Evidence of augmented central pain processing in idiopathic chronic low back pain

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Giesecke, T. (author)

Evidence of augmented central pain processing in idiopathic chronic low back pain

Article/chapterEnglish2004

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2004
Wiley,2004

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LIBRIS-ID:oai:gup.ub.gu.se/52752
https://gup.ub.gu.se/publication/52752URI
https://doi.org/10.1002/art.20063DOI

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Language:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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OBJECTIVE: For many individuals with chronic low back pain (CLBP), there is no identifiable cause. In other idiopathic chronic pain conditions, sensory testing and functional magnetic resonance imaging (fMRI) have identified the occurrence of generalized increased pain sensitivity, hyperalgesia, and altered brain processing, suggesting central augmentation of pain processing in such conditions. We compared the results of both of these methods as applied to patients with idiopathic CLBP (n = 11), patients with widespread pain (fibromyalgia; n = 16), and healthy control subjects (n = 11). METHODS: Patients with CLBP had low back pain persisting for at least 12 months that was unexplained by MRI/radiographic changes. Experimental pain testing was performed at a neutral site (thumbnail) to assess the pressure-pain threshold in all subjects. For fMRI studies, stimuli of equal pressure (2 kg) and of equal subjective pain intensity (slightly intense pain) were applied to this same site. RESULTS: Despite low numbers of tender points in the CLBP group, experimental pain testing revealed hyperalgesia in this group as well as in the fibromyalgia group; the pressure required to produce slightly intense pain was significantly higher in the controls (5.6 kg) than in the patients with CLBP (3.9 kg) (P = 0.03) or the patients with fibromyalgia (3.5 kg) (P = 0.006). When equal amounts of pressure were applied to the 3 groups, fMRI detected 5 common regions of neuronal activation in pain-related cortical areas in the CLBP and fibromyalgia groups (in the contralateral primary and secondary [S2] somatosensory cortices, inferior parietal lobule, cerebellum, and ipsilateral S2). This same stimulus resulted in only a single activation in controls (in the contralateral S2 somatosensory cortex). When subjects in the 3 groups received stimuli that evoked subjectively equal pain, fMRI revealed common neuronal activations in all 3 groups. CONCLUSION: At equal levels of pressure, patients with CLBP or fibromyalgia experienced significantly more pain and showed more extensive, common patterns of neuronal activation in pain-related cortical areas. When stimuli that elicited equally painful responses were applied (requiring significantly lower pressure in both patient groups as compared with the control group), neuronal activations were similar among the 3 groups. These findings are consistent with the occurrence of augmented central pain processing in patients with idiopathic CLBP.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
Adult
Anatomy
Cross-Sectional
Brain/anatomy & histology/*physiopathology
Chronic Disease
Cross-Sectional Studies
Female
Fibromyalgia/physiopathology/psychology
Humans
Hyperalgesia/*physiopathology/psychology
Low Back Pain/*physiopathology/psychology
Magnetic Resonance Imaging
Male
Middle Aged
Pain Measurement
Pain Threshold/physiology
Pressure
Questionnaires

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Gracely, R. H. (author)
Grant, M. A. (author)
Nachemson, Alf,1931Gothenburg University,Göteborgs universitet,Institutionen för de kirurgiska disciplinerna, Avdelningen för ortopedi,Institute of Surgical Sciences, Department of Orthopaedics(Swepub:gu)xnaalf (author)
Petzke, F. (author)
Williams, D. A. (author)
Clauw, D. J. (author)
Göteborgs universitetInstitutionen för de kirurgiska disciplinerna, Avdelningen för ortopedi (creator_code:org_t)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

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