Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case–control study

• Published in: Experimental brain research Vol. 233; no. 8; pp. 2391 - 2399
• Main Authors: Corrêa, Juliana Barbosa, Costa, Leonardo Oliveira Pena, de Oliveira, Naiane Teixeira Bastos, Sluka, Kathleen A., Liebano, Richard Eloin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2015; Springer; Springer Nature B.V
• Subjects: Adult; Back pain; Biomedical and Life Sciences; Biomedicine; Care and treatment; Case-Control Studies; Central Nervous System Sensitization - physiology; Chairs; Chronic Pain; Female; Health care; Humans; Hyperalgesia; Hyperalgesia - physiopathology; Low back pain; Low Back Pain - physiopathology; Male; Middle Aged; Nervous system; Neurology; Neurosciences; Pain Perception - physiology; Pain Threshold - physiology; Physical therapy; Public health; Research Article; Sex Factors; Women; Brazil; Diffuse noxious inhibitory controls; Low back pain; Pain inhibition; Central nervous system sensitization; Hyperalgesia
• ISSN: 0014-4819; 1432-1106
• DOI: 10.1007/s00221-015-4309-6

Quantitative sensory testing is widely used in human research to investigate the state of the peripheral and central nervous system contributions in pain processing. It is a valuable tool to help identify central sensitization and may be important in the treatment of low back pain. The aim of this study was to evaluate changes in local and segmental hypersensitivity and endogenous pain inhibition in people with chronic nonspecific low back pain. Thirty patients with chronic low back pain and thirty healthy subjects were studied. Pressure pain thresholds (PPTs) were measured from the lumbar region and over the tibialis anterior muscle (TA). A cold pressor test was used to assess the activation of conditioned pain modulation (CPM), and PPTs in the lumbar region were recorded 30 s after immersion of participant’s foot in a bucket with cold water. People with chronic low back pain have significantly lower PPT than controls at both the lumbar region [89.5 kPa (mean difference) 95 % CI 40.9–131.1 kPa] and TA [59.45 kPa (mean difference) 95 % CI 13.49–105.42 kPa]. During CPM, people with chronic low back pain have significantly lower PPT than controls in lumbar region [118.6 kPa (mean difference) 95 % CI 77.9–159.2 kPa]. Women had significantly lower PPTs than men in both lumbar region [101.7 kPa (mean difference) 95 % CI 37.9–165.7 kPa] and over the TA [189.7 kPa (mean difference) 95 % CI 14.2–145.2 kPa]. There was no significant difference in PPTs in men between healthy controls and those with low back pain, suggesting the significant differences are mediated primarily by difference between women.