Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain

Keith M Smart, Catherine Blake, Anthony Staines, Michael Thacker, Catherine Doody

Research output: Contribution to journalArticlepeer-review

60 Citations (Scopus)

Abstract

As a mechanisms-based classification of pain 'peripheral neuropathic pain' (PNP) refers to pain arising from a primary lesion or dysfunction in the peripheral nervous system. Symptoms and signs associated with an assumed dominance of PNP in patients attending for physiotherapy have not been extensively studied. The purpose of this study was to identify symptoms and signs associated with a clinical classification of PNP in patients with low back (± leg) pain. Using a cross-sectional, between-subjects design; four hundred and sixty-four patients with low back (± leg) pain were assessed using a standardised assessment protocol. Patients' pain was assigned a mechanisms-based classification based on experienced clinical judgement. Clinicians then completed a clinical criteria checklist specifying the presence or absence of various clinical criteria. A binary logistic regression analysis with Bayesian model averaging identified a cluster of two symptoms and one sign predictive of PNP, including: 'Pain referred in a dermatomal or cutaneous distribution', 'History of nerve injury, pathology or mechanical compromise' and 'Pain/symptom provocation with mechanical/movement tests (e.g. Active/Passive, Neurodynamic) that move/load/compress neural tissue'. This cluster was found to have high levels of classification accuracy (sensitivity 86.3%, 95% CI: 78.0-92.3; specificity 96.0%, 95% CI: 93.4-97.8; diagnostic odds ratio 150.9, 95% CI: 69.4-328.1). Pattern recognition of this empirically-derived cluster of symptoms and signs may help clinicians identify an assumed dominance of PNP mechanisms in patients with low back pain disorders in a way that might usefully inform subsequent patient management.
Original languageEnglish
Pages (from-to)345-51
Number of pages7
JournalManual Therapy
Volume17
Issue number4
DOIs
Publication statusPublished - Aug 2012

Keywords

  • Severity of Illness Index
  • Sensitivity and Specificity
  • Young Adult
  • Analysis of Variance
  • Humans
  • Bayes Theorem
  • Ireland
  • Nociceptive Pain
  • Aged
  • Low Back Pain
  • Cross-Sectional Studies
  • Aged, 80 and over
  • Peripheral Nervous System Diseases
  • Adult
  • Musculoskeletal Pain
  • Middle Aged
  • Cluster Analysis
  • Female
  • Male

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