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REHABILITATION MEDICINE CENTER FOR REHABILITATION
REHABILITATION MEDICINE CENTER FOR REHABILITATION
ICF
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Pain management challenge
• No gold-standard, goals: ─ Acute pain remission
─ Chronic pain control and maintain functioning
• 40% of chronic pain sufferers report inadequate pain control
• CLBP: main cause for DALYs = most disabling condition
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Widespread and persistent pain
‘All-in the head’ OR undergo expensive and invasive assessment procedures
VS. Common underlying mechanism?
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• Normal Sensation
•
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Central Sensitization
“Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.” (IASP)
https://www.youtube.com/watch?v=8defN4iIbho&feature=youtu.be
REHABILITATION MEDICINE
CENTER FOR REHABILITATION
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Are Central Sensitization and Functioning related in patients with
Chronic Low Back Pain?
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CS - CSI
• Severity levels :
─ Subclinical = 0 to 29
─ Mild = 30 to 39
─ Moderate = 40 to 49
─ Severe = 50 to 59
─ Extreme = 60 to 100
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CS - QST
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DNIC - Diffuse noxious inhibitory control
Functioning
• Floor-to-Waist Lift:
Weight lifted (kg)
• Maximal Aerobic Capacity:
Peak VO2 (ml/min/kg)
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CLBP patients (n=33)
Mean (SD)
Age (yrs) 42.1 (12.5)
Sex: Men 14 (42.4%)
Painful Area:
Low back 16 (48.5%)
Overall back and/or Multiple locations 17 (51.5%)
Symptom days 1637.3 (2078.1)
Medication use 22 (66.7%)
Work status: Working 10 (30.3%)
Lift (kg) 16.1 (10.4)
Peak VO2 (ml/min/kg) 24.6 (8.3)
CSI part A (0-100) 40.7 (13.9)
Pain disability – PDI (0-70) 35.5 (13.8)
Pain intensity –VAS (0-10) 4.7 (2.4)
Work ability – WAS (0-10) 4.4 (2.3)
Physical functioning - Rand36-PF (0-100) 47.6 (20.0)
Injustice – IEQ (0-48) 15.4 (9.6)
Catastrophyzing – PCS (0-52) 17.6 (11.7)
Psychological Symptoms – BSI (0-4) 21.3 (15.1)
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Are Central Sensitization and Functioning related in patients with
Chronic Low Back Pain?
Unstandardized
Coefficient P
Lift (kg)
𝑅2: 59.1%
CSI part A -0,204 0,161
CSI part A -0,173 0,099
Clinician-observed exertion (CR-10) 1,655 0,020
Physical functioning - Rand-PF 0,202 0,011
Sex: Man -7,569 0,011
Peak VO2 (ml/min/kg)
𝑅2: 53.8%
CSI part A 0,004 0,971
CSI part A -0,061 0,506
Age (yrs) -0,443 0,000
Sex: Man -5,197 0,031
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How does pain respond when an exerting activity is performed?
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PRQ 1 PRQ 2 PRQ 3
Heavy or unusual physical activities done in the past 24h 7 (21.2%) 6 (18.2%) 5 (15.2%)
Body reactions that have not been experienced before 3 (9.1%) 4 (12.1%)
Use of pain-killers 7 (21.2%)
Insights gained
No sig. association ≠ No CS effect
• CS and functioning no sig. association ─ Small association: ⬆ CSI score ⬇ Lift capacity
⬆ CSI score ⬇ Max. aerobic capacity
• Pain response: ⬇ physical pain increase in legs, but not in lower back DNIC involvement?
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