None listed
Conditions
Brief summary
Low back pain (LBP) is a highly prevalent health condition affecting up to 80% of individuals at some point in life. It is acknowledged that abnormal clinical findings, such as structural alterations of the spine found from imaging, poorly correlate with clinical status. Further, current prediction models that take into account psychological, demographical and physical factors explain only a small proportion of the variance in clinical outcomes. In recent years, evidence has accumulated that abnormal somatosensory processing occurs in people with chronic LBP. Psychophysical studies have commonly found pain hypersensitivity to various sensory stimuli in people with chronic LBP compared with healthy controls, not only at the back, but also at non-painful remote sites (e.g. at the hand). These changes in pain sensitivity in areas remote from the low back implicate abnormal central mechanisms. At present, it is not yet established to what extent these sensory alterations contribute to the generation and maintenance of LBP. Also, the temporal aspects of these changes are unknown. However, recent research has shown that somatosensory abnormalities can be detected early (i.e. within 4 weeks) after the onset of LBP. These include augmented spinal cord excitability as well as pressure pain hypersensitivity. Further, longitudinal studies in acute whiplash injury cohorts have shown that widespread pain hypersensitivity persisted only in subjects who did not recover at 6 months. Cold pain threshold was found the sensory parameter that most significantly predicted non-recovery at 6 months. The primary aim of this study is to investigate whether psychophysical measures of pain sensitivity contribute to predicting non-recovery in low back pain and to evaluate the time course of somatosensory changes from the onset of low back pain to 4 months.
Interventions
In this observational study, participants will be assessed first within 3 weeks from onset of low back pain. The assessment will take approximately 2 hours and it will involve baseline data collection, questionnaires administration and quantitative sensory testing (QST). In addition, an evidence-based booklet of basic advice on the management of low back pain that aligns with practice guidelines ("The Back Book") will be provided to all participants. Data collection will include:
- Extent of rec
In this observational study, participants will be assessed first within 3 weeks from onset of low back pain. The assessment will take approximately 2 hours and it will involve baseline data collection, questionnaires administration and quantitative sensory testing (QST). In addition, an evidence-based booklet of basic advice on the management of low back pain that aligns with practice guidelines ("The Back Book") will be provided to all participants. Data collection will include: - Extent of recovery (Back Pain Recovery Scale); - Pain intensity (0-10 VAS pain scale); - Self-reported functional status (Functional Rating Index Scale); - Self-reported disability (Roland Morris Disability questionnaire); - Sensory and affective dimensions of pain (Short-From McGill Pain questionnaire); - Neuropathic pain screening (PainDETECT questionnaire); - Psychological features (Pain-Self Efficacy questionnaire (PSEQ), Depression, anxiety and stress (DASS-21), Pain catastrophizing Scale (PCS)). QST assessment will be performed by one trained physiotherapist blinded to participants' condition using standardized protocols and it will include the following tests: cold and heat pain threshold, wind-up ratio, pressure pain threshold, two-point discrimination threshold, thermal temporal summation, conditioned pain modulation (CPM). QST measures will be taken at the back bilaterally (cold and heat pain threshold, wind-up ratio, pressure pain threshold, two point-discrimination threshold) and from the left hand as a remote control site (cold and heat pain threshold, wind-up ratio, pressure pain threshold). Thermal temporal summation will be tested on the palmar surface of the hand. CPM will be performed using a cold bath as a conditioning stimulus and two test stimuli, heat pain and pressure pain. Participants will be reassessed after 2 months and 4 months. In these sessions, QST measurements and clinical information (e.g. questionnaires) will be collected. Participants will be contacted at 6 months after LBP onset to attain pain scores and recovery status.
Sponsors
Dr Julia Hush
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
At least 18 years of age; low back pain with or without leg pain; pain duration within 3 weeks from onset; average pain intensity over the last few days at least 3 on a 11-point Numeric Pain Rating Scale.
Exclusion criteria
Signs or symptoms of serious spinal pathology (e.g. tumor, infection, fracture); any pain condition in the past year that has lasted for >1/12 and affected daily function or work activity; diagnosed co-morbid pain syndrome (e.g. fibromyalgia, irritable bowel syndrome, osteoarthritis); medical condition known to affect the nervous system (i.e. neurological disease, diabetes); previous lumbar surgery; pregnancy; unstable psychiatric disorder; substance abuse; severe cognitive impairment (arising from head injury or other comorbidity); long term use of medications that may impact on cognitive or sensory function (e.g. opiates greater than daily morphine equivalent 40mg); unable to read, write and understand English.
Outcome results
None listed