title: Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems.
abstract: Classifying patients with chronic low back pain (CLBP) may facilitate targeted treatment, and optimise outcomes. Most classification systems (CS) do not consider multiple, interacting dimensions (for example, psychological or movement dimensions) involved in the lived experience of people with CLBP. A framework incorporating these multiple dimensions, and acknowledging individual variability, could provide a pathway to better assess and treat people with CLBP. Here we explored this proposition, presenting four cases (P1-4), profiling their clinical presentations within a multidimensional framework. P1's profile was characterised by localised lumbar sensitisation consistent with dominant peripheral nociception. P2 presented a 'mixed' profile characterised by localised lumbar hypersensitivity, combined with factors suggestive of centrally-mediated facilitation of nociception. P3's profile suggested widespread hypersensitivity possibly reflective of dominant centrally-mediated pain mechanisms. P4's profile was characterised by dominant psychosocial factors and comorbidities. These cases are discussed in relation to contemporary CLBP CS, highlighting the complexity of these disorders and limitations of CS for people with CLBP and their treating health professionals. This paper reinforces the need for a consensus CS for people with CLBP that is flexible, has clinical utility and considers all relevant dimensions.
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, Australia. Electronic address: martin.rabey@curtin.edu.au.
authors.forename: Martin
authors.initials: M
authors.lastname: Rabey
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, Australia.
authors.forename: Darren
authors.initials: D
authors.lastname: Beales
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Slater
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Sullivan
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000145:classification*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold
keywords: Back pain; Biopsychosocial; Classification