Indication for spinal sensitization in chronic low back pain: mechanical hyperalgesia adjacent to but not within the most painful body area

Laura Sirucek; Iara De Schoenmacker; Paulina Simonne Scheuren; Robin Lütolf; Lindsay Mary Gorrell; Anke Langenfeld; Mirjam Baechler; Jan Rosner; Brigitte Wirth; Michèle Hubli; Petra Schweinhardt

doi:10.1097/PR9.0000000000001166

Indication for spinal sensitization in chronic low back pain: mechanical hyperalgesia adjacent to but not within the most painful body area

Pain Rep. 2024 Jun 17;9(4):e1166. doi: 10.1097/PR9.0000000000001166. eCollection 2024 Aug.

Authors

Laura Sirucek^{1

2}, Iara De Schoenmacker^{2

3

4}, Paulina Simonne Scheuren^{2

3

5}, Robin Lütolf³, Lindsay Mary Gorrell¹, Anke Langenfeld¹, Mirjam Baechler¹, Jan Rosner^{3

6

7}, Brigitte Wirth¹, Michèle Hubli^{2

3}, Petra Schweinhardt^{1

2}

Affiliations

¹ Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
² Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
³ Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
⁴ Biomedical Data Science Lab, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.
⁵ International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
⁶ Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
⁷ Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Abstract

Introduction: In 85% of patients with chronic low back pain (CLBP), no specific pathoanatomical cause can be identified. Besides primary peripheral drivers within the lower back, spinal or supraspinal sensitization processes might contribute to the patients' pain.

Objectives: The present study conceptualized the most painful area (MP) of patients with nonspecific CLBP as primarily affected area and assessed signs of peripheral, spinal, and supraspinal sensitization using quantitative sensory testing (QST) in MP, a pain-free area adjacent to MP (AD), and a remote, pain-free control area (CON).

Methods: Fifty-nine patients with CLBP (51 years, SD = 16.6, 22 female patients) and 35 pain-free control participants individually matched for age, sex, and testing areas (49 years, SD = 17.5, 19 female participants) underwent a full QST protocol in MP and a reduced QST protocol assessing sensory gain in AD and CON. Quantitative sensory testing measures, except paradoxical heat sensations and dynamic mechanical allodynia (DMA), were Z-transformed to the matched control participants and tested for significance using Z-tests (α = 0.001). Paradoxical heat sensations and DMA occurrence were compared between cohorts using Fisher's exact tests (α = 0.05). The same analyses were performed with a high-pain and a low-pain CLBP subsample (50% quantile).

Results: Patients showed cold and vibration hypoesthesia in MP (all Ps < 0.001) and mechanical hyperalgesia (P < 0.001) and more frequent DMA (P = 0.044) in AD. The results were mainly driven by the high-pain CLBP subsample. In CON, no sensory alterations were observed.

Conclusion: Mechanical hyperalgesia and DMA adjacent to but not within MP, the supposedly primarily affected area, might reflect secondary hyperalgesia originating from spinal sensitization in patients with CLBP.

Keywords: Central sensitization; Chronic pain; Quantitative sensory testing; Secondary hyperalgesia.