve discrimination for whether LBP was present at six months (AUC = 0.59). CONCLUSIONS This study confirmed the suboptimal predictive accuracy of the SBT, administered during acute LBP, for LBP recovery at six months. Assessment of HACS in acute LBP does not improve the predictive accuracy of the SBT.
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Affiliation(s)
- Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Peter Humburg
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, UNSW Sydney, New South Wales, Australia
| | - Luke C Jenkins
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Valentina Buscemi
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - M E Gonalez-Alvarez
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; International School of Doctoral, Rey Juan Carlos University, 28008, Madrid, Spain
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, UNSW Sydney, Australia
| | - Matthew B Liston
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, Shepherd's House, King's College London, London, UK
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Physical Therapy, University of Western Ontario, London, Ontario, Canada; The Gray Centre for Mobility and Activity, University of Western Ontario, London, Ontario, Canada
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Gevers-Montoro C, Romero-Santiago B, Medina-García I, Larranaga-Arzamendi B, Álvarez-Gálovich L, Ortega-De Mues A, Piché M. Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial. THE JOURNAL OF PAIN 2024; 25:104500. [PMID: 38369221 DOI: 10.1016/j.jpain.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
Chronic primary low back pain (CPLBP) refers to low back pain that persists over 3 months, that cannot be explained by another chronic condition, and that is associated with emotional distress and disability. Previous studies have shown that spinal manipulative therapy (SMT) is effective in relieving CPLBP, but the underlying mechanisms remain elusive. This randomized placebo-controlled dual-blind mixed experimental trial (NCT05162924) aimed to investigate the efficacy of SMT to improve CPLBP and its underlying mechanisms. Ninety-eight individuals with CPLBP and 49 controls were recruited. Individuals with CPLBP received SMT (n = 49) or a control intervention (n = 49), 12 times over 4 weeks. The primary outcomes were CPLBP intensity (0-100 on a numerical rating scale) and disability (Oswestry Disability Index). Secondary outcomes included pressure pain thresholds in 4 body regions, pain catastrophizing, Central Sensitization Inventory, depressive symptoms, and anxiety scores. Individuals with CPLBP showed widespread mechanical hyperalgesia (P < .001) and higher scores for all questionnaires (P < .001). SMT reduced pain intensity compared with the control intervention (mean difference: -11.7 [95% confidence interval, -11.0 to -12.5], P = .01), but not disability (P = .5). Similar mild to moderate adverse events were reported in both groups. Mechanical hyperalgesia at the manipulated segment was reduced after SMT compared with the control intervention (P < .05). Pain catastrophizing was reduced after SMT compared with the control intervention (P < .05), but this effect was not significant after accounting for changes in clinical pain. Although the reduction of segmental mechanical hyperalgesia likely contributes to the clinical benefits of SMT, the role of pain catastrophizing remains to be clarified. PERSPECTIVE: This randomized controlled trial found that 12 sessions of SMT yield greater relief of CPLBP than a control intervention. These clinical effects were independent of expectations, and accompanied by an attenuation of hyperalgesia in the targeted segment and a modulation of pain catastrophizing.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Quebec, Canada; CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada; Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | - Blanca Romero-Santiago
- Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | - Isabel Medina-García
- Madrid College of Chiropractic, RCU María Cristina, San Lorenzo de El Escorial, Madrid, Spain
| | | | - Luis Álvarez-Gálovich
- Instituto Avanzado de Columna, Fundación Jiménez Díaz Hospital, Madrid, Madrid, Spain; Fujitega Research Foundation, Madrid, Madrid, Spain
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois- Rivières, Quebec, Canada; CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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Wilson AT, Hanney WJ, Richardson RM, Klausner SH, Bialosky JE. Biopsychosocial contributors to irritability in individuals with shoulder or low back pain. J Man Manip Ther 2024; 32:400-411. [PMID: 38108631 PMCID: PMC11257012 DOI: 10.1080/10669817.2023.2294679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability. METHODS 40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland's criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low). RESULTS Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation. DISCUSSION/CONCLUSION Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.
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Affiliation(s)
- Abigail T. Wilson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - William J. Hanney
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
- Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA
| | - Randi M. Richardson
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Sheila H. Klausner
- Division of Physical Therapy, University of Central Florida, School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, Orlando, FL, USA
| | - Joel E. Bialosky
- University of Florida Department of Physical Therapy, Gainesville, FL, USA
- Brooks-PHHP Research Collaboration, Gainesville, FL, USA
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García-Dopico N, Terrasa JL, González-Roldán AM, Velasco-Roldán O, Sitges C. Unraveling the Left-Right Judgment Task in Chronic Low Back Pain: Insights Through Behavioral, Electrophysiological, Motor Imagery, and Bodily Disruption Perspectives. THE JOURNAL OF PAIN 2024; 25:104484. [PMID: 38307439 DOI: 10.1016/j.jpain.2024.01.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
Bodily disruptions have been consistently demonstrated in individuals with chronic low back pain. The performance on the left-right judgment task has been purposed as an indirect measure of the cortical proprioceptive representation of the body. It has been suggested to be dependent on implicit motor imagery, although the available evidence is conflicting. Hence, the aim of this case-control observational study was to examine the performance (accuracy and reaction times) and event-related potentials while performing the left-right judgment task for back and hand images in individuals with chronic low back pain versus healthy controls, along with its relationship with self-reported measurements and quantitative sensory testing. While self-reported data suggested bodily disruptions in the chronic low back pain sample, this was not supported by quantitative sensory testing. Although both groups displayed the same performance, our results suggested an increased attentional load on participants with chronic low back pain to achieve equal performance, measured by a higher N1 peak amplitude in occipital electrodes, especially when the effect of contextual images arises. The absence of differences in the reaction times for the left-right judgment task between both groups, along with inconsistencies in self-reported and quantitative sensory testing data, could question the involvement of implicit motor imagery in solving the task. In conclusion, our results suggest disrupted attentional processing in participants with chronic low back pain to solve the left-right judgment task. PERSPECTIVE: Although there are no differences in the performance of the left-right judgment task (hits, reaction times) between chronic low back pain patients and controls, the analysis of event-related potentials revealed that patients require a higher cognitive load, measured by N1 peak amplitude.
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Affiliation(s)
- Nuria García-Dopico
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Juan L Terrasa
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Ana M González-Roldán
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
| | - Olga Velasco-Roldán
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Palma, Spain; Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Carolina Sitges
- Research Institute of Health Sciences (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma, Spain
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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gløersen M, Kvien TK, Magnusson K, Haugen IK. Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100367. [PMID: 37234862 PMCID: PMC10206186 DOI: 10.1016/j.ocarto.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Objective To determine whether the comorbidity burden and co-existing comorbidities are cross-sectionally and/or longitudinally associated with pain and pain sensitization in a cohort study of people with hand OA. Design We examined whether comorbidity burden and individual comorbidities based on the self-administered Comorbidity Index (range: 0-42) at baseline were associated with pain outcomes at baseline and 3 years follow-up. Pain outcomes included hand and overall bodily pain (range: 0-10) as well as pressure pain thresholds at the tibialis anterior muscle (kg/cm2) and temporal summation (distal radioulnar joint) as measures of central pain sensitization. We performed linear regression analyses adjusted for age, sex, body mass index, physical exercise and education. Results We included 300 and 196 participants in cross-sectional and longitudinal analyses, respectively. Using baseline data, the burden of comorbidities was associated with greater pain in hands (beta = 0.61, 95% CI 0.37, 0.85) and overall body (beta = 0.60, 95% CI 0.37, 0.87). Similar strength of associations was found between comorbidity burden (baseline) and follow-up pain. Among the individual comorbidities, back pain and depression were associated with nearly one unit higher pain score in hands and overall body at both baseline and follow-up. Only back pain was related to lower pressure pain thresholds at follow up (beta = -0.24, 95% CI -0.50, -0.001). Conclusion People with hand OA and greater comorbidity burden, co-existing back pain or depression reported greater pain severity than their counterparts, also 3 years later. These results acknowledge the relevance of accounting for comorbidities in the pain experience in people with hand OA.
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Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K. Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K. Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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