A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS)

Abstract

Objectives: To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention. Methods: Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT 'treatment as usual'. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge Results: Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group. Discussion: Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́source of symptoms is addressed.

Lack of evidence for stating ‘spinal source’ of pain in EXPOSS study

“…We read with interest the recent research paper 'A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS)' by Rosedale et al [1]. This study highlights some interesting opportunities for physical therapists and other clinicians practicing Mechanical Diagnosis and Therapy (MDT).…”

Erforschung der Indikatoren für Extremitäten-Schmerzen spinalen Ursprungs, identifiziert durch die Mechanische Diagnose und Therapie (MDT): Sekundäranalyse einer prospektiven Kohortenstudie

“…In der Studie, die dieser Sekundäranalyse zugrunde liegt, wurden vor und nach der Intervention die Parameter Schmerz, Funktion und psychosoziale Faktoren erhoben. Die Gruppe "spinaler Ursprung" zeigte dabei durchschnittlich ein besseres Outcome als die Gruppe "Ursprung in der Extremität" [6].…”

“…Halimi und Poulter kritisierten vor allem an der ersten Analyse der Daten 6 den auch hier verwendeten Begriff „spinaler Ursprung“ 7 . Dieser Begriff ist sicherlich kontrovers und diskutabel, da Schmerz immer das Ergebnis eines Prozesses der Verarbeitung multisensorischer Signale ist 8 und nicht einer Körperregion unterliegt.…”

“…Die Studie entsprach dem Design einer multizentrischen prospektiven Kohortenstudie und hatte das Ziel, zu untersuchen, wie hoch die Prävalenz eines spinalen Ursprungs isolierter Extremitätenschmerzen ist [6]. Der Begriff "spinaler Ursprung" wurde von den Autoren verwendet, um Schmerzen oder sonstige Systeme in den Extremitäten zu bezeichnen, die in der Studie von Rosedale et al [6] erfolgreich mit Behandlungsstrategien, die nur auf die Wirbelsäule zielen, therapiert wurden. Der Be-griff "spinaler Ursprung" wird demnach von den Autoren als die Körperregion verstanden, deren Therapie die Symptome beeinflusst.…”

Author’s response to Anthony Halimi and David Poulter’s letter to the editor regarding ‘A study exploring the prevalence of extremity pain of spinal source (EXPOSS)’

“…We would like to thank Anthony Halimi and David Poulter for taking the time to comment on our recently published article [1]. We welcome the opportunity to respond to these valid questions and further elaborate on some aspects of our study.…”