Prädiktive Faktoren für die zentrale Sensibilisierung bei Patienten mit Low Back Pain

Zusammenfassung

Bei den pathophysiologischen Mechanismen der zentralen Sensitivierung ist die Sensibilität des ZNS auf einen normalen oder unterschwelligen afferenten Input gesteigert. Dieser Vorgang ist ein potenzieller Mechanismus, der einer Gruppe chronischer Krankheitsbilder unterliegt (Fibromyalgie, Kiefergelenkbeschwerden, Reizdarmsyndrom, Spannungskopfschmerz, andauernde Nacken- und Rückenschmerzen).

Aufgrund eines fehlenden Goldstandards für den diagnostischen Prozess war das Ziel dieser Literatursuche, prädiktive Faktoren für eine zentrale Sensibilisierung bei Patienten mit Rückenschmerzen zu identifizieren. Die Recherche nach relevanter Literatur fand in den Datenbanken PubMed, PEDro, CINAHL und Sport Discus statt. Zehn selektierte Arbeiten wiesen auf verschiedene Faktoren für die Bestimmung der zentralen Sensitivierung sowie drei mögliche Klassifizierungssysteme hin.

Abstract

Pathophysiological mechanisms of central sensitisation explain increased sensitivity of the central nervous system to normal or subliminal afferent input. This process is a potential mechanism underlying several chronic clinical patterns (fibromyalgia, temporomandibular joint complaints, irritable bowel syndrome, tension headache, persisting neck and back pain).

Due to the lack of a gold standard for the diagnostic process the aim of this literature search was to identify predictive factors for a central sensitisation in patients with low back pain. The review of relevant literature was performed in the databases PubMed, PEDro, CINAHL and Sport Discus. Ten selected articles indicated different factors for determination of central sensitisation as well as three possible classification systems.

Schlüsselwörter

Rückenschmerzen - zentrale Sensibilisierung - Diagnose - körperliche Untersuchung - klinische Leitlinien

Key words

low back pain - central sensitisation - diagnosis - physical examination - clinical guidelines

• Literatur

• 1 Hoy D, March L, Brooks P. et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73: 968-974
• 2 O’Sullivan P. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005; 10: 242-255 doi:10.1016/j.math.2005.07.001
• 3 Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011; 152 (Suppl. 03) S2-S15 doi:10.1016/j.pain.2010.09.030
• 4 Nijs J, Apeldoorn A, Hallegraeff H. et al. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician 2015; 18: E333-E346
• 5 Arendt-Nielsen L, Morlion B, Perrot S. et al. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22: 216-241
• 6 Sanzarello I, Merlini L, Rosa MA. et al. Central sensitization in chronic low back pain: A narrative review. J Back Musculoskelet Rehabil 2016; 29: 625-633
• 7 McCarthy CJ, Roberts C, Gittins M. et al. A Process of Subgroup Identification in Non-specific Low Back Pain Using a Standard Clinical Examination and Cluster Analysis. Physiother Res Int 2012; 17: 92-100
• 8 Smart KM, Blake C, Staines A. et al. The Discriminative validity of “nociceptive”, “peripheral neuropathic”, and “central sensitization” as mechanisms-based classifications of musculoskeletal pain. Clin J Pain 2011; 27: 655-663
• 9 Airaksinen O, Brox JI, Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 02) S192-S300
• 10 Bair E, Ohrbach R, Fillingim RB. et al. Multivariable modeling of phenotypic risk factors for first-onset TMD: the OPPERA prospective cohort study. J Pain 2013; 14 (Suppl. 12) T102-T115
• 11 International Association for the Study of Pain (IASP). IASP Terminology. 2019 www.iasp-pain.org/terminology?navItem​Number=576#Centralsensitization Stand: 09.07.2020
• 12 Crombie I. Pocket Guide to Critical Appraisal. Oxford: Blackwell; 2007
• 13 Joanna Briggs Insitute (JBI). Evidence-Based Practice Resources and Publications 2020. www.joannabriggs.org/ebp#tools Stand: 09.07.2020
• 14 Delitto A, George SZ, van Dillen L. et al. Low back pain. J Orthop Sports Phys Ther 2012; 42: A1-A57
• 15 Oliveira CB, Maher CG, Pinto RZ. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018; 27: 2791-2803
• 16 Smart KM, Blake C, Staines A. et al. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (± leg) pain. Man Ther 2012; 17: 119-215
• 17 Smart KM, Blake C, Staines A. et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17: 336-344
• 18 Winslow JJ, Jackson M, Getzin A. et al. Rehabilitation of a Young Athlete with Extension-Based Low Back Pain Addressing Motor-Control Impairments and Central Sensitization. J Athl Train 2018; 53: 168-173
• 19 Starkweather A, Julian T, Ramesh D. et al. Circulating Lipids and Acute Pain Sensitization: An Exploratory Analysis. Nurs Res 2017; 66: 454-461
• 20 Bialosky JE, George SZ, Horn ME. et al. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain 2014; 15: 136-148
• 21 Suman A, Schaafsma F, van de Ven P. et al. Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among general practitioners. BMC Health Serv Res 2018; 18: 358
• 22 Tannor AY. Lumbar Spine X-Ray as a Standard Investigation for all Low back Pain in Ghana: Is It Evidence Based?. Ghana Med J 2017; 51: 24-29
• 23 Haines T, Bowles KA. Cost-effectiveness of using a motion-sensor biofeedback treatment approach for the management of sub-acute or chronic low back pain: economic evaluation alongside a randomised trial. BMC Musculoskelet Disord 2017; 18: 18
• 24 Lindbäck Y, Tropp H, Enthoven P. et al. PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol. BMC Musculoskelet Disord 2016; 17: 270
• 25 Shin Y, Shin JS, Lee J. et al. A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: Preliminary research for clinical practice guidelines. BMC Complement Altern Med 2015; 15: 432
• 26 Froud R, Bjørkli T, Bright P. et al. The effect of journal impact factor, reporting conflicts, and reporting funding sources, on standardized effect sizes in back pain trials: a systematic review and meta-regression. BMC Musculoskelet Disord 2015; 16: 370
• 27 Jenkins HJ, Hancock MJ, French SD. et al. Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review. CMAJ 2015; 187: 401-408
• 28 Germon T, Singleton W, Hobart J. Is NICE guidance for identifying lumbar nerve root compression misguided?. Eur Spine J 2014; 23 (Suppl. 01) S20-S24
• 29 Ip IK, Gershanik EF, Schneideret LI. et al. Impact of IT-enabled intervention on MRI use for back pain. Am J Med 2014; 127: 512-518.e1
• 30 Mortimer D, French SD, McKenzie SE. et al. Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting. PLoS One 2013; 8: e75647
• 31 Graves JM, Fulton-Kehoe D, Jarvik JG. et al. Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain. Health Serv Res 2014; 49: 645-665
• 32 Kvistad KA, Espeland A. [Diagnostic imaging in neck and low back pain]. Tidsskr Nor Laegeforen 2010; 130: 2256-2259
• 33 Laerum E, Brox JI, Werner EL. [Low back pain – still a clinical challenge]. Tidsskr Nor Laegeforen 2010; 130: 2248-2251
• 34 Manchikanti L, Datta S, Derby R. et al. A critical review of the American Pain Society clinical practice guidelines for interventional techniques: Part 1. Diagnostic interventions. Pain Physician 2010; 13: E141-E174
• 35 Koes BW, van Tulder M, Lin CWC. et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19: 2075-2094
• 36 Garcia AN, da Cunha Menezes Costa L, Hancock MJ. et al. McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up. Br J Sports Med 2018; 52: 594-600
• 37 McLellan RK, Haas NS, Kownacki RP. et al. Using Electronic Health Records and Clinical Decision Support to Provide Return-to-Work Guidance for Primary Care Practitioners for Patients with Low Back Pain. J Occup Environ Med 2017; 59: e240-e244
• 38 Borgetto B, Tomlin G, Max S. et al. Evidenz in der Gesundheitsversorgung: Die Forschungspyramide. In: Haring R. Gesundheitswissenschaften. Berlin: Springer; 2018
• 39 Neziri AY, Scaramozzino P, Andersen OK. et al. Reference values of mechanical and thermal pain tests in a pain-free population. Eur J Pain 2011; 15: 376-383
• 40 Casser HR, Arnold B, Brinkschmidt T. et al. [Multidisciplinary assessment for multimodal pain therapy. Indications and range of performance]. Schmerz 2013; 27: 363-370
• 41 Mücke M, Kuhls H, Radbruch L. et al. Quantitative sensory testing (QST). English version. Schmerz; 2016.