Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain.
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Affiliation
Physiotherapy Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. k.smart@svuh.ieIssue Date
2012-08MeSH
AdultAged
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
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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. 2012, 17 (4):352-7 Man TherJournal
Manual therapyDOI
10.1016/j.math.2012.03.002PubMed ID
22464885Abstract
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.Item Type
ArticleLanguage
enISSN
1532-2769ae974a485f413a2113503eed53cd6c53
10.1016/j.math.2012.03.002
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