title: Subgroups of musculoskeletal pain patients and their psychobiological patterns - the LOGIN study protocol.
abstract: BACKGROUND
  Pain conditions of the musculoskeletal system are very common and have tremendous socioeconomic impact. Despite its high prevalence, musculoskeletal pain remains poorly understood and predominantly non-specifically and insufficiently treated.The group of chronic musculoskeletal pain patients is supposed to be heterogeneous, due to a multitude of mechanisms involved in chronic pain. Psychological variables, psychophysiological processes, and neuroendocrine alterations are expected to be involved. Thus far, studies on musculoskeletal pain have predominantly focused on the general aspects of pain processing, thus neglecting the heterogeneity of patients with musculoskeletal pain. Consequently, there is a need for studies that comprise a multitude of mechanisms that are potentially involved in the chronicity and spread of pain. This need might foster research and facilitate a better pathophysiological understanding of the condition, thereby promoting the development of specific mechanism-based treatments for chronic pain. Therefore, the objectives of this study are as follows: 1) identify and describe subgroups of patients with musculoskeletal pain with regard to clinical manifestations (including mental co-morbidity) and 2) investigate whether distinct sensory profiles or 3) distinct plasma levels of pain-related parameters due to different underlying mechanisms can be distinguished in various subgroups of pain patients.
  
  
  METHODS
  We will examine a population-based chronic pain sample (n = 100), a clinical tertiary care sample (n = 100) and pain-free patients with depression or post-traumatic stress disorder and pain-free healthy controls (each n = 30, respectively). The samples will be pain localisation matched by sex and age to the population-based sample. Patients will undergo physical examination and thorough assessments of mental co-morbidity (including psychological trauma), perceptual and central sensitisation (quantitative sensory testing), descending inhibition (conditioned pain modulation, the diffuse noxious inhibitory control-like effect), as well as measurement of the plasma levels of nerve growth factor and endocannabinoids.
  
  
  CONCLUSIONS
  The identification of the underlying pathophysiologic mechanisms in different subgroups of chronic musculoskeletal pain patients will contribute to a mechanism-based subgroup classification. This will foster the development of mechanism-based treatments and holds promise to treat patients more sufficient.
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany. andreas.gerhardt@med.uni-heidelberg.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerhardt
authors.forename: Mechthild
authors.initials: M
authors.lastname: Hartmann
authors.forename: Jonas
authors.initials: J
authors.lastname: Tesarz
authors.forename: Susanne
authors.initials: S
authors.lastname: Janke
authors.forename: Sabine
authors.initials: S
authors.lastname: Leisner
authors.forename: Günter
authors.initials: G
authors.lastname: Seidler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eich
mesh_terms: D002908:Chronic Disease; D002985:Clinical Protocols; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D063388:Endocannabinoids / Q000097:blood; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D020932:Nerve Growth Factor / Q000097:blood; D010147:Pain Measurement; D017288:Pain Threshold; D012107:Research Design; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D063128:Tertiary Health Care
chemical_list: D063388:Endocannabinoids; D020932:Nerve Growth Factor