title: Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain.
abstract: BACKGROUND
  Low back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP patients should be classified clinically as either predominantly nociceptive, neuropathic, or central sensitization pain.
  
  
  OBJECTIVE
  To explain how clinicians can differentiate between nociceptive, neuropathic, and central sensitization pain in patients with LBP.
  
  
  METHODS
  Narrative review and expert opinion
  
  
  METHODS
  Universities, university hospitals and private practices
  
  
  METHODS
  Recently, a clinical method for the classification of central sensitization pain versus neuropathic and nociceptive pain was developed. It is based on a body of evidence of original research papers and expert opinion of 18 pain experts from 7 different countries. Here we apply this classification algorithm to the LBP population.
  
  
  RESULTS
  The first step implies examining the presence of neuropathic low back pain. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm.
  
  
  CONCLUSIONS
  The classification criteria are substantiated by several original research findings including a Delphi survey, a study of a large group of LBP patients, and validation studies of the Central Sensitization Inventory. Nevertheless, these criteria require validation in clinical settings.
  
  
  CONCLUSIONS
  The pain classification system for LBP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focussed on pain mechanisms solely.
authors.affiliation: Pain in Motion Research Group; Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
authors.forename: Jo
authors.initials: J
authors.lastname: Nijs
authors.forename: Adri
authors.initials: A
authors.lastname: Apeldoorn
authors.forename: Hank
authors.initials: H
authors.lastname: Hallegraeff
authors.forename: Jacqui
authors.initials: J
authors.lastname: Clark
authors.forename: Rob
authors.initials: R
authors.lastname: Smeets
authors.forename: Annaleen
authors.initials: A
authors.lastname: Malfliet
authors.forename: Enrique L
authors.initials: EL
authors.lastname: Girbes
authors.forename: Margot
authors.initials: M
authors.lastname: De Kooning
authors.forename: Kelly
authors.initials: K
authors.lastname: Ickmans
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D009437:Neuralgia / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D059226:Nociceptive Pain / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D010147:Pain Measurement / Q000145:classification* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011795:Surveys and Questionnaires / Q000592:standards