Abstract
BackgroundThe nociceptive withdrawal reflex (NWR) has been proven to be a valuable tool in the objective assessment of central hyperexcitability in the nociceptive system at spinal level that is present in some chronic pain disorders, particularly chronic low back and neck pain. However, most of the studies on objective assessment of central hyperexcitability focus on population differences between patients and healthy individuals and do not provide tools for individual assessment. In this study, a prediction model was developed to objectively assess central hyperexcitability in individuals. The method is based on statistical properties of the EMG signals associated with the nociceptive withdrawal reflex. The model also supports individualized assessment of patients, including an estimation of the confidence of the predicted result.Resultsup to 80% classification rates were achieved when differentiating between healthy volunteers and chronic low back and neck pain patients. EMG signals recorded after stimulation of the anterolateral and heel regions and of the sole of the foot presented the best prediction rates.ConclusionsA prediction model was proposed and successfully tested as a new approach for objective assessment of central hyperexcitability in the nociceptive system, based on statistical properties of EMG signals recorded after eliciting the NWR. Therefore, the present statistical prediction model constitutes a first step towards potential applications in clinical practice.
Highlights
The nociceptive withdrawal reflex (NWR) has been proven to be a valuable tool in the objective assessment of central hyperexcitability in the nociceptive system at spinal level that is present in some chronic pain disorders, chronic low back and neck pain
It has been shown that the NWR is a valuable tool in the objective assessment of central hyperexcitability in the spinal nociceptive system that is present in many chronic pain disorders [7,9]
Several factors can influence the EMG signals recorded after stimulation of each site depending on the location of the electrode on the sole of the foot, such as skin thickness or nerve fiber density [24]
Summary
The nociceptive withdrawal reflex (NWR) has been proven to be a valuable tool in the objective assessment of central hyperexcitability in the nociceptive system at spinal level that is present in some chronic pain disorders, chronic low back and neck pain. Patients with chronic pain syndromes, such as whiplash, fibromyalgia, osteoarthritis, basal ganglia disorders, migraine and tension-type headache, endometriosis or chronic low back pain may display such pain hypersensitivity after stimulation of healthy tissues, most likely resulting from The assessment of these conditions may be hampered by the subjective and unreliable nature of self-report based instruments. The establishment of objective, affordable and reliable measures of pain hypersensitivity would advance the understanding of neural mechanisms behind chronic pain, provide a basis for improved clinical management of pain, and establish much needed objective measures of treatment success or failure [4] In this regard, the nociceptive withdrawal reflex (NWR) is a potential biomarker that has already been proven useful in the assessment of physiological, chemical and pharmacological modulation of nociceptive transmission/processing [5,6,7,8,9]. Most of the studies on objective assessment of central hyperexcitability focus on population differences between patients and healthy individuals and do not provide tools for individual assessment [7,8]
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