Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain

Roussel, Nathalie; Nijs, Jo; Meeus, Mira; Mylius, Veit; Fayt, Cécile; Oostendorp, Rob A.B.

doi:10.1097/ajp.0b013e31826f9a71

Cited by 262 publications

(206 citation statements)

References 117 publications

(198 reference statements)

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“…Stress is considered a normal reaction to an unpleasant stimulus, such as LBP, but can, if sustained, cause illness and disease according to CATS. Sensitization of the central nervous system is further an increasingly recognized feature in many patients with CLBP (Roussel et al, 2013), in which an amplification of neural signaling elicits pain hypersensitivity (Woolf, 2011). Top-down approaches, such as CBT and exercise therapy, are implied for patients with central sensitization, and would as such be expected to decrease pain and disability.…”

Section: Discussionmentioning

confidence: 99%

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

Harris

Moe

Eriksen

et al. 2017

European Journal of Pain

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Rehabilitation through EXTRA funds. 2Physical group exercise and CBT for low back pain Conflicts of interestThe authors report no conflict of interest. What does this study add?Positive-outcome bias in publishing is a serious concern that has increased over last years.Our study demonstrates that treatments that previously have been found to be effective and are included in most treatment guidelines, such as group cognitive behavior therapy and exercise, were not effective in this given context compared to a brief, cognitive intervention.This implies that an optimized brief intervention is difficult to outperform in patients on sick leave due to low back pain.

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Section: Discussionmentioning

confidence: 99%

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

Harris

Moe

Eriksen

et al. 2017

European Journal of Pain

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“…11 The literature on CPM in chronic LBP is sparse. A recent review 12 found only 1 study, not supporting an alteration in CPM. 13 This confirms our assumption that measuring the time course may provide more information than single assessments.…”

Section: Cpm In Low Back Painmentioning

confidence: 93%

Conditioned Pain Modulation in Patients With Acute and Chronic Low Back Pain

Mlekusch

Neziri

Limacher

et al. 2016

The Clinical Journal of Pain

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Objectives: Disturbed endogenous pain modulation is likely one of the mechanisms underlying central hypersensitivity and might be a contributing factor for the development and maintenance of chronic pain. To our knowledge, no study has investigated endogenous pain modulation in both acute and chronic low back pain (LBP). We tested the hypothesis that endogenous pain inhibition is impaired in patients with acute and chronic LBP. Materials and Methods:We evaluated 40 patients with acute LBP, 34 patients with chronic LBP and 30 pain-free controls for their conditioned pain modulation (CPM), with pressure pain tolerance and cold pressor as test and conditioning stimulus, respectively. Measurements were repeated up to 10 minutes after cold pressor test.Results: There was no difference in CPM among the groups immediately after cold pressor test. However, the decline in CPM effect was significantly faster in chronic and acute LBP patients than in controls, with no evidence for differences between pain groups.Discussion: The present study provides evidence for some alterations of endogenous modulation in both acute and chronic LBP. CPM was still detected in both patient groups, indicating that endogenous modulation, although effective for a shorter duration, is partially functioning in patients with LBP.Key Words: conditioned pain modulation, acute low back pain, chronic low back pain (Clin J Pain 2016;32:116-121) T he central nervous system is capable to modulate signals coming from peripheral tissues, leading to either amplification or attenuation of the nociceptive input. 1 One important aspect of central pain modulation is endogenous inhibition, as its impaired efficiency may be a determinant of symptoms in pain patients. In humans, 1-test paradigm to evaluate the endogenous pain modulatory system is conditioned pain modulation (CPM), which occurs when the response to a painful test stimulus is inhibited by an additional conditioning painful stimulus. 2 Disturbed CPM is likely one of the mechanisms underlying central hypersensitivity and might be 1 contributing factor for the development and maintenance of chronic pain. Patients with chronic low back pain (LBP) display decreased pain thresholds after stimulation of nonpainful tissues and enlargement of the areas of referred pain, 3-5 which is strongly suggestive for widespread central hypersensitivity. Although hypersensitivity has been documented, the mechanisms underlying exaggerated pain responses in acute and chronic LBP are unclear. One of these mechanisms may be deficient endogenous pain modulation. Most studies have focused on chronic pain conditions, but deficient pain modulation could also be present in the acute phase. Furthermore, most studies have assessed CPM at 1 time-point, and information on its time course after cessation of the conditioning stimulus is sparse.The hypothesis of this study was that endogenous pain inhibition is impaired in patients with acute and chronic LBP. We evaluated the inhibitory effect not only immediately after the condit...

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“…3 On the behavioral side, there is increasing evidence of sensorimotor malfunctions in patients with CLBP, related to chronic symptoms that might eventually result in disability. 4,5 Still, the underlying cortical processing of sensory information of the lower back has not been investigated in detail in (C)LBP patients. In healthy individuals, we have recently reported cortical processing of a nonpainful manual technique, that is, posterior-to-anterior (PA) pressure onto lumbar vertebrae.…”

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confidence: 99%

Reorganization in Secondary Somatosensory Cortex in Chronic Low Back Pain Patients

Hotz‐Boendermaker

Marcar

Meier

et al. 2016

Spine

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STUDY DESIGN: A cross-sectional comparative study between chronic low back pain (CLBP) patients and healthy control subjects. OBJECTIVE: The aim of this study was to investigate reorganization in the sensory cortex by comparing cortical activity due to mechanosensory stimulation of the lumbar spine in CLBP patients versus a control group by using functional magnetic resonance imaging (fMRI). SUMMARY OF BACKGROUND DATA: LBP is now the number 1 condition across the world in terms of years living with a disability. There is growing evidence that maladaptive changes in the processing of sensory input by the central nervous system are central to understanding chronic (back) pain. METHODS: Nonpainful, posterior-anterior (PA) movement pressure was applied manually to lumbar vertebrae at L1, L3, and L5 in 13 healthy subjects and 13 CLBP patients. The manual pressure (30 N) was monitored and controlled using sensors. A randomized stimulation protocol was used consisting of 51 pressure stimuli of 5 seconds duration. fMRI data analysis was performed for the group activation within the primary and secondary sensory cortices (S1 and S2, respectively) and the representation of the individual vertebrae was extracted and statistically analyzed. RESULTS: Nonpainful PA pressure revealed no cortical reorganization in S1. In contrast, the extent of S2 activation in the CLBP group was significantly reduced in both hemispheres. In the control group, a somatotopy was identified for the lumbar vertebrae between L1 and L3, respectively, and L5 in S2 of the right hemisphere. Most importantly, a blurring of the somatotopic representation of the lumbar spine in S2 was observed in the patient group. CONCLUSION: Together, these maladaptive changes suggest a reorganization of higher-order processing for sensory information in CLBP patients that might have implications for a decreased sensory acuity, also related to body perception and subsequent altered functioning of the lumbar spine. LEVEL OF EVIDENCE: 2. Study Design. A cross-sectional comparative study between chronic low back pain (CLBP) patients and healthy control subjects.Objective. The aim of this study was to investigate reorganization in the sensory cortex by comparing cortical activity due to mechanosensory stimulation of the lumbar spine in CLBP patients versus a control group by using functional magnetic resonance imaging (fMRI). Summary of Background Data. LBP is now the number 1 condition across the world in terms of years living with a disability. There is growing evidence that maladaptive changes in the processing of sensory input by the central nervous system are central to understanding chronic (back) pain. Methods. Nonpainful, posterior-anterior (PA) movement pressure was applied manually to lumbar vertebrae at L1, L3, and L5 in 13 healthy subjects and 13 CLBP patients. The manual pressure (30 N) was monitored and controlled using sensors. A randomized stimulation protocol was used consisting of 51 pressure stimuli of 5 seconds duration. fMRI data analysis was ...

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Central Sensitization and Altered Central Pain Processing in Chronic Low Back Pain

Cited by 262 publications

References 117 publications

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

Brief intervention, physical exercise and cognitive behavioural group therapy for patients with chronic low back pain (The CINS trial)

Conditioned Pain Modulation in Patients With Acute and Chronic Low Back Pain

Reorganization in Secondary Somatosensory Cortex in Chronic Low Back Pain Patients

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