Central Sensitization in Chronic Low Back Pain and Comorbid Fibromyalgia

Sport injury, Man with back pain
Patients with chronic low back pain and comorbid fibromyalgia may have central sensitization and psychosocial symptoms.

Patients with chronic low back pain (CLBP) and comorbid fibromyalgia may have central sensitization and psychosocial symptoms, according to a study published in the Clinical Journal of Pain.

Participants with CLBP lasting ≥3 months and a low back pain severity score ≥3 on a 0 to 10 numeric rating pain scale were recruited from the community in Kansas City, Kansas (n=46). A total of 22 healthy control participants without CLBP were also enrolled in the study. All participants completed a demographic questionnaire, the 2011 fibromyalgia survey, a psychosocial questionnaire, and were tested for pressure pain thresholds and conditioned pain modulation.

Disability, pain catastrophizing, fear avoidance beliefs, and anxiety and depression were assessed using self-reported questionnaires. A total of 22 participants (48%) with CLBP also had fibromyalgia.

Participants with vs without fibromyalgia had lower pressure pain threshold values in the thumbnail (P =.011) and lower back (P =.003) and lower conditioned pain modulation values in the thumbnail (P =.002) as well as greater levels of pain catastrophizing, anxiety, and depression symptoms (P <.05).

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The 2011 fibromyalgia survey scores were found to correlate with  pressure pain threshold and conditioned pain modulation values of the thumbnail and with psychosocial symptoms (P <.001). The 2011 fibromyalgia survey scores also correlated with body mass index (r = 0.315; P =.033) and average pain intensity (r = 0.403; P <.01).

Study limitations include the small sample size, the recruitment of participants from a single geographic area in the United States, the cross-sectional design, and the self-reported nature of several symptom measures.

“The results suggest that [patients with CLBP] should be assessed based on their underlying causes rather than diagnosis in clinical practice,” concluded the study authors.

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Reference

Aoyagi K, He J, Nicol AL, et al. A subgroup of chronic low back pain patients with central sensitization [published online August 12, 2019]. Clin J Pain. doi:10.1097/AJP.0000000000000755