Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain.

2.50
Hdl Handle:
http://hdl.handle.net/10147/251315
Title:
Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation 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 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. 2012, 17 (4):336-44 Man Ther
Journal:
Manual therapy
Issue Date:
Aug-2012
URI:
http://hdl.handle.net/10147/251315
DOI:
10.1016/j.math.2012.03.013
PubMed ID:
22534654
Abstract:
As a mechanisms-based classification of pain 'central sensitisation pain' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP 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 CSP 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 three symptoms and one sign predictive of CSP, including: 'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/non-specific aggravating/easing factors', 'Pain disproportionate to the nature and extent of injury or pathology', 'Strong association with maladaptive psychosocial factors (e.g. negative emotions, poor self-efficacy, maladaptive beliefs and pain behaviours)' and 'Diffuse/non-anatomic areas of pain/tenderness on palpation'. This cluster was found to have high levels of classification accuracy (sensitivity 91.8%, 95% confidence interval (CI): 84.5-96.4; specificity 97.7%, 95% CI: 95.6-99.0). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of CSP in patients with low back pain disorders in a way that might usefully inform their management.
Item Type:
Article
Language:
en
MeSH:
Adult; Aged; Aged, 80 and over; Analysis of Variance; Bayes Theorem; Central Nervous System Sensitization; Cross-Sectional Studies; Female; Humans; Ireland; Logistic Models; Low Back Pain; Male; Middle Aged; Musculoskeletal Pain; Pain Measurement; Pain Threshold; Peripheral Nervous System Diseases; Physical Examination; Psychology; Regression Analysis; 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.accessioned2012-11-07T15:06:38Z-
dc.date.available2012-11-07T15:06:38Z-
dc.date.issued2012-08-
dc.identifier.citationMechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. 2012, 17 (4):336-44 Man Theren_GB
dc.identifier.issn1532-2769-
dc.identifier.pmid22534654-
dc.identifier.doi10.1016/j.math.2012.03.013-
dc.identifier.urihttp://hdl.handle.net/10147/251315-
dc.description.abstractAs a mechanisms-based classification of pain 'central sensitisation pain' (CSP) refers to pain arising from a dominance of neurophysiological dysfunction within the central nervous system. Symptoms and signs associated with an assumed dominance of CSP 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 CSP 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 three symptoms and one sign predictive of CSP, including: 'Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to multiple/non-specific aggravating/easing factors', 'Pain disproportionate to the nature and extent of injury or pathology', 'Strong association with maladaptive psychosocial factors (e.g. negative emotions, poor self-efficacy, maladaptive beliefs and pain behaviours)' and 'Diffuse/non-anatomic areas of pain/tenderness on palpation'. This cluster was found to have high levels of classification accuracy (sensitivity 91.8%, 95% confidence interval (CI): 84.5-96.4; specificity 97.7%, 95% CI: 95.6-99.0). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of CSP in patients with low back pain disorders in a way that might usefully inform their 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.meshCentral Nervous System Sensitization-
dc.subject.meshCross-Sectional Studies-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshIreland-
dc.subject.meshLogistic Models-
dc.subject.meshLow Back Pain-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshMusculoskeletal Pain-
dc.subject.meshPain Measurement-
dc.subject.meshPain Threshold-
dc.subject.meshPeripheral Nervous System Diseases-
dc.subject.meshPhysical Examination-
dc.subject.meshPsychology-
dc.subject.meshRegression Analysis-
dc.subject.meshSeverity of Illness Index-
dc.subject.meshYoung Adult-
dc.titleMechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation 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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