Better Classification for Low Back Pain.
• Low back pain (LBP) is often classified based on perceived tissue damage. However, sub-acute and chronic pain is often not nociception based, but drifts to central pain mechanisms. Neuropathic pain further confounds the picture.
• Chiropractic neurologists who work with LBP would do themselves and their patients a great favor if they would classify the pains based on a new approach.
• This article suggests that LBP be classified as predominantly nociceptive, neuropathic or central.
Background: Low back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP patients should be classified clinically as either predominantly nociceptive, neuropathic, or central sensitization pain.
Objective: To explain how clinicians can differentiate between nociceptive, neuropathic, and central sensitization pain in patients with LBP.
Study design: Narrative review and expert opinion
Setting: Universities, university hospitals and private practices
Methods: Recently, a clinical method for the classification of central sensitization pain versus neuropathic and nociceptive pain was developed. It is based on a body of evidence of original research papers and expert opinion of 18 pain experts from 7 different countries. Here we apply this classification algorithm to the LBP population.
Results: The first step implies examining the presence of neuropathic low back pain. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm.
Limitations: The classification criteria are substantiated by several original research findings including a Delphi survey, a study of a large group of LBP patients, and validation studies of the Central Sensitization Inventory. Nevertheless, these criteria require validation in clinical settings.
Conclusion: The pain classification system for LBP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focused on pain mechanisms solely.
Jo Nijs, PhD, Adri Apeldoorn, PhD, Hank Hallegraeff, PhD, Jacqui Clark, Msc, PT, Rob Smeets, MD, PhD , Anneleen Malfliet, MSc, PT, Enrique L. Girbés, MSc, PT, Margot De Kooning, MSc, and Kelly Ickmans, PhD. Low Back Pain: Guidelines for Clinical Classification of Predominant Neuropathic, Nociceptive, or Central Sensitization Pain. Pain Physician. 2015 May-Jun;18(3):E333-46. June 20th 2015