Abstract
BackgroundChronic back pain is known to be associated with altered tactile acuity. Tactile acuity is measured using the Two-Point Discrimination (TPD) test in both clinical and research settings. In subjects with chronic low back pain, the TPD threshold (TPDT) is increased and is associated with persistent pain. It remains unknown, however, whether TPDT is also altered in cases of clinical acute pain, or whether it could be used as a predictor of future pain and disability at an early stage of LBP.The main objective of this study was to investigate the predictive value of baseline TPDT for pain and disability at 3 and 6 months after the onset of acute LBP. The TPDT in acute low back pain (LBP) and the development of TPDT over 6 months has also been assessed.MethodsLBP participants (n = 124) with acute LBP (< 4 weeks) were included. Subjects were examined within 4 weeks of pain onset and followed-up after 3 and 6 months of pain onset. Horizontal and vertical TPDTs of the lower back were collected. Linear mixed models were subsequently used to evaluate the association of TPDT with pain and disability over time.ResultsThe vertical TPDT showed a mean (SD) of 4.9 cm (1.6) and the horizontal TPDT a mean (SD) of 6.0 cm (1.5) at baseline. The vertical TPDT altered from baseline up to 6 months from 4.9 to 4.6 cm and the horizontal TPDT from 6.0 to 5.4 cm. The association between the TPDT and the Oswestry Disability Index (ODI) after 6 months was moderate. Linear mixed models revealed no association between TPDT, pain and disability over the progression of LBP.ConclusionTPDTs appear to be raised in subjects with acute LBP. However, our study revealed no predictive capability of the TPDT for disability and pain. No comparisons are possible in the absence of similar studies, indicating the need for further research is in this area.
Highlights
Chronic back pain is known to be associated with altered tactile acuity
Pain intensity Numeric Rating Scale (NRS) 0–10, Disability Oswestry Disability Index (ODI): score ≤ 20% = minimal disability; score 21- 40% = moderate disability; score ≤ 41- 60% = severe disability; score > 61–80% = crippling disability; score > 81% bed-bound [28], TPD threshold (TPDT) Two-point discrimination threshold measured with a plastic calliper ruler in vertical and horizontal direction from 1–10 cm TPDT in the acute pain state At baseline, the mean TPDTs measured in this study were as follows: mean (SD) 4.9 cm (1.6) in the vertical direction and 6.0 cm (1.5) in the horizontal direction
TPDT in the acute pain state While there is a well-established body of literature on the TPDT for healthy adults, there is no comparable work on the TPDT for clinical acute low back pain (LBP) subjects
Summary
Chronic back pain is known to be associated with altered tactile acuity. Tactile acuity is measured using the Two-Point Discrimination (TPD) test in both clinical and research settings. In subjects with chronic low back pain, the TPD threshold (TPDT) is increased and is associated with persistent pain It remains unknown, whether TPDT is altered in cases of clinical acute pain, or whether it could be used as a predictor of future pain and dis‐ ability at an early stage of LBP. Baseline values of depression and maladaptive cognitions are clinical predictors of pain intensity and disability after 6 months [13]. These results indicate the necessity to identify high-risk LBP subjects at the earliest possible stage [14, 15]. We propose tactile acuity as a novel prospective assessment tool
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