Abstract
Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term ‘human assumed central sensitisation’ (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.
Highlights
The worldwide prevalence of chronic low back pain (CLBP) ranges between 2–25% [1,2,3].According to the 2017 global burden of disease study low back pain is the leading cause of years lived with disability [4]
As a gold standard for human assumed central sensitisation’ (HACS) assessment does not exist, it was important to gauge the various terminologies applied to HACS as well as assessment methods in humans used in literature
The Central Sensitisation Inventory (CSI) is a questionnaire that is often used, in the included studies of this review, and can be a quick tool for identifying whether symptoms may be associated with HACS or syndrome/disorder/disease related to HACS
Summary
The worldwide prevalence of chronic low back pain (CLBP) ranges between 2–25% [1,2,3]. According to the 2017 global burden of disease study low back pain is the leading cause of years lived with disability [4]. Recent evidence suggests that assessments of pain might represent underlying pain mechanisms and possibly help to identify patients at risk of poor response to different treatments for low back pain [5,6]. Nociplastic pain has been suggested to cover a subset of patients with CLBP with widespread hyperalgesia, facilitated temporal summation of pain, and/or impaired conditioned pain modulation, without clear evidence of actual or threatened tissue damage, that are less likely to respond positively to standard pain treatments [9,10]. Before the term nociplastic pain was introduced, terms used included centralised pain [11,12], hyperresponsiveness [13], central hypersensitivity [14], and central sensitisation (CS) [11]
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