Open AccessLow Back Pain: Guidelines for the Clinical Classification of Predominant Neuropathic, Nociceptive, or Central Sensitization Pain
Author(s) -
Jo Nijs,
Adri T. Apeldoorn,
Hank Hallegraeff,
Jacqui Clark,
Rob Smeets,
Anneleen Malfliet,
Enrique Lluch Girbés,
Margot De Kooning,
Kelly Ickmans
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/e333
Subject(s) - medicine , neuropathic pain , nociception , low back pain , central sensitization , sensitization , population , referred pain , physical therapy , physical medicine and rehabilitation , anesthesia , pathology , alternative medicine , receptor , environmental health , immunology
Background: Low back pain (LBP) is a heterogeneous disorder including patientswith dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g.,lumbar radiculopathy), and central sensitization pain. In order to select an effectiveand preferably also efficient treatment in daily clinical practice, LBP patients shouldbe classified clinically as either predominantly nociceptive, neuropathic, or centralsensitization pain.Objective: To explain how clinicians can differentiate between nociceptive,neuropathic, and central sensitization pain in patients with LBP.Study Design: Narrative review and expert opinion.Setting: Universities, university hospitals and private practices.Methods: Recently, a clinical method for the classification of central sensitizationpain versus neuropathic and nociceptive pain was developed. It is based on a bodyof evidence of original research papers and expert opinion of 18 pain experts from 7different countries. Here we apply this classification algorithm to the LBP population.Results: The first step implies examining the presence of neuropathic low backpain. Next, the differential diagnosis between predominant nociceptive and centralsensitization pain is done using a clinical algorithm.Limitations: The classification criteria are substantiated by several original researchfindings including a Delphi survey, a study of a large group of LBP patients, andvalidation studies of the Central Sensitization Inventory. Nevertheless, these criteriarequire validation in clinical settings.Conclusion: The pain classification system for LBP should be an addition to availableclassification systems and diagnostic procedures for LBP, as it is focussed on painmechanisms solely.Key words: Chronic pain, neuroscience, diagnosis, clinical reasoning, examination,assessment