Identifying chronic low back pain phenotypic domains and characteristics accounting for individual variation: a systematic review

Abstract

Interpatient variability is frequently observed among individuals with chronic low back pain (cLBP). This review aimed at identifying phenotypic domains and characteristics that account for interpatient variability in cLBP. We searched MEDLINE ALL (through Ovid), Embase Classic and EMBASE (through Ovid), Scopus, and CINAHL Complete (through EBSCOhost) databases. Studies that aimed to identify or predict cLBP different phenotypes were included. We excluded studies that focused on specific treatments. The methodological quality was assessed using an adaptation of the Downs and Black tool. Forty-three studies were included. Although the patient and pain-related characteristics used to identify phenotypes varied considerably across studies, the following were among the most identified phenotypic domains and characteristics that account for interpatient variability in cLBP: pain-related characteristics (including location, severity, qualities, and duration) and pain impact (including disability, sleep, and fatigue), psychological domains (including anxiety and depression), behavioral domains (including coping, somatization, fear avoidance, and catastrophizing), social domains (including employment and social support), and sensory profiling (including pain sensitivity and sensitization). Despite these findings, our review showed that the evidence on pain phenotyping still requires further investigation. The assessment of the methodological quality revealed several limitations. We recommend adopting a standard methodology to enhance the generalizability of the results and the implementation of a comprehensive and feasible assessment framework to facilitate personalized treatments in clinical settings.

General and Pain‐Associated Psychological Distress Phenotypes Among Patients With Low Back Pain in the Military Health System

“…Sample sizes varied across studies significantly (eg, 24–1037 participants). For chronic LBP, the most identified phenotypic domains accounting for variability among patients included psychological and behavioral domains, similar to our findings, in addition to social, sensory profiling, and pain‐related characteristics and pain impact domains 56 . Much less work has been focused on cohorts with varying acuity of symptoms (eg, acute, subacute, and chronic).…”

“…Numerous studies have conducted phenotyping analyses in patients with LBP using a variety of methods and patient‐level variables 27,53–55 . For chronic LBP specifically, a recent systematic review found 43 studies, 56 with the number of phenotypes identified ranging from two to nine per study 54,56 . The large majority of studies identified three to four phenotypes 56 .…”

“…For chronic LBP specifically, a recent systematic review found 43 studies, 56 with the number of phenotypes identified ranging from two to nine per study 54,56 . The large majority of studies identified three to four phenotypes 56 . Sample sizes varied across studies significantly (eg, 24–1037 participants).…”