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Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain.
Smart, Keith M Blake, Catherine Staines, Anthony Thacker, Mick Doody, Catherine
Smart, Keith M
Blake, Catherine
Staines, Anthony
Thacker, Mick
Doody, Catherine
Advisors
Editors
Other Contributors
Date
2012-08
Date Submitted
Keywords
Other Subjects
Subject Mesh
Adult
Aged
Analysis of Variance
Bayes Theorem
Cluster Analysis
Cross-Sectional Studies
Female
Humans
Ireland
Low Back Pain
Male
Middle Aged
Musculoskeletal Pain
Nociceptive Pain
Pain Measurement
Pain Threshold
Peripheral Nervous System Diseases
Physical Examination
Sensitivity and Specificity
Severity of Illness Index
Aged
Analysis of Variance
Bayes Theorem
Cluster Analysis
Cross-Sectional Studies
Female
Humans
Ireland
Low Back Pain
Male
Middle Aged
Musculoskeletal Pain
Nociceptive Pain
Pain Measurement
Pain Threshold
Peripheral Nervous System Diseases
Physical Examination
Sensitivity and Specificity
Severity of Illness Index
Planned Date
Start Date
Collaborators
Principal Investigators
Files
Alternative Titles
Publisher
Abstract
As a mechanisms-based classification of pain 'nociceptive pain' (NP) refers to pain attributable to the activation of the peripheral receptive terminals of primary afferent neurones in response to noxious chemical, mechanical or thermal stimuli. The symptoms and signs associated with clinical classifications of NP have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of NP 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 after which their pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist indicating the presence/absence of various symptoms and signs. A regression analysis identified a cluster of seven clinical criteria predictive of NP, including: 'Pain localised to the area of injury/dysfunction', 'Clear, proportionate mechanical/anatomical nature to aggravating and easing factors', 'Usually intermittent and sharp with movement/mechanical provocation; may be a more constant dull ache or throb at rest', and the absence of 'Pain in association with other dysesthesias', 'Night pain/disturbed sleep', 'Antalgic postures/movement patterns' and 'Pain variously described as burning, shooting, sharp or electric-shock-like'. This cluster was found to have high levels of classification accuracy (sensitivity 90.9%, 95% CI: 86.6-94.1; specificity 91.0%, 95% CI: 86.1-94.6). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of NP mechanisms in patients with low back pain disorders.
Language
en
ISSN
1532-2769
eISSN
ISBN
DOI
10.1016/j.math.2012.03.002
PMID
22464885