Low Back Pain: Guidelines for the Clinical Classification

Low back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP patients should be classified clinically as either predominantly nociceptive, neuropathic, or central sensitization pain.

Despite extensive global research efforts, chronic pain remains a challenging issue for clinicians and a huge socio-economic problem. Within the chronic pain population, low back pain (LBP) is one of the most prevalent musculoskeletal disorders, affecting 70% – 85% of the adult population at some point in life. Twelve months after the onset of LBP, 45% – 75% of patients still experience pain, accounting for major expenses in health care and disability systems.

Chronic lumbar radicular pain is the most common neuropathic pain syndrome which affects 20% to 35% of patients with LBP. People with neuropathic LBP often experience higher levels of pain, disability, anxiety, depression, and reduced quality of life as compared to nociceptive LBP. Following identification of red flags, excluding the possibility of neuropathic LBP is often the first step in clinical practice. Guidelines have been published for the classification of neuropathic pain. The criteria specify that a lesion or disease of the nervous system (either central or peripheral) is identifiable and that pain is limited to a “neuroanatomically plausible” distribution. The neuropathic pain criteria preclude the use of the term “neuropathic pain” for people with diffuse or widespread pain and nervous system sensitization (i.e., CS pain), as the latter is free of a history of a lesion or disease of the nervous system and is typically characterized by a pain distribution that is not neuroanatomically plausible. The pain classification system for LBP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focussed on pain mechanisms solely.

Read the full white paper here: http://www.painphysicianjournal.com/2015/may/2015;18;E333-E346.pdf

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