den Bandt H1, Paulis W1, Beckwee D2, Ickmans K2, Nijs J2, Voogt L1
1University of Applied Sciences Rotterdam, Dept. of Physiotherapy, Rotterdam, Netherlands, 2Vrije Universiteit Brussel, Dept. of Physiotherapy, Human Physiology and Anatomy, Brussel, Belgium
Background: Non-specific low back pain (nsLBP) is a complex and highly prevalent health issue. Current guidelines for nsLBP suggest biopsychosocial approaches and individually-tailored interventions, consisting of combinations of education, exercise, and hands-on interventions. Although the success of these interventions is well demonstrated, effect-sizes are still generally small and recurrent rates are high. There is a clear need for improvement. One suggestion that is proposed is to better align treatments for low back pain with underlying biological processes. Research suggests that central nervous system changes may play an important role in nsLBP. Quantitative sensory testing (QST) is a way of assessing sensory functioning and is used to detect functional changes in (central) nociceptive processing.
Purpose: The aim of this systematic review and meta-analysis is to examine sensory functioning measured with QST in patients with nsLBP in order to determine if enhanced functioning is apparent in (subgroups of) the nsLBP population.
Methods: Literature was searched up to November 13th 2017 in five databases; Medline, Cochrane, Google Scholar, Web of Science and CINAHL. QST-data from people with nsLBP and healthy controls (HC) were included and concerned 1) pressure pain thresholds (PPTs), 2) temporal summation (TS) and 3) conditioned pain modulation (CPM). Risk of bias was assessed, using the Newcastle-Ottawa quality assessment scale (NOS). Results from different studies were pooled for meta-analysis.
Results: Of 6206 studies, 22 studies were included. Methodological quality varied between zero and six points. For the meta-analysis seven clusters were formed. Meta-analysis showed that people with nsLBP have significantly lower PPTs at remote sites and increased TS locally (lumbar) compared to HC. TS hand and CPM measurements demonstrated inconsistent outcomes.
Conclusion(s): In this meta-analysis evidence was found for lower pain thresholds at remote sites measured by PPT and at local sites measured by TS (lumbar), suggesting central sensitisation. Results from other QST-measures show inconsistent results. Reasons for this can be that pain mechanisms have not changed within the nsLBP group, or differences in study population and/or QST-protocols used. A recommendation is to standardize TS and CPM protocols in order to obtain less ambiguous results.
Implications: Results of this systematic review and meta-analysis show that enhanced sensory functioning is apparent in (subgroups of) people with nsLBP. This is the first meta-analysis on QST measurement outcomes in the nsLBP population. Results show that central neurophysiological processes are apparent in at least a subgroup of this population. This finding has consequences for daily physical therapy practice.
Keywords: Non-specific low back pain, central sensitisation, quantitative sensory testing
Funding acknowledgements: There was no external funding
Purpose: The aim of this systematic review and meta-analysis is to examine sensory functioning measured with QST in patients with nsLBP in order to determine if enhanced functioning is apparent in (subgroups of) the nsLBP population.
Methods: Literature was searched up to November 13th 2017 in five databases; Medline, Cochrane, Google Scholar, Web of Science and CINAHL. QST-data from people with nsLBP and healthy controls (HC) were included and concerned 1) pressure pain thresholds (PPTs), 2) temporal summation (TS) and 3) conditioned pain modulation (CPM). Risk of bias was assessed, using the Newcastle-Ottawa quality assessment scale (NOS). Results from different studies were pooled for meta-analysis.
Results: Of 6206 studies, 22 studies were included. Methodological quality varied between zero and six points. For the meta-analysis seven clusters were formed. Meta-analysis showed that people with nsLBP have significantly lower PPTs at remote sites and increased TS locally (lumbar) compared to HC. TS hand and CPM measurements demonstrated inconsistent outcomes.
Conclusion(s): In this meta-analysis evidence was found for lower pain thresholds at remote sites measured by PPT and at local sites measured by TS (lumbar), suggesting central sensitisation. Results from other QST-measures show inconsistent results. Reasons for this can be that pain mechanisms have not changed within the nsLBP group, or differences in study population and/or QST-protocols used. A recommendation is to standardize TS and CPM protocols in order to obtain less ambiguous results.
Implications: Results of this systematic review and meta-analysis show that enhanced sensory functioning is apparent in (subgroups of) people with nsLBP. This is the first meta-analysis on QST measurement outcomes in the nsLBP population. Results show that central neurophysiological processes are apparent in at least a subgroup of this population. This finding has consequences for daily physical therapy practice.
Keywords: Non-specific low back pain, central sensitisation, quantitative sensory testing
Funding acknowledgements: There was no external funding
Topic: Musculoskeletal: spine; Pain & pain management
Ethics approval required: No
Institution: not applicable
Ethics committee: not applicable
Reason not required: It is a systematic review
All authors, affiliations and abstracts have been published as submitted.
