Classification based on Pain!

Reference:Smart KM, et al Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (�leg) pain. Man Ther. 2012 Apr;17(2):119-25.

Some authors have proposed three basic classifications of spinal pain based on the neurophysiological mechanisms responsible for its production and maintenance.

i) Nociceptive pain (NP)

ii) Peripheral neuropathic pain (PNP)

iii) Central sensitization pain (CSP)

NP is basically pain arising from mechanical or chemical irritation of somatic structures such as muscles, ligaments, joints, discs etc. E.g. localized back pain a day after snow shovelling

PNP is pain arising from peripheral neural tissue mechanosensitivity
E.g. S1 nerve root pain, paraesthesia on the little toe and a positive SLR test

CSP is pain due to abnormal processing of the cerebral cortex and the spinal cord. The pain is non-anatomical and disproportionate to possible pathologies of the tissues or the peripheral nerve.

Although quite complex, CSP has been shown to be due to changes in cortical processing and the loss of spinal inhibitory inter-neurons.

This clinical research paper demonstrated that patients classified as CSP had significantly more severe pain, higher levels of anxiety, higher levels of depression and greater disability …which are all poor prognostic factors to low back pain.

What’s the clinical relevance? Patients with spinal pain classified as NP or PNP may be treated with pain relieving modalities, manual therapy, and specific exercise prescription focusing on the centralization phenomenon and pain reduction.

On the other hand, patients with spinal pain classified as CSP should not be managed with focus on pain relief …as it is bound to failure, but focus must be on progressive graded imagery, independent exercise program, functional goal setting, pain education, visualization, relaxation, mirror therapy and CNS desensitization techniques.

Posted on: July 05, 2012


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