Classification of low back-related leg pain—A proposed patho-mechanism-based approach

Schäfer, Axel; Hall, Toby; Briffa, Kathy

doi:10.1016/j.math.2007.10.003

Cited by 91 publications

(105 citation statements)

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“…The present study is a starting point for the evolvement and refinement of the classification system for LB&LP, as other classification systems have evolved as well [35]. After providing evidence for feasibility, reliability and plausibility [12,13], content and construct validity of the classification system still need to be demonstrated. …”

Section: Discussionmentioning

confidence: 93%

“…By classifying patients in defined, pathomechanism-based categories, homogenous samples of patients with a higher likelihood of positive response to neural mobilisation could be achieved. The use of the classification system [12] could therefore lead to more consistent results in future trials and could help to improve effectiveness of neural mobilisation interventions in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…We employed a judgemental method based on the clinical experience of the authors as well as a review of the relevant observational and experimental research literature to develop the classification criteria. The rationale for the classification system and the corresponding signs and symptoms for each of the groups has been presented in detail previously [12].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

et al. 2010

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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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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

et al. 2010

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“…Whilst many clinical presentations of pain may be attributable to a mix of nociceptive, peripheral neuropathic and central mechanisms, the concept of pain arising from a relative dominance of PNP mechanisms has been proposed (Bennett et al 2006;Schäfer et al 2009). …”

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confidence: 99%

Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

et al. 2012

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“…All symptomatic subjects were classified into one of four groups following a pre-14 established examination protocol [12] (Figure 1). The assessment protocol includes 15 subjective questions relating to area of pain, duration of symptoms, and aggravating 16 and easing factors.…”

Section: Classification 13mentioning

confidence: 99%

Low back related leg pain: An investigation of construct validity of a new classification system

Schäfer

Hall

Rolke

et al. 2014

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1Background: Leg pain is associated with back pain in 25-65% of all cases and 2 classified as somatic referred pain or radicular pain. However, distinction between the 3 two may be difficult as different pathomechanisms may cause similar patterns of pain. 4Therefore a pathomechanism based classification system was proposed, with four 5 distinct hierarchical and mutually exclusive categories: Neuropathic Sensitization 6 (NS) comprising major features of neuropathic pain with sensory sensitization; 7 Denervation (D) arising from significant axonal compromise; Peripheral Nerve 8 Sensitization (PNS) with marked nerve trunk mechanosensitivity; and 9Musculoskeletal (M) with pain referred from musculoskeletal structures. 10Objective: To investigate construct validity of the classification system 11 Methods: Construct validity was investigated by determining the relationship of 12 nerve functioning with subgroups of patients and asymptomatic controls. Thus 13 somatosensory profiles of subgroups of patients with low back related leg pain 14 (LBRLP) and healthy controls were determined by a comprehensive quantitative 15 sensory test (QST) protocol. It was hypothesized that subgroups of patients and 16 healthy controls would show differences in QST profiles relating to underlying 17 pathomechanisms. 18Results: 77 subjects with LBRLP were recruited and classified in one of the four 19 groups. Additionally, 18 age and gender matched asymptomatic controls were 20 measured. QST revealed signs of pain hypersensitivity in group NS and sensory 21 deficits in group D whereas Groups PNS and M showed no significant differences 22 when compared to the asymptomatic group. 23 3 Conclusions: These findings support construct validity for two of the categories of 1 the new classification system, however further research is warranted to achieve 2 construct validation of the classification system as a whole. 3 4

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Classification of low back-related leg pain—A proposed patho-mechanism-based approach

Cited by 91 publications

References 91 publications

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

Mechanisms-based classifications of musculoskeletal pain: Part 2 of 3: Symptoms and signs of peripheral neuropathic pain in patients with low back (±leg) pain

Low back related leg pain: An investigation of construct validity of a new classification system

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