Abstract
BackgroundSensory discrimination training (SDT) for people with chronic low back pain (CLBP) is a novel approach based on theories of the cortical reorganization of the neural system. SDT aims to reverse cortical reorganization, which is observed in chronic pain patients. SDT is still a developing therapeutic approach and its effects have not been systematically reviewed. The aim of this systematic review was to evaluate if SDT decreases pain and improves function in people with CLBP.MethodsA systematic review was performed on the available literature to evaluate the effects of SDT. Randomised controlled trials compared the effectiveness of SDT on pain and function in people with CLBP with the effectiveness of other physiotherapy interventions, no treatment, or sham therapy. The methodological quality of the included studies and the clinical relevance of reported treatment effects were investigated.ResultsThe original search revealed 42 records of which 6 fulfilled the inclusion criteria. The majority of studies showed that SDT caused statistically significant improvements in pain and function, but only two studies reported clinically relevant improvements. The applied SDT varied considerably with regard to dosage and content. The methodological quality of the included studies also varied, which hampered the comparability of results.ConclusionsAlthough SDT seems to improve pain and function in people with CLBP, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power and sample selection as well as to the content and dosage of the SDT intervention. We recommend a large, well-powered, prospective randomized control study that uses a standardized SDT approach to address the hypothesis that SDT causes clinically relevant improvements in pain and function.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0997-8) contains supplementary material, which is available to authorized users.
Highlights
Sensory discrimination training (SDT) for people with chronic low back pain (CLBP) is a novel approach based on theories of the cortical reorganization of the neural system
Chronic low back pain (CLBP) has been associated with neurochemical, structural, and functional cortical changes [1] of several brain regions including the somatosensory cortex. Those changes have been observed in people with CLBP [1], phantom limb pain [2] and chronic regional pain syndrome (CRPS) [3,4,5] and manifest in medialization and expansion of the cortical representation of the low back in the primary and secondary somatosensory cortex [1, 6] and are commonly described
Cortical reorganization presents a barrier to successful recovery; the plasticity that underpins cortical reorganization suggests that it might be responsive to targeted treatments [10], such as sensory discrimination training (SDT)
Summary
Sensory discrimination training (SDT) for people with chronic low back pain (CLBP) is a novel approach based on theories of the cortical reorganization of the neural system. SDT comprises tactile discrimination [11] and sensorimotor retraining [12] approaches, which involve the recognition of the location and the type of the stimuli by the patient (localization training) These treatment approaches improve tactile acuity, normalize cortical reorganization and decrease pain in. Instead of comprising a passive and repetitive stimulation of the affected area or of another body part, such treatments require active perception and localization of the stimulus (discrimination component) by the patient These approaches are not fully developed from a pathoanatomical perspective [1], since the processes involved in cortical reorganization in CLBP are not fully understood [13]
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