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

2.50
Hdl Handle:
http://hdl.handle.net/10147/251281
Title:
Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.
Authors:
Smart, Keith M; Blake, Catherine; Staines, Anthony; Thacker, Mick; Doody, Catherine
Affiliation:
Physiotherapy Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. k.smart@svuh.ie
Citation:
Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain. 2012, 17 (4):345-51 Man Ther
Journal:
Manual therapy
Issue Date:
Aug-2012
URI:
http://hdl.handle.net/10147/251281
DOI:
10.1016/j.math.2012.03.003
PubMed ID:
22465002
Abstract:
As a mechanisms-based classification of pain 'peripheral neuropathic pain' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: 'Pain referred in a dermatomal or cutaneous distribution', 'History of nerve injury, pathology or mechanical compromise' and 'Pain/symptom provocation with mechanical/movement tests (e.g. Active/Passive, Neurodynamic) that move/load/compress neural tissue'. This cluster was found to have high levels of classification accuracy (sensitivity 86.3%, 95% CI: 78.0-92.3; specificity 96.0%, 95% CI: 93.4-97.8; diagnostic odds ratio 150.9, 95% CI: 69.4-328.1). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of PNP mechanisms in patients with low back pain disorders in a way that might usefully inform subsequent patient management.
Item Type:
Article
Language:
en
MeSH:
Adult; Aged; Aged, 80 and over; Analysis of Variance; Bayes Theorem; Cluster Analysis; Cross-Sectional Studies; Female; Humans; Ireland; Low Back Pain; Male; Middle Aged; Musculoskeletal Pain; Nociceptive Pain; Peripheral Nervous System Diseases; Sensitivity and Specificity; Severity of Illness Index; Young Adult
ISSN:
1532-2769

Full metadata record

DC FieldValue Language
dc.contributor.authorSmart, Keith Men_GB
dc.contributor.authorBlake, Catherineen_GB
dc.contributor.authorStaines, Anthonyen_GB
dc.contributor.authorThacker, Micken_GB
dc.contributor.authorDoody, Catherineen_GB
dc.date.accessioned2012-11-07T15:08:36Z-
dc.date.available2012-11-07T15:08:36Z-
dc.date.issued2012-08-
dc.identifier.citationMechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain. 2012, 17 (4):345-51 Man Theren_GB
dc.identifier.issn1532-2769-
dc.identifier.pmid22465002-
dc.identifier.doi10.1016/j.math.2012.03.003-
dc.identifier.urihttp://hdl.handle.net/10147/251281-
dc.description.abstractAs a mechanisms-based classification of pain 'peripheral neuropathic pain' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: 'Pain referred in a dermatomal or cutaneous distribution', 'History of nerve injury, pathology or mechanical compromise' and 'Pain/symptom provocation with mechanical/movement tests (e.g. Active/Passive, Neurodynamic) that move/load/compress neural tissue'. This cluster was found to have high levels of classification accuracy (sensitivity 86.3%, 95% CI: 78.0-92.3; specificity 96.0%, 95% CI: 93.4-97.8; diagnostic odds ratio 150.9, 95% CI: 69.4-328.1). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of PNP mechanisms in patients with low back pain disorders in a way that might usefully inform subsequent patient management.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Manual therapyen_GB
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAnalysis of Variance-
dc.subject.meshBayes Theorem-
dc.subject.meshCluster Analysis-
dc.subject.meshCross-Sectional Studies-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshIreland-
dc.subject.meshLow Back Pain-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshMusculoskeletal Pain-
dc.subject.meshNociceptive Pain-
dc.subject.meshPeripheral Nervous System Diseases-
dc.subject.meshSensitivity and Specificity-
dc.subject.meshSeverity of Illness Index-
dc.subject.meshYoung Adult-
dc.titleMechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.en_GB
dc.typeArticleen
dc.contributor.departmentPhysiotherapy Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. k.smart@svuh.ieen_GB
dc.identifier.journalManual therapyen_GB
dc.description.provinceLeinsteren
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