RELATIONSHIP BETWEEN CENTRAL SENSITIVITY SYNDROME AND THE KEELE START BACK TOOL VERIFIED BY JAPANESE PATIENTS WITH LOW BACK PAIN

H. Nagahori¹, H. Momma², T. Miki³

Background: Low back pain (LBP) is one of the most common diseases observed in the world. In fact, its recurrence rate and chronicity rate are 44-78% and 5-10% respectively, and biopsychosocial factors are reported to be associated with its chronicity. The Keele STarT Back Screening Tool (SBT) is a questionnaire developed for people with LBP. It stratifies the severity of LBP and assesses psychosocial factors involved in it. It has been proved to be effective for prognostic prediction of chronicle LBP. Central sensitization (CS) is an excessive response to nociceptive stimulation in the central nervous system. Previous studies reported the relationship between CS and chronicle LBP, indicating the possibility that CS plays an important role in the treatment of patients with LBP. Central sensitivity syndromes (CSSs) was advocated as the heterogeneous group of disorders related to CS, and the central sensitization inventory (CSI) is used to evaluate it. Many reports exist on the relationship between SBT and some psychosocial factors, but few reports exist on the relationship between SBT and CSSs.  

Purpose: The primary purpose of this study was to investigate the relationship between CSSs and the SBT of Japanese LBP patients. 

Methods: Ethical approval: We received approval from the Faculty of Health Sciences Research Ethic Committee, Kyorin University (REF: 2019-51). Informed consent was obtained from all the participants.  
Design: Cross-sectional study
Subjects: Patients with LBP who received rehabilitation intervention at an orthopedic clinic in Japan.
Exclusion criteria: We excluded patients younger than 18 years old, those who have spinal fracture, those who suffer from visceral or metastatic disease, and dementia patients.
Measurement items: We measured the following items in the first rehabilitation session.
The 9-item short version of the CSI (CSI-9), the SBT, Numerical rating scale (NRS), the Oswestry Disability Index (ODI), the EQ-5D-5L and the duration of LBP.
Statistical analysis: We created a normal distribution curve to examine the subjects’ demographics and analyzed it with the help of the Kolmogorov-Smirnov test. Subsequently, we figured out the Spearman’s rank correlation coefficient to analyze the relationships between the CSI-9 and the other measurement items. We set the significance level at 0.05 and conducted all analyzes using IBM SPSS version 26.0.

Results: Forty-three patients participated in this study. The Spearman’s rank correlation coefficient showed the significant correlations between the CSI-9 and the SBT (r=0.39), the EQ-5D-5L (r=-0.38), the ODI (r=0.31) and the duration (r=0.30).

Conclusion(s): This study indicates that the CSSs has a low correlation with the SBT.

Implications: The correlation between the CSI-9 and SBT indicates the importance of suspecting the involvement of the CSSs in the treatment of severe LBP. Furthermore, the CSI-9 was associated not with the psychosocial score in the SBT and the pain intensity but with the duration of the disease. Thus, there is a possibility that the CSSs is implicated as a cause of LBP, especially in the case of chronic LBP. Finally, the correlation between the CSI-9 and SBT indicates that the CSI-9 is effective as a prognostic prediction tool for patients with LBP.

Funding, acknowledgements: We are highly grateful to all colleagues for always provide helpful supports through the long data collection.

Keywords: Low back pain, Central sensitivity syndromes, The Keele STarT Back Screening Tool

Topic: Pain & pain management

Did this work require ethics approval? Yes

Institution: Kyorin University

Committee: Health Sciences Research Ethic Committee

Ethics number: 2019-51