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Chiropractic Research Review

The Role of Pain Sensitivity in Fibromyalgia and Chronic Low Back Pain

Chronic low back pain (CLBP) is the most common disorder associated with disability in industrialized countries, amounting to as much as 50 billion dollars in direct and indirect costs per year in the U.S.

alone. The failure of existing models to adequately predict outcomes in patients with CLBP suggests that other factors may require consideration.

Previous research has demonstrated that individuals with low pain thresholds experience chronic widespread or regional pain, even in the absence of structural abnormalities. Chronic global body pain not accompanied by structural abnormalities (termed "fibromyalgia") has been documented in 10% of the population.

The authors of this study suggest that experimental pain sensitivity (tenderness) is an important consideration when assessing the clinical status of patients with CLBP. To that end, 45 patients with CLBP were assessed for a variety of demographic, structural and psychosocial factors known to contribute to clinical status, including testing for pain tolerance and threshold. Patient sensitivity was assessed by use of a dolorimeter (algometer) at the 18 areas of the body designated in fibromyalgia as tender points, and at four control locations (areas deemed non-tender in previous studies).

Results: An average of 5.2 tender points were noted in CLBP patients, a greater number than the average found in the general population. Clinical pain and reported physical function were significantly associated with tenderness. This association was maintained even after controlling for demographic, structural and psychosocial variables. The authors also found that "patients with diminished ability to function and greater clinical pain tended to have a lower pain threshold at control points and were thus more globally tender."

The authors caution that their findings do not establish a pattern of causality, i.e., whether increased tenderness causes pain and decreased physical functioning, or whether chronic pain and decreased functioning contribute to increased tenderness. However, they note that the results support the hypothesis that tenderness accounts for a unique proportion of variance in clinical status outcome measures. These findings emphasize the value of considering tenderness in the assessment of chronic low back pain.

Clauw DJ, Williams D, Lauerman W, et al. Pain sensitivity as a correlate of clinical status in individuals with chronic low back pain. Spine, Oct. 1, 1999:24(19), pp2035-41.

Chiropractic Research Review

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