Abstract
BackgroundBiopsychosocial factors above and beyond pathoanatomical changes likely contribute to the severity of chronic low back pain. A pro-nociceptive endogenous pain modulatory balance (↓inhibition and ↑facilitation) may be an important contributor to chronic low back pain severity and physical function; however, additional research is needed to address this possibility. The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and cLBP severity self-reported on a validated questionnaire.MethodsOne hundred thirty-four individuals with chronic low back pain were enrolled in this two-session study. During the first study session, temporal summation of mechanical pain and conditioned pain modulation were assessed at the lumbar spine to determine endogenous pain facilitation and inhibition, respectively. One week later, participants returned for a second study session whereby they reported their pain severity and pain interference using the Brief Pain Inventory-Short Form. Movement-evoked pain and physical function capacity were assessed upon completion of the balance, walking, and transition from sit to stand tests of the Short Physical Performance Battery.ResultsTemporal summation of mechanical pain, but not conditioned pain modulation, significantly and prospectively predicted greater movement-evoked pain and poorer physical function on the Short Physical Performance Battery. Neither temporal summation nor conditioned pain modulation were significantly related to self-reported pain severity or pain interference on the Brief Pain Inventory-Short Form.ConclusionsFindings suggest that a pro-nociceptive pain modulatory balance characterized by enhanced pain facilitation may be an important driver of movement-evoked pain severity and poor physical function in individuals with chronic low back pain.
Highlights
Low back pain is one of the most common disabling conditions in the world [1]
conditioned pain modulation (CPM) did not significantly predict movement-evoked pain (β = .02, p = .781). These findings suggest that enhanced endogenous pain facilitation may be an important driver of subsequent movement-evoked pain experiences in adults with Chronic low back pain (cLBP) (Fig. 2a)
Our findings suggest that a pro-nociceptive pain modulatory balance, characterized by a high degree of endogenous pain facilitation (i.e., temporal summation (TS) of mechanical pain), may be an important contributor to future episodes of movement-evoked cLBP severity and poorer physical function when assessed with the Short Physical Performance Battery (SPPB)
Summary
Low back pain is one of the most common disabling conditions in the world [1]. The worldwide point prevalence of activity-limiting (acute and chronic) low back pain is approximately 12% [2], which equates to approximately 933 million people globally suffering with low back pain at any given time. Chronic low back pain (cLBP) refers to pain lasting at least 12 week or longer, and it is consistently among the top five most common reasons for primary care physician visits [3]. This is alarming given the substantial (and growing) direct and indirect economic costs associated with cLBP [3]. In line with growing prevalence and expense, the last two decades saw steadily increased utilization of interventions targeting cLBP, including surgical, pharmacological, and non-pharmacological approaches [4,5,6]. Despite increased utilization, sustained pain relief and functional restoration is rarely achieved for those with cLBP. The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and cLBP severity self-reported on a validated questionnaire
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