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An observational study of centrally facilitated pain in individuals with chronic low back pain

Georgopoulos, Vasileios; Akin-Akinyosoye, Kehinde; Smith, Stephanie; McWilliams, Daniel F.; Hendrick, Paul; Walsh, David A.

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Authors

Kehinde Akin-Akinyosoye

Paul Hendrick

DAVID WALSH david.walsh@nottingham.ac.uk
Professor of Rheumatology



Abstract

Central pain facilitation can hinder recovery in people with chronic low back pain (CLBP). The aim of this observational study was to investigate whether indices of centrally facilitated pain are associated with pain outcomes in a hospital-based cohort of individuals with CLBP undertaking a pain management programme. Participants provided self-report and pain sensitivity data at baseline (n=97), and again 3-months (n=87) after a cognitive behavioural therapy-based group intervention including physiotherapy. Indices of centrally facilitated pain were; Pressure Pain detection Threshold (PPT), Temporal Summation (TS) and Conditioned Pain Modulation (CPM) at the forearm, Widespread Pain Index (WPI) classified using a body manikin, and a Central Mechanisms Trait (CMT) factor derived from 8 self-reported characteristics of anxiety, depression, neuropathic pain, fatigue, cognitive dysfunction, pain distribution, catastrophizing and sleep. Pain severity was a composite factor derived from Numerical Rating Scales. Cross-sectional and longitudinal regression models were adjusted for age and sex. Baseline CMT and WPI each was associated with higher pain severity (CMT: r=0.50, p<0.001, WPI: r=0.21, p=0.04) at baseline as well as at 3 months (CMT: r=0.38, p<0.001, WPI: r=0.24, p=0.02). High baseline CMT remained significantly associated with pain at 3 months after additional adjustment for baseline pain (β=2.45, p=0.04, R2=0.25, p<0.0001). QST indices of pain hypersensitivity were not significantly associated with pain outcomes at baseline or at 3 months. In conclusion, central mechanisms beyond those captured by QST are associated with poor CLBP outcome and might be targets for improved therapy.

Journal Article Type Article
Acceptance Date Mar 5, 2022
Online Publication Date May 1, 2022
Publication Date May 1, 2022
Deposit Date Mar 14, 2022
Publicly Available Date May 1, 2022
Journal PAIN Reports
Electronic ISSN 2471-2531
Peer Reviewed Peer Reviewed
Volume 7
Issue 3
Article Number e1003
DOI https://doi.org/10.1097/PR9.0000000000001003
Keywords Anesthesiology and Pain Medicine
Public URL https://nottingham-repository.worktribe.com/output/7602056
Publisher URL https://journals.lww.com/painrpts/Fulltext/2022/06000/An_observational_study_of_centrally_facilitated.5.aspx

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