Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study

Abstract

IntroductionA relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes.Methods and analysisA cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age.Ethics and disseminationThe study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders.Trial registration numberNTR7167/NL6980.

<p>Female Overrepresentation in Low Back-Related Leg Pain: A Retrospective Study of the Autonomic Response to a Minimally Invasive Procedure</p>

“…The measurement of the ANS response to noxious stimulation in patients with CS is seen as a viable promise for finding an objective parameter that would confirm NP. 17 A recent study by Nickel et al, 18 showed that sympathetic function is more related to stimulus intensity than perceived pain intensity. A similar observation was provided in our previous studies on a minimally invasive procedure applied to patients with both LBLP and MPS.…”

Comparing the Impact of Multi-Session Left Dorsolateral Prefrontal and Primary Motor Cortex Neuronavigated Repetitive Transcranial Magnetic Stimulation (nrTMS) on Chronic Pain Patients

“…In NSLBP, pain sensations do not necessarily reflect the presence of a peripheral noxious stimulus because neurons in the pain pathway can be activated by a low threshold, innocuous or non-noxious inputs [13]. The neurobiological cause is thought to be maladaptive plasticity such as central sensitization, which manifests as distort or amplify (hyperalgesia and allodynia), increase degree or duration (after sensations and temporal summation), and spatial extent (expansion of the receptive field), as well as a reduced conditioned pain modulation [13,14]. In chronic pain patients, the prevalent expectation for brain activity is a sustained or enhanced activation of areas already identified for acute pain [15].…”

The Rationale for the Automation of a New Diagnostic Thermography Protocol to Confirm a Chronic-Low-Back-Pain Subtype Related to Nociplastic Pain

“…However, some data indicate its diagnostic utility in cases when noxious stimulation is involved, and immediate ANS imbalance reactions are registered [18][19][20]. Heart rate variability (HRV) has been proposed to support the central sensitization examination [21,22]. It has remarkable potential, especially for nociplastic pain, where ANS dysregulation is an important factor.…”