Highlights
- •Enhanced sensitivity consistent with generalized hyperalgesia was observed.
- •Acute back pain includes 4 subgroups with sensitivity and modulation profiles.
- •Various factors including sleep and alcohol explain some variation in presentation.
Abstract
Generalized hyperalgesia and impaired pain modulation are reported in chronic low
back pain (LBP). Few studies have tested whether these features are present in the
acute phase. This study aimed to test for differences in pain presentation in early-acute
LBP and evaluate the potential contribution of other factors to variation in sensitivity.
Individuals within 2 weeks of onset of acute LBP (n = 126) and pain-free controls
(n = 74) completed questionnaires related to their pain, disability, behavior, and
psychological status before undergoing conditioned pain modulation (CPM) and pain
threshold (heat, cold, and pressure) testing at the back and forearm/thumb. LBP participants
were more sensitive to heat and cold at both sites and pressure at the back than controls,
without differences in CPM. Only those with high-pain (numeric rating scale ≥4) were
more sensitive to heat at the forearm and pressure at the back. Four subgroups with
distinct features were identified: “high sensitivity,” “low CPM efficacy,” “high sensitivity/low
CPM efficacy,” and “low sensitivity/high CPM efficacy.” Various factors such as sleep
and alcohol were associated with each pain measure. Results provide evidence for generalized
hyperalgesia in many, but not all, individuals during acute LBP, with variation accounted
for by several factors. Specific pain phenotypes provide candidate features to test
in longitudinal studies of LBP outcome.
Perspective
Sensory changes indicative of increased/decreased central processing of pain and nociceptive
input presented differently between individuals with acute LBP and were related to
factors such as sleep and alcohol. This may underlie variation in outcome and suggest
potential for early identification of individuals with poor long-term outcome.
Key words
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Article info
Publication history
Published online: March 26, 2018
Accepted:
February 22,
2018
Received in revised form:
January 18,
2018
Received:
November 14,
2017
Footnotes
This research was funded by the National Health and Medical Research Council (NHMRC) of Australia (Project Grant: ID631369; Program Grant: APP1091302). P.W.H. was supported by NHMRC Fellowship APP1002190. G.L.M. was supported by NHMRC Fellowship ID1061279. M.S. was supported by NHMRC Fellowship APP1002489.
In the past 5 years, G.L.M. has received support from Pfizer, Workers' Compensation boards in Australia, North America, and Europe, the International Olympic Committee, and Port Adelaide Football Club. P.W.H. and G.L.M. receive speaker's fees for lectures on pain and rehabilitation and received royalties for books on pain. The remaining authors have no conflicts of interest to declare.
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© 2018 by the American Pain Society
