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Kapitza C, Luedtke K, Komenda M, Kiefhaber M, Schmid AB, Ballenberger N, Tampin B. Inter- and intra-rater-reliability of a clinical framework for spine-related neck-arm pain. Musculoskelet Sci Pract 2023; 67:102853. [PMID: 37657399 DOI: 10.1016/j.msksp.2023.102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE A mechanism-based clinical framework for spine-related pain differentiates (i) somatic referred pain, ii) heightened nerve mechanosensitivity, iii) radicular pain, iv) radiculopathy and mixed-pain. This study aimed to determine the reliability of proposed framework. METHOD Fifty-one people with unilateral spine-related neck-arm pain were assessed and categorized by examiner-1. The classifications were compared to those made by two other examiners, based on written documentation of examiner-1. Cohens kappa was calculated between examiner-pairs; Fleiss Kappa among all examiners to assess agreement in classifying subgroups and entire framework. RESULT Inter-rater-reliability showed moderate to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI 0.87-1.0) to 1.0 (95% CI: 1.0-1.0), radicular pain: 0.46 (95% CI: 0.19-0.69) to 0.62 (95% CI: 0.42-0.81), radiculopathy: 0.65 (95% CI: 0.43-0.84) to 0.80 (95% CI: 0.63-0.96) mixed-pain: 0.54 (95% CI: 0.21-0.81) to 0.75 (95% CI: 0.48-0.94). There was almost perfect to moderate reliability among all examiners (somatic: no variation, mechanosensitivity: 0.97 (95% CI: 0.82-1.0), radicular pain: 0.56 (95% CI: 0.40-0.71), radiculopathy: 0.74 (95% CI: 0.58-0.90), mixed-pain: 0.63 (95% CI: 0.47-0.79), entire framework: 0.64 (95% CI: 0.57-0.71)). Intra-rater-reliability showed substantial to almost perfect reliability (somatic: no variation, mechanosensitivity: 0.96 (95% CI: 0.87-1.0), radicular pain: 0.76 (95% CI: 0.57-0.92), radiculopathy: 0.84 (95% CI: 0.67-0.96), mixed-pain: 0.83 (95% CI: 0.60-1.0), entire framework: 0.80 (95% CI: 0.61-0.92). CONCLUSION Moderate to almost perfect reliability in subgrouping people with spine-related neck-arm pain and substantial reliability for entire framework support this classification's reliability.
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Affiliation(s)
- C Kapitza
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany; Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany.
| | - K Luedtke
- Universität zu Lübeck, Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), Luebeck, Germany
| | - M Komenda
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany
| | - M Kiefhaber
- Praxis für Physiotherapie Kiefhaber, Bad Dürkheim, Germany
| | - A B Schmid
- Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - N Ballenberger
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany
| | - B Tampin
- Hochschule Osnabrueck, University of Applied Sciences, Faculty of Business, Management and Social Sciences, Department Movement and Rehabilitation Science, Osnabrueck, Germany; Department of Physiotherapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Margelli M, Segat A, Raule M, Giacchetti C, Zanoli G, Pellicciari L. A reliability study of a novel visual ischemic palpation scale in an experimental setting. Musculoskelet Sci Pract 2021; 54:102384. [PMID: 33992885 DOI: 10.1016/j.msksp.2021.102384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Manual palpation is an important part of the clinical examination and generally it has low reliability. The aim of this study was to assess the reliability of a novel method for discriminating 3 different levels of palpation force. METHODS This reliability study included 96 healthy physiotherapists and physiotherapy students, who have been taught a new palpation graduated procedure called Visual Ischemic Palpatory Scale (VIPS), aimed to classify the applied pressure based on the finger's ischemia. Force was recorded by a force measurement system putting sensor over a rigid surface. To study the characteristic of VIPS the analysis of variance (ANOVA), Spearman rank correlation coefficient, Intraclass Correlation Coefficient (ICC), Standard Error of Measurements (SEM), and Minimal Detectable Change (MDC) were calculated. RESULTS Three distinct degrees were found with distinct forces expression: 1st degree 76.04 g (95% CI 65.86-86.22), 2nd degree 307.87 g (95% CI 263.29-352.44) and 3rd degree 1319.48 g (CI 1204.73-1434.23). Male participants significantly recorded a greater force than females. Good to excellent reliability across degrees were found (0.89 [95% CI: 0.82-0.97]), and final agreement found that more than 65.6% of sample recorded a force in the cut-offs identified. SEM values became bigger as the recorded force increased and MDC were equal to 48.94 g, 188.73 g, and 379.24 g for 1st, 2nd, and 3rd degree, respectively. CONCLUSIONS VIPS would appear to have three distinct degrees, sex dependent, with specific force expression for each degree and a good to excellent intra-rater reliability, but a poor agreement between raters.
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Affiliation(s)
- Michele Margelli
- Faculty of Medicine and Surgery, Department of Clinical Ccience and Translation Medicine, University of Rome Tor Vergata, Roma, Italy; Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Studio Andreotti-Margelli Terapika, Ferrara, Italy.
| | | | - Maddalena Raule
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Caterina Giacchetti
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Gustavo Zanoli
- Faculty of Medicine and Surgery, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; Casa di Cura SM Maddalena, Occhiobello, Italy.
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Shraim MA, Massé-Alarie H, Hodges PW. Methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a systematic review. Pain 2021; 162:1007-1037. [PMID: 33136983 DOI: 10.1097/j.pain.0000000000002113] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022]
Abstract
ABSTRACT Mechanism-based classification of pain has been advocated widely to aid tailoring of interventions for individuals experiencing persistent musculoskeletal pain. Three pain mechanism categories (PMCs) are defined by the International Association for the Study of Pain: nociceptive, neuropathic, and nociplastic pain. Discrimination between them remains challenging. This study aimed to build on a framework developed to converge the diverse literature of PMCs to systematically review methods purported to discriminate between them; synthesise and thematically analyse these methods to identify the convergence and divergence of opinion; and report validation, psychometric properties, and strengths/weaknesses of these methods. The search strategy identified articles discussing methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system. Studies that assessed the validity of methods to discriminate between categories were assessed for quality. Extraction and thematic analysis were undertaken on 184 articles. Data synthesis identified 200 methods in 5 themes: clinical examination, quantitative sensory testing, imaging, diagnostic and laboratory testing, and pain-type questionnaires. Few methods have been validated for discrimination between PMCs. There was general convergence but some disagreement regarding findings that discriminate between PMCs. A combination of features and methods, rather than a single method, was generally recommended to discriminate between PMCs. Two major limitations were identified: an overlap of findings of methods between categories due to mixed presentations and many methods considered discrimination between 2 PMCs but not others. The results of this review provide a foundation to refine methods to differentiate mechanisms for musculoskeletal pain.
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Affiliation(s)
- Muath A Shraim
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
| | - Hugo Massé-Alarie
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
- Centre Interdisciplinaire de recherche en réadaptation et Integration sociale (CIRRIS), Université Laval, Québec, QC, Canada
| | - Paul W Hodges
- The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, QLD, Australia
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Systematic Review and Synthesis of Mechanism-based Classification Systems for Pain Experienced in the Musculoskeletal System. Clin J Pain 2020; 36:793-812. [DOI: 10.1097/ajp.0000000000000860] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Stynes S, Konstantinou K, Dunn KM. Classification of patients with low back-related leg pain: a systematic review. BMC Musculoskelet Disord 2016; 17:226. [PMID: 27215590 PMCID: PMC4877814 DOI: 10.1186/s12891-016-1074-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The identification of clinically relevant subgroups of low back pain (LBP) is considered the number one LBP research priority in primary care. One subgroup of LBP patients are those with back related leg pain. Leg pain frequently accompanies LBP and is associated with increased levels of disability and higher health costs than simple low back pain. Distinguishing between different types of low back-related leg pain (LBLP) is important for clinical management and research applications, but there is currently no clear agreement on how to define and identify LBLP due to nerve root involvement. The aim of this systematic review was to identify, describe and appraise papers that classify or subgroup populations with LBLP, and summarise how leg pain due to nerve root involvement is described and diagnosed in the various systems. METHODS The search strategy involved nine electronic databases including Medline and Embase, reference lists of eligible studies and relevant reviews. Selected papers were appraised independently by two reviewers using a standardised scoring tool. RESULTS Of 13,358 initial potential eligible citations, 50 relevant papers were identified that reported on 22 classification systems. Papers were grouped according to purpose and criteria of the classification systems. Five themes emerged: (i) clinical features (ii) pathoanatomy (iii) treatment-based approach (iv) screening tools and prediction rules and (v) pain mechanisms. Three of the twenty two systems focused specifically on LBLP populations. Systems that scored highest following quality appraisal were ones where authors generally included statistical methods to develop their classifications, and supporting work had been published on the systems' validity, reliability and generalisability. There was lack of consistency in how LBLP due to nerve root involvement was described and diagnosed within the systems. CONCLUSION Numerous classification systems exist that include patients with leg pain, a minority of them focus specifically on distinguishing between different presentations of leg pain. Further work is needed to identify clinically meaningful subgroups of LBLP patients, ideally based on large primary care cohort populations and using recommended methods for classification system development.
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Affiliation(s)
- Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Stynes S, Konstantinou K, Dunn KM, Lewis M, Hay EM. Reliability among clinicians diagnosing low back-related leg pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2734-40. [PMID: 26703790 DOI: 10.1007/s00586-015-4359-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate agreement and reliability among clinicians when diagnosing low back-related leg pain (LBLP) in primary care consulters. METHODS Thirty-six patients were assessed by one of six physiotherapists and diagnosed as having either leg pain due to nerve root involvement (sciatica) or referred leg pain. Assessments were video recorded. In part one, the physiotherapists each viewed videos of six patients they had not assessed. In part two, videos were viewed by another six health professionals. All clinicians made an independent differential diagnosis and rated their confidence with diagnosis (range 50-100 %). RESULTS In part one agreement was 72 % with fair inter-rater reliability (K = 0.35, 95 % CI 0.07, 0.63). Results for part two were almost identical (K = 0.34, 95 % CI 0.02, 0.69). Agreement and reliability indices improved as diagnostic confidence increased. CONCLUSION Reliability was fair among clinicians from different backgrounds when diagnosing LBLP but improved substantially with high confidence in clinical diagnosis.
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Affiliation(s)
- Siobhán Stynes
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK.
| | - Kika Konstantinou
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK
| | - Kate M Dunn
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, ST5 5BG, Staffordshire, UK
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The clinical utility of pain classification in non-specific arm pain. ACTA ACUST UNITED AC 2015; 20:157-65. [DOI: 10.1016/j.math.2014.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/04/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
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Abstract
We need to overcome limitations of present assessment and also integrate newer research in our work about sciatica. Inflammation induces changes in the DRG and nerve root. It sensitizes the axons. Nociceptor is a unique axon. It is pseudo unipolar: both its ends, central and peripheral, behave in similar fashion. The nerve in periphery which carries these axons may selectively become sensitive to mechanical pressure--"mechanosensitized," as we coin the phrase. Many pain questionnaires are used and are effective in identifying neuropathic pain solely on basis of descriptors but they do not directly physically correlate nerve root and pain. A thorough neurological evaluation is always needed. Physical examination is not direct pain assessment but testing mobility of nerve root and its effect on pain generation. There is a dogmatic dominance of dermatomes in assessment of leg pain. They are unreliable. Images may not correlate with symptoms and pathology in about 28% of cases. Electrophysiology may be normal in purely inflamed nerve root. Palpation may help in such inflammatory setting to refine our assessment further. Confirmation of sciatica is done by selective nerve root block (SNRB) today but it is fraught with several complications and needs elaborate inpatient and operating room set up. We have used the unique property of the pseudo unipolar axon that both its ends have similar functional properties and so inject along its peripheral end sodium channel blockers to block the basic cause of the mechanosensitization namely upregulated sodium channels in the root or DRG. Thus using palpation we may be able to detect symptomatic nerve in stage of inflammation and with distal end injection, along same inflamed nerve we may be able to abolish and so confirm sciatica. Discussions of sciatica pain diagnosis tend to immediately shift and centre on the affected disc rather than the nerve. Theoretically it may be possible to detect the affected nerve by palpating the nerve and relieve pain moment we desensitize the nerve.
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Fingleton CP, Dempsey L, Smart K, Doody CM. Intraexaminer and Interexaminer Reliability of Manual Palpation and Pressure Algometry of the Lower Limb Nerves in Asymptomatic Subjects. J Manipulative Physiol Ther 2014; 37:97-104. [DOI: 10.1016/j.jmpt.2013.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/24/2013] [Accepted: 11/01/2013] [Indexed: 12/26/2022]
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Inter-therapist agreement in classifying patients with cervical radiculopathy and patients with non-specific neck–arm pain. ACTA ACUST UNITED AC 2012; 17:445-50. [DOI: 10.1016/j.math.2012.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/25/2012] [Accepted: 05/01/2012] [Indexed: 11/17/2022]
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Karayannis NV, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet Disord 2012; 13:24. [PMID: 22348236 PMCID: PMC3395852 DOI: 10.1186/1471-2474-13-24] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 02/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several classification schemes, each with its own philosophy and categorizing method, subgroup low back pain (LBP) patients with the intent to guide treatment. Physiotherapy derived schemes usually have a movement impairment focus, but the extent to which other biological, psychological, and social factors of pain are encompassed requires exploration. Furthermore, within the prevailing 'biological' domain, the overlap of subgrouping strategies within the orthopaedic examination remains unexplored. The aim of this study was "to review and clarify through developer/expert survey, the theoretical basis and content of physical movement classification schemes, determine their relative reliability and similarities/differences, and to consider the extent of incorporation of the bio-psycho-social framework within the schemes". METHODS A database search for relevant articles related to LBP and subgrouping or classification was conducted. Five dominant movement-based schemes were identified: Mechanical Diagnosis and Treatment (MDT), Treatment Based Classification (TBC), Pathoanatomic Based Classification (PBC), Movement System Impairment Classification (MSI), and O'Sullivan Classification System (OCS) schemes. Data were extracted and a survey sent to the classification scheme developers/experts to clarify operational criteria, reliability, decision-making, and converging/diverging elements between schemes. Survey results were integrated into the review and approval obtained for accuracy. RESULTS Considerable diversity exists between schemes in how movement informs subgrouping and in the consideration of broader neurosensory, cognitive, emotional, and behavioural dimensions of LBP. Despite differences in assessment philosophy, a common element lies in their objective to identify a movement pattern related to a pain reduction strategy. Two dominant movement paradigms emerge: (i) loading strategies (MDT, TBC, PBC) aimed at eliciting a phenomenon of centralisation of symptoms; and (ii) modified movement strategies (MSI, OCS) targeted towards documenting the movement impairments associated with the pain state. CONCLUSIONS Schemes vary on: the extent to which loading strategies are pursued; the assessment of movement dysfunction; and advocated treatment approaches. A biomechanical assessment predominates in the majority of schemes (MDT, PBC, MSI), certain psychosocial aspects (fear-avoidance) are considered in the TBC scheme, certain neurophysiologic (central versus peripherally mediated pain states) and psychosocial (cognitive and behavioural) aspects are considered in the OCS scheme.
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Affiliation(s)
- Nicholas V Karayannis
- School of Health and Rehabilitation Sciences, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Gwendolen A Jull
- School of Health and Rehabilitation Sciences, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Qld 4072, Australia
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Nelson R, Hall T. Bilateral dorsal foot pain in a young tennis player managed by neurodynamic treatment techniques. ACTA ACUST UNITED AC 2011; 16:641-5. [DOI: 10.1016/j.math.2011.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/08/2011] [Accepted: 02/09/2011] [Indexed: 11/25/2022]
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Kumar SP. Cancer Pain: A Critical Review of Mechanism-based Classification and Physical Therapy Management in Palliative Care. Indian J Palliat Care 2011; 17:116-26. [PMID: 21976851 PMCID: PMC3183600 DOI: 10.4103/0973-1075.84532] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mechanism-based classification and physical therapy management of pain is essential to effectively manage painful symptoms in patients attending palliative care. The objective of this review is to provide a detailed review of mechanism-based classification and physical therapy management of patients with cancer pain. Cancer pain can be classified based upon pain symptoms, pain mechanisms and pain syndromes. Classification based upon mechanisms not only addresses the underlying pathophysiology but also provides us with an understanding behind patient's symptoms and treatment responses. Existing evidence suggests that the five mechanisms – central sensitization, peripheral sensitization, sympathetically maintained pain, nociceptive and cognitive-affective – operate in patients with cancer pain. Summary of studies showing evidence for physical therapy treatment methods for cancer pain follows with suggested therapeutic implications. Effective palliative physical therapy care using a mechanism-based classification model should be tailored to suit each patient's findings, using a biopsychosocial model of pain.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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Petersen SM, Scott DR. Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain. J Man Manip Ther 2011; 18:89-96. [PMID: 21655391 DOI: 10.1179/106698110x12640740712572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Low back pain and leg pain commonly occur together. Multiple factors can cause low back related leg pain; therefore, identification of the source of symptoms is required in order to develop an appropriate intervention program. The patient in this case presented with low back and leg pain. A patho-mechanism based classification is described in combination with the patient's subjective and objective examination findings to guide treatment. The patient's symptoms improved marginally with intervention addressing primarily the musculoskeletal impairments and with intervention addressing primarily the neurodynamic impairments. Full functional improvements were attained with a manual therapy intervention directed at both mechanisms simultaneously. The approach described in this case address a mixed pathology utilizing passive accessory and passive physiological lumbar mobilizations in combination with lower extremity neurodynamic mobilization. The patient reported complete resolution of symptoms after a total of seven visits over a period of 6 weeks. While specific guidelines do not yet exist for treatment based on the classification approach utilized, this case report provides an example of manual therapy to address low back related leg pain of mixed pathology.
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Kumar SP, Saha S. Mechanism-based Classification of Pain for Physical Therapy Management in Palliative care: A Clinical Commentary. Indian J Palliat Care 2011; 17:80-6. [PMID: 21633629 PMCID: PMC3098553 DOI: 10.4103/0973-1075.78458] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification–based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective) are explained with recent evidence for physical therapy treatments for each of the mechanisms.
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Affiliation(s)
- Senthil P Kumar
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, India
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Schäfer A, Hall T, Müller G, Briffa K. Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:482-90. [PMID: 21116662 DOI: 10.1007/s00586-010-1632-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 08/17/2010] [Accepted: 11/07/2010] [Indexed: 10/18/2022]
Abstract
The objective is to determine if pain and disability outcomes of patients treated with neural mobilisation differ for sub-classifications of low back and leg pain (LB&LP). Radiating leg pain is a poor prognostic factor for recovery in patients with LBP. To improve outcome, a new pathomechanism-based classification system was proposed: neuropathic sensitization (NS), denervation (D), peripheral nerve sensitization (PNS) and musculoskeletal (M). Seventy-seven patients with unilateral LB&LP were recruited. Following classification, all subjects were treated seven times with neural mobilisation techniques. A successful outcome was defined as achieving a minimal clinically important change in pain intensity (11-point numerical rating scale), physical function (Roland Morris disability questionnaire) and global perceived change (7-point Likert scale: from 1 = "completely recovered" to 7 = "worse than ever"). The proportion of responders was significantly greater in PNS (55.6%) than the other three groups (NS 10%; D 14.3% and M10%). After adjusting for baseline differences, mean magnitude of improvement of the outcome measures were significantly greater in PNS compared to the other groups. Patients classified as PNS have a more favourable prognosis following neural mobilisation compared to the other groups.
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Affiliation(s)
- Axel Schäfer
- Faculty of Social Work and Health, Degree Programmes for Occupational Therapy, Speech and Language Therapy & Physiotherapy, HAWK University of Applied Science and Arts, Goschentor 1, 31134 Hildesheim, Germany.
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O'Hearn M, Lowry C, Emerson-Kavchak A, Courtney C. Re: "Interrater reliability of a new classification scheme for patients with neural low back-related leg pain" Schafer A et al. J Man Manip Ther 2009;17:109-116. J Man Manip Ther 2010; 17:e115-6. [PMID: 20140147 DOI: 10.1179/106698109791352193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Cook C. Sub-group Classification of Low Back Related Leg Pain: Is this the Catalyst Needed for Other Challenging Conditions? J Man Manip Ther 2009; 17:70-2. [PMID: 20046547 PMCID: PMC2700501 DOI: 10.1179/106698109790824677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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