Characterisation of low back pain

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Chronic low back pain (CLBP) causes ongoing pain, disability and
psychological suffering, at a huge personal and socio-economic cost. CLBP
is a heterogeneous condition and its mechanisms are poorly understood.
Characterisation and classification of low back pain (LBP) is controversial,
there is disagreement on the characterisation and diagnosis of neuropathic
low back pain (NuLBP) in relation to mechanical LBP (MLBP). Diagnostic
uncertainty is coupled with poor clinical outcomes for treatment. There is
therefore an urgent need to develop more effective assessment strategies to
identify and better differentiate NuLBP from MLBP in order to facilitate a
better understanding of underlying mechanisms and more successful
treatments.
The primary aim of this study was to establish clinical profiles of CLBP, in
particular, differences between MLBP and NuLBP using Questionnairebased
behavioural evaluation and sensory testing, structural neuroimaging
(voxel based morphometry) and functional neuroimaging (arterial spin
labelling). Significant differences were identified between CLBP patients and
healthy controls and between NuLBP and MLBP patients in multiple
behavioural domains measuring pain, function and psychological well-being.
Significant differences were demonstrated in CLBP patients compared to
controls in both tactile threshold discrimination and two-point discrimination
and between NuLBP and MLBP in tactile threshold discrimination. Functional
and structural neuroimaging showed significant differences between all
groups in widespread brain regions involved in the evaluation of decision
making and planning, mood and emotion, modulation of pain and
representation of body schema.
This study has demonstrated the ability to characterise CLBP using a battery
of behavioural, examination and functional and structural neuroimaging
methodologies and has been able to differentiate between CLBP patients
and controls and importantly, between NuLBP and MLBP patients. This work
demonstrates the impact of CLBP across sensory-discriminative, affectivemotivational and cognitive-evaluative dimensions of the pain experience and shows the increased impact and burden on those who suffer with NuLBP
compared to MLBP.
Date of Award2014
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMatthew Howard (Supervisor) & Michael Thacker (Supervisor)

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