• Corpus ID: 21141933

Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain.

@article{Nijs2015LowBP,
  title={Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain.},
  author={Jo Nijs and Adri T. Apeldoorn and Hank Hallegraeff and Jacqui R Clark and Rob J.E.M. Smeets and Annaleen Malfliet and Enrique Lluh Girbes and Margot De Kooning and Kelly Ickmans},
  journal={Pain physician},
  year={2015},
  volume={18 3},
  pages={
          E333-46
        }
}

• J. Nijs, A. Apeldoorn, +6 authors K. Ickmans
• Published 2015
• Medicine, Psychology
• Pain physician

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.

STUDY DESIGN
Narrative review and expert opinion

SETTING
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.

LIMITATIONS
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.

CONCLUSION
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.