Highlights
- •Sensory and clinical pain profiles are different in subtypes of back pain.
- •Patients with radiating pain demonstrated facilitated temporal pain summation.
- •Different back pain conditions may require different treatment strategies.
Abstract
Facilitated pain mechanisms and impaired pain inhibition are often found in chronic
pain patients. This study compared clinical pain profiles, pain sensitivity, as well
as pronociceptive and antinociceptive mechanisms in patients with localized low back
pain (n = 18), localized neck pain (n = 17), low back and radiating leg pain (n = 18),
or neck and radiating arm pain (n = 17). It was hypothesized that patients with radiating
pain had facilitated pain mechanisms and impaired pain inhibition compared with localized
pain patients. Cuff algometry was performed on the nonpainful lower leg to assess
pressure pain threshold, tolerance, temporal summation of pain (increase in pain scores
to 10 repeated stimulations at pressure pain tolerance intensity), and conditioning
pain modulation (increase in pressure pain threshold during pain conditioning on the
contralateral leg). Heat detection and heat pain threshold at the nonpainful hand
were also assessed. Clinical pain intensity, psychological distress, and disability
were assessed with questionnaires. Temporal summation of pain was increased in patients
with radiating back pain compared with localized back pain (P < .03). Patients with radiating arm pain or localized low back pain demonstrated
hyperalgesia to heat and pressure in nonpainful body areas (P < .05), as well as well as a facilitated clinical pain profile compared with patients
with localized neck pain (P = .03). Patients with radiating pain patterns demonstrated facilitated temporal summation
suggesting differences in the underlying pain mechanisms between patients with localized
back pain and radiating pain.
Perspective
These findings have clinical implications because the underlying mechanisms in different
back pain conditions may require different treatment strategies.
Key words
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Article info
Publication history
Published online: March 23, 2017
Accepted:
March 13,
2017
Received in revised form:
February 20,
2017
Received:
December 7,
2016
Footnotes
Nocitech is partly owned by Aalborg University. Center for Neuroplasticity and Pain is supported by the Danish National Research Foundation (DNRF121).
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
