Pain Mechanisms in Low Back Pain: A Systematic Review and Meta-analysis of Mechanical Quantitative Sensory Testing Outcomes in People With Non-Specific Low Back Pain

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Abstract

STUDY DESIGN: Systematic review and meta-analysis.

BACKGROUND: Quantitative mechanical sensory testing (QST) assesses sensory functioning and detects functional changes in (central) nociceptive processing. In the current low back pain literature it has been hypothesized that these functional changes might be apparent in people with non-specific low back pain (NSLBP), although the results are mixed.

OBJECTIVE: The aim of this systematic review/meta-analysis was to appraise and summarize the literature about QST outcomes in people with subacute and chronic NSLBP and healthy controls (HC).

METHODS: This systematic review and meta-analysis was reported using PRISMA guidelines. Five databases were searched for relevant literature. Studies comparing mechanical QST-measures involving people with subacute and chronic low back pain and HC were included if 1) pressure pain thresholds (PPTs), 2) temporal summation (TS) and/or 3) conditioned pain modulation (CPM) were reported. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale (NOS). If possible, the results from different studies were pooled.

RESULTS: Twenty-four studies were included. NOS scores varied between one and six points. Meta-analysis showed that people with NSLBP, compared to HC have significantly lower PPTs at remote sites and increased TS at the lower back. For example, PPTs measured at the scapula, were significantly lower in patients with NSLBP than in HC (pooled mean difference (MD): 119.2, 95% confidence interval (CI): (91.8, 146.6), P<0.00001.

CONCLUSION: This meta-analysis found that overall PPT measurements at remote body parts are significantly lower in the group with NSLBP compared with HC. TS and CPM measurements demonstrated mixed outcomes.

LEVEL OF EVIDENCE: Therapy, level 3a. J Orthop Sports Phys Ther, Epub 23 Aug 2019. doi:10.2519/jospt.2019.8876.

Original languageEnglish
Pages (from-to)698-715
Number of pages18
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume49
Issue number10
Early online date2019
DOIs
Publication statusPublished - 1 Oct 2019

Keywords

  • central sensitization
  • conditioned pain modulation
  • low back pain
  • pressure pain threshold
  • temporal summation

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