Abstract
Gluteal syndrome (GS), a new low-back-pain subtype mimicking sciatica, has been included in the 11th Revision of the International Classification of Diseases (ICD-11). Low back pain is a symptom, not a disease, and the main problem associated with it is pain complexity. A plausible pain generator of gluteal syndrome is the central sensitization process and the therapeutic target area, which are trigger points located within the gluteal muscles. It has been hypothesized that dysregulated immune and autonomic nervous systems (ANS) are involved in central sensitization development. Changes in ANS regulation, mainly through the sympathetic branch, provoke nociceptor activation indirectly by a vasoconstriction–vasodilatation imbalance, or directly by sympathetic–nociceptor activation resulting in widespread pain, hyperalgesia, and allodynia. The minimally invasive procedure (MIP) uses thermography to confirm a completely new biological phenomenon, which suggests a pathological autonomic response to noxious stimuli and can possibly become an objective marker of some nociplastic pain subtypes related to trigger points. This review provides the biological and technical rationale for the automation of the MIP—a possible future diagnostic tool for an objective gluteal syndrome confirmation.
Highlights
The aim of this review is to provide the biological and technical rationale for the minimally invasive procedure (MIP), which could become a possible future diagnostic tool for an objective confirmation of nociplastic pain related to muscles, e.g., gluteal syndrome
The minimally invasive procedure is intended to confirm a completely new biological phenomenon, which suggests a pathological autonomic response to noxious stimuli and can possibly become an objective marker of some nociplastic pain subtypes. It applies a new type of the active dynamic thermography method and uses invasive nociceptive muscle stimulation for the first time
The MIP protocol is based on the analysis of one side only and focuses on the confirmation or not of a pathological autonomic phenomenon occurrence within the perceived pain zone
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Secondary musculoskeletal pain is when the pain is progressing to chronicity due to some underlying condition and assumes persistent local or systemic inflammation due to infection, crystal deposition, autoimmune or autoinflammatory processes, local structural musculoskeletal changes, or nervous system diseases not classified as musculoskeletal but causing symptoms that can provoke musculoskeletal problems (e.g., hypertonicity in Parkinson disease or spasticity in multiple sclerosis) Another clinical aspect of LBP is pain followed by leg pain diagnosed as radicular pain, sciatica, facet joint syndrome, sacroiliac joint pain, etc. The palpatory criteria commonly used for trigger points diagnosis are regarded as not objective and they are widely questioned [13,14] This means that the new LBP subtype is likely to become another pain syndrome that is difficult to manage. The aim of this review is to provide the biological and technical rationale for the minimally invasive procedure (MIP), which could become a possible future diagnostic tool for an objective confirmation of nociplastic pain related to muscles, e.g., gluteal syndrome
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