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Miki T1,2, Nishigami T3, Takebayashi T4, Yamamura M4, Yamauchi T2
1Sapporo Maruyama Orthopedic Hospital, Sapporo Hokkaido, Japan, 2Hokkaido University, Graduate School of Health Science, Sapporo, Japan, 3Konan Women's University, Kobe, Japan, 4Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
Background: Central Sensitization(CS) is known as the increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. Recently, Central Sensitization Inventory(CSI) have developed as screening CS and been utilized to evaluate patient condition in the clinical situation. Recently, the influence of psychosocial and cognitive behavioral factors, such as depression, pain catastrophizing, fear avoidance behavior, and anxiety have been reported in patients with low back pain. However, the relationship between those factors and CS has not yet been studied for pre-surgical patients with low back.
Purpose: The purpose of the study is to investigate the percentage of CS for pre-surgical patients of low back pain and compare those scores between high CS group and low CS group. In addition, we analyze the relationship between CS and pain, QOL, disability and psychosocial factors.
Methods: Participants with low back pain in pre-surgical patients were included in the study. Inclusion criteria were 1)Diagnosed “lumbar spinal stenosis” or “a lumber hernia” and scheduled for surgery in our hospital, 2)20-85 years 3)participants enable to understand Japanese. Demographic (age, gender, height, weight), CSI, Tampa of Kinesophobia(TSK), Pain catastrophizing scale(PCS), The Hospital Anxiety and Depression Scale(HADS), Roland-Morris Disability Questionnaire(RDQ), Numeric rating scale(NRS) as assessing pain intensity for low back and legs, Euro-Qol 5 Dimensions(EQ-5D) as assessing health-related quality of life (QOL) were assessed in all participants in a day one prior to surgery.
The patients were divided into two groups depending on the CSI score(CSI score ≥ 30 and CSI score 30). Between two groups (high CS group and low CS group) were compared using independent sample t-tests or Mann-Whitney U-tests depending on the normality of the data for all outcomes. In addition, the association between CSI and psychosocial factors, pain intensity, QOL, and disability was analyzed. Normality of the data was analyzed using the Shapiro-Wilk test. The significance level was set at 0.05.
Results: 145 participants (86 male and 59 female) were analyzed. The median (sum of squares) of CS was 24(15-32) and high CS was observed in 47 participants (32.4%) of patients. There was no significant difference Demographic date between the two group.
The differences between groups were statistically significant for PCS, TSK, HADS(Anxiety), HADS (depression), EQ-5D, NRS(low back), NRS(legs) and RDQ.
In addition, significant associations were found between CS and all other outcomes, especially CPS and HADS (anxiety) and HADS (depression). r=0.51,0.47 and 0.45 respectively (p .0001).
Conclusion(s): The results in the present study show PCS, TSK, HADS (anxiety and depression), NRS for low back and legs, RQD and EQ-5D were a significantly high score in high CS group. In addition, CSI was significantly associated with psychological factors, pain intensity, QOL and disability for the pre-surgical patient with low back pain.
Implications: We might offer different physiotherapy patients in CS. For example, therapists should consider implementing interventions addressing as fear of movement, pain catastrophizing and pain neuroscience education after taking surgery.
Keywords: Central Sensitization, Low back Pain, Psychological factors
Funding acknowledgements: The authors received no specific funding for this work.
Purpose: The purpose of the study is to investigate the percentage of CS for pre-surgical patients of low back pain and compare those scores between high CS group and low CS group. In addition, we analyze the relationship between CS and pain, QOL, disability and psychosocial factors.
Methods: Participants with low back pain in pre-surgical patients were included in the study. Inclusion criteria were 1)Diagnosed “lumbar spinal stenosis” or “a lumber hernia” and scheduled for surgery in our hospital, 2)20-85 years 3)participants enable to understand Japanese. Demographic (age, gender, height, weight), CSI, Tampa of Kinesophobia(TSK), Pain catastrophizing scale(PCS), The Hospital Anxiety and Depression Scale(HADS), Roland-Morris Disability Questionnaire(RDQ), Numeric rating scale(NRS) as assessing pain intensity for low back and legs, Euro-Qol 5 Dimensions(EQ-5D) as assessing health-related quality of life (QOL) were assessed in all participants in a day one prior to surgery.
The patients were divided into two groups depending on the CSI score(CSI score ≥ 30 and CSI score 30). Between two groups (high CS group and low CS group) were compared using independent sample t-tests or Mann-Whitney U-tests depending on the normality of the data for all outcomes. In addition, the association between CSI and psychosocial factors, pain intensity, QOL, and disability was analyzed. Normality of the data was analyzed using the Shapiro-Wilk test. The significance level was set at 0.05.
Results: 145 participants (86 male and 59 female) were analyzed. The median (sum of squares) of CS was 24(15-32) and high CS was observed in 47 participants (32.4%) of patients. There was no significant difference Demographic date between the two group.
The differences between groups were statistically significant for PCS, TSK, HADS(Anxiety), HADS (depression), EQ-5D, NRS(low back), NRS(legs) and RDQ.
In addition, significant associations were found between CS and all other outcomes, especially CPS and HADS (anxiety) and HADS (depression). r=0.51,0.47 and 0.45 respectively (p .0001).
Conclusion(s): The results in the present study show PCS, TSK, HADS (anxiety and depression), NRS for low back and legs, RQD and EQ-5D were a significantly high score in high CS group. In addition, CSI was significantly associated with psychological factors, pain intensity, QOL and disability for the pre-surgical patient with low back pain.
Implications: We might offer different physiotherapy patients in CS. For example, therapists should consider implementing interventions addressing as fear of movement, pain catastrophizing and pain neuroscience education after taking surgery.
Keywords: Central Sensitization, Low back Pain, Psychological factors
Funding acknowledgements: The authors received no specific funding for this work.
Topic: Musculoskeletal: spine; Pain & pain management; Outcome measurement
Ethics approval required: Yes
Institution: Hokkaido University
Ethics committee: Graduate School of Health Sciences
Ethics number: 17-110
All authors, affiliations and abstracts have been published as submitted.
