title: Ranking of parameters of pain hypersensitivity according to their discriminative ability in chronic low back pain.
abstract: Low back pain is associated with plasticity changes and central hypersensitivity in a subset of patients. We performed a case-control study to explore the discriminative ability of different quantitative sensory tests in distinguishing between 40 cases with chronic low back pain and 300 pain-free controls, and to rank these tests according to the extent of their association with chronic pain. Gender, age, height, weight, body mass index, and psychological measures were recorded as potential confounders. We used 26 quantitative sensory tests, including different modalities of pressure, heat, cold, and electrical stimulation. As measures of discrimination, we estimated receiver operating characteristics (ROC) and likelihood ratios. Six tests seemed useful (in order of their discriminative ability): (1) pressure pain detection threshold at the site of most severe pain (fitted area under the ROC, 0.87), (2) single electrical stimulation pain detection threshold (0.87), (3) single electrical stimulation reflex threshold (0.83), (4) pressure pain tolerance threshold at the site of most severe pain (0.81), (5) pressure pain detection threshold at suprascapular region (0.80), and (6) temporal summation pain threshold (0.80). Pressure and electrical pain modalities seemed most promising and may be used for diagnosis of pain hypersensitivity and potentially for identifying individuals at risk of developing chronic low back pain over time.
authors: University Department of Anaesthesiology and Pain Therapy, Bern University Hospital, Inselspital, Bern, Switzerland Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland CTU Bern, Bern University Hospital, Inselspital, Bern, Switzerland Pain Unit, Clinic Wilhelm Schulthess, Zurich, Switzerland Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Denmark.
authors: Alban Y
authors: AY
authors: Neziri
authors: Michele
authors: M
authors: Curatolo
authors: Andreas
authors: A
authors: Limacher
authors: Eveline
authors: E
authors: Nüesch
authors: Bogdan
authors: B
authors: Radanov
authors: Ole K
authors: OK
authors: Andersen
authors: Lars
authors: L
authors: Arendt-Nielsen
authors: Peter
authors: P
authors: Jüni
mesh_terms: D001416:Back Pain / Q000175:diagnosis* / Q000503:physiopathology*; D059350:Chronic Pain / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index