Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems
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Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1e4), profiling their clinical presentations within a multidimensional framework.P1's profile was characterised by localised lumbar sensitisation consistent with dominant peripheral nociception. P2 presented a ‘mixed’ profile characterised by localised lumbar hypersensitivity, combined with factors suggestive of centrally-mediated facilitation of nociception. P3's profile suggested widespread hypersensitivity possibly reflective of dominant centrally-mediated pain mechanisms. P4's profile was characterised by dominant psychosocial factors and comorbidities. These cases are discussed in relation to contemporary CLBP CS, highlighting the complexity of these disorders and limitations of CS for people with CLBP and their treating health professionals. This paper reinforces the need for a consensus CS for people with CLBP that is flexible, has clinical utility and considers all relevant dimensions.
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Pain provocation following sagittal plane repeated movements in people with chronic low back pain: Associations with pain sensitivity and psychological profilesRabey, Martin; Smith, Anne; Beales, Darren; Slater, Helen; O'Sullivan, Peter (2017)Background and aims Provocative pain responses following standardised protocols of repeated sagittal plane spinal bending have not been reported in people with chronic low back pain (CLBP). Potential differing pain responses ...
STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patientsRabey, Martin; Kendall, Michelle; Godden, Chris; Liburd, Jermaine; Netley, Hayley; O'Shaughnessy, Ciaran; O'Sullivan, Peter; Smith, Anne; Beales, Darren (2019)Background: Investigation of movement and sensory profiles across STarT Back risk subgroups. Methods: A chronic low back pain cohort (n = 290) were classified as low, medium or high risk using the STarT Back Tool, and ...
Rabey, M.; Smith, Anne; Beales, Darren; Slater, Helen; O'Sullivan, Peter (2017)Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To derive prognostic models for people with chronic low back pain (CLBP) (n=294) based upon an extensive array of potentially prognostic ...