Top

Systematic Reviews

Published in:

Open Access 01-12-2022 | Back Pain | Systematic review update

Nonoperative treatment for pain sensitization in patients with low back pain: protocol for a systematic review

Authors: Tanawin Nopsopon, Areerat Suputtitada, Irin Lertparinyaphorn, Krit Pongpirul

Published in: Systematic Reviews | Issue 1/2022

Abstract

Background

Low back pain is a disability that occurs worldwide. It is a heterogeneous disorder that affects patients with dominant nociceptive, neuropathic, and central sensitization pain. An important pathophysiology of low back pain involves pain sensitization. Various nonoperative interventions are available for treatment, but there is inconclusive evidence on the effectiveness of these interventions for pain sensitization, leading to arbitrary nonoperative treatments for low back pain.

Methods

We will conduct a systematic review of RCTs evaluating the effectiveness and safety of nonoperative treatment for pain sensitization in patients with low back pain. The primary outcomes will be static quantitative sensory testing, dynamic quantitative sensory testing, and pain algometry. The secondary outcome will be adverse events. We will search the PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library databases. Two independent authors will screen the titles and abstracts, review full texts, extract data, assess the risk of bias, and evaluate the quality of evidence. We will qualitatively and quantitatively synthesize the results using a random effects model for meta-analysis.

Discussion

This systematic review aims to provide evidence regarding which treatment, if any, provides the greatest benefit for pain sensitization and safety among patients with low back pain. Evidence synthesized from this systematic review will inform clinical practice and further research. Since there is still a small amount of research, additional studies might need to be conducted in the future.

Systematic review registration

Submitted to PROSPERO on March 20, 2021, CRD42021244054

Available only for authorised users

Airaksinen O, Brox J, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion A, Reis S, Staal J, Ursin H, Zanoli G. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300. https://doi.org/10.1007/s00586-006-1072-1.

Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91. https://doi.org/10.1016/S0140-6736(11)60610-7.

Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, Bronfort G, van Tulder MW. Editorial Board of the Cochrane Back, Neck Group. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015;40(21):1660–73. https://doi.org/10.1097/BRS.0000000000001061.

Krismer M, van Tulder M. Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol. 2007;21(1):77–91. https://doi.org/10.1016/j.berh.2006.08.004.

Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90(1):139–47. https://doi.org/10.1016/j.mayocp.2014.09.010.

Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. https://doi.org/10.1016/S0140-6736(15)60692-4.

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47. https://doi.org/10.1016/S0140-6736(16)30970-9.

da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613–24. https://doi.org/10.1503/cmaj.111271.

Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009;339:b3829. https://doi.org/10.1136/bmj.b3829.

10.

Steffens D, Hancock MJ, Pereira LS, Kent PM, Latimer J, Maher CG. Do MRI findings identify patients with low back pain or sciatica who respond better to particular interventions? A systematic review. Eur Spine J. 2016;25(4):1170–87. https://doi.org/10.1007/s00586-015-4195-4.

11.

van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169–91. https://doi.org/10.1007/s00586-006-1071-2.

12.

Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain. 2008;137(3):473–477. https://doi.org/10.1016/j.pain.2008.04.025.

13.

Baranauskas G, Nistri A. Sensitization of pain pathways in the spinal cord: cellular mechanisms. Prog Neurobiol. 1998;54(3):349–65. https://doi.org/10.1016/s0301-0082(97)00067-1.

14.

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15. https://doi.org/10.1016/j.pain.2010.09.030.

15.

Hübscher M, Moloney N, Leaver A, Rebbeck T, McAuley JH, Refshauge KM. Relationship between quantitative sensory testing and pain or disability in people with spinal pain-a systematic review and meta-analysis. Pain. 2013;154(9):1497–1504. https://doi.org/10.1016/j.pain.2013.05.031.

16.

Roussel NA, Nijs J, Meeus M, Mylius V, Fayt C, Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth? Clin J Pain. 2013;29(7):625–38. https://doi.org/10.1097/AJP.0b013e31826f9a71.

17.

den Bandt HL, Paulis WD, Beckwée D, Ickmans K, Nijs J, Voogt L. Pain Mechanisms in Low Back Pain: A Systematic Review With Meta-analysis of Mechanical Quantitative Sensory Testing Outcomes in People With Nonspecific Low Back Pain. J Orthop Sports Phys Ther. 2019;49(10):698–715. https://doi.org/10.2519/jospt.2019.8876.

18.

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368–83. https://doi.org/10.1016/S0140-6736(18)30489-6.

19.

Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015(9):CD001929. https://doi.org/10.1002/14651858.CD001929.

20.

Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. https://doi.org/10.1002/14651858.CD013814.

21.

Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005:CD001351. https://doi.org/10.1002/14651858.CD001351.

22.

Wieland LS, Skoetz N, Pilkington K, Vempati R, D'Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017;1(1):CD010671. https://doi.org/10.1002/14651858.CD010671.

23.

Marin TJ, Van Eerd D, Irvin E, Couban R, Koes BW, Malmivaara A, van Tulder MW, Kamper SJ. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev. 2017;6(6):CD002193. https://doi.org/10.1002/14651858.CD002193.

24.

Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. https://doi.org/10.1136/bmj.h444.

25.

Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database Syst Rev. 2010;2010(4):CD005427. https://doi.org/10.1002/14651858.CD005427.

26.

Ebadi S, Henschke N, Forogh B, Nakhostin Ansari N, van Tulder MW, Babaei-Ghazani A, Fallah E. Therapeutic ultrasound for chronic low back pain. Cochrane Database Syst Rev. 2020;7(7):CD009169. https://doi.org/10.1002/14651858.CD009169.

27.

Maas ET, Ostelo RW, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. 2015:CD008572. https://doi.org/10.1002/14651858.CD008572.

28.

Urrútia G, Burton AK, Morral A, Bonfill X, Zanoli G. Neuroreflexotherapy for non-specific low-back pain. Cochrane Database Syst Rev. 2004:CD003009. https://doi.org/10.1002/14651858.CD003009.

29.

Király M, Bender T, Hodosi K. Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. Rheumatol Int. 2018;38(11):2045–2052. https://doi.org/10.1007/s00296-018-4134-x.

30.

Wei W, Tang HY, Li YZ, Wang TS. Effectiveness of extracorporeal shock wave for low back pain: A protocol of systematic review. Medicine (Baltimore). 2019;98(7):e14511. https://doi.org/10.1097/MD.0000000000014511.

31.

Walewicz K, Taradaj J, Rajfur K, Ptaszkowski K, Kuszewski MT, Sopel M, Dymarek R. The Effectiveness Of Radial Extracorporeal Shock Wave Therapy In Patients With Chronic Low Back Pain: A Prospective, Randomized, Single-Blinded Pilot Study. Clin Interv Aging. 2019;14:1859–69. https://doi.org/10.2147/CIA.S224001.

32.

Glazov G, Yelland M, Emery J. Low-dose laser acupuncture for non-specific chronic low back pain: a double-blind randomised controlled trial. Acupunct Med. 2014;32(2):116–23. https://doi.org/10.1136/acupmed-2013-010456.

33.

AAbdelbasset WK, Nambi G, Alsubaie SF, Abodonya AM, Saleh AK, Ataalla NN, Ibrahim AA, Tantawy SA, Kamel DM, Verma A, Moawd SA. A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain. Evid Based Complement Alternat Med. 2020;2020:1350281. https://doi.org/10.1155/2020/1350281.

34.

Abdelbasset WK, Nambi G, Elsayed SH, Alrawaili SM, Ataalla NN, Abodonya AM, Saleh AK, Moawd SA. Short-term clinical efficacy of the pulsed Nd: YAG laser therapy on chronic nonspecific low back pain: A randomized controlled study. Medicine (Baltimore). 2020;99(36):e22098. https://doi.org/10.1097/MD.0000000000022098.

35.

Røe C. Transcranial magnetic stimulation, paravertebral muscles training, and postural control in chronic low back pain. Scand J Pain. 2016;12:60–61. https://doi.org/10.1016/j.sjpain.2016.04.004.

36.

Shafiee S, Hasanzadeh Kiabi F, Shafizad M, Emami Zeydi A. Repetitive transcranial magnetic stimulation: a potential therapeutic modality for chronic low back pain. Korean J Pain. 2017;30(1):71–72. https://doi.org/10.3344/kjp.2017.30.1.71.

37.

Ng SK, Urquhart DM, Fitzgerald PB, Cicuttini FM, Hussain SM, Fitzgibbon BM. The Relationship Between Structural and Functional Brain Changes and Altered Emotion and Cognition in Chronic Low Back Pain Brain Changes: A Systematic Review of MRI and fMRI Studies. Clin J Pain. 2018;34(3):237–261. https://doi.org/10.1097/AJP.0000000000000534.

38.

Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016;2(2):CD012087. https://doi.org/10.1002/14651858.CD012087.

39.

Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2008;33(16):1766–74. https://doi.org/10.1097/BRS.0b013e31817e69d3.

40.

van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain. Cochrane Database Syst Rev. 2020;4(4):CD013581. https://doi.org/10.1002/14651858.CD013581.

41.

van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003:CD004252. https://doi.org/10.1002/14651858.CD004252.

42.

Nopsopon T, Pongpirul K, Rittiphairoj T, Lertparinyaphorn I, Suputtitada A. The therapeutic effect of intra-articular facet joint injection with normal saline as a comparator for chronic low back pain: a systematic review and meta-analysis. MedRxiv. 2021; https://doi.org/10.1101/2021.01.27.21250595.

43.

Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014:CD004504. https://doi.org/10.1002/14651858.CD004504.

44.

Wu T, Zhao WH, Dong Y, Song HX, Li JH. Effectiveness of Ultrasound-Guided Versus Fluoroscopy or Computed Tomography Scanning Guidance in Lumbar Facet Joint Injections in Adults With Facet Joint Syndrome: A Meta-Analysis of Controlled Trials. Arch Phys Med Rehabil. 2016;97(9):1558–63. https://doi.org/10.1016/j.apmr.2015.11.013.

45.

Smart KM, Blake C, Staines A, Doody C. The Discriminative validity of "nociceptive," "peripheral neuropathic," and "central sensitization" as mechanisms-based classifications of musculoskeletal pain. Clin J Pain. 2011;27(8):655–63. https://doi.org/10.1097/AJP.0b013e318215f16a.

46.

Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther. 2012;17(4):336–44. https://doi.org/10.1016/j.math.2012.03.013.

47.

Blumenstiel K, Gerhardt A, Rolke R, Bieber C, Tesarz J, Friederich HC, Eich W, Treede RD. Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia. Clin J Pain. 2011;27(8):682–90. https://doi.org/10.1097/AJP.0b013e3182177654.

48.

Arendt-Nielsen L, Morlion B, Perrot S, Dahan A, Dickenson A, Kress HG, Wells C, Bouhassira D, Drewes AM. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain. 2018;22(2):216–41. https://doi.org/10.1002/ejp.1140.

49.

Aspinall SL, Jacques A, Leboeuf-Yde C, Etherington SJ, Walker BF. Pressure pain threshold and temporal summation in adults with episodic and persistent low back pain trajectories: a secondary analysis at baseline and after lumbar manipulation or sham. Chiropr Man Therap. 2020;28(1):36. https://doi.org/10.1186/s12998-020-00326-5.

50.

Chapman KB, van Roosendaal BK, Yousef TA, Vissers KC, van Helmond N. Dorsal Root Ganglion Stimulation Normalizes Measures of Pain Processing in Patients with Chronic Low-Back Pain: A Prospective Pilot Study using Quantitative Sensory Testing. Pain Pract. 2021;21(5):568–577. https://doi.org/10.1111/papr.12992.

51.

Nim CG, Weber KA, Kawchuk GN, O'Neill S. Spinal manipulation and modulation of pain sensitivity in persistent low back pain: a secondary cluster analysis of a randomized trial. Chiropr Man Therap. 2021;29(1):10. https://doi.org/10.1186/s12998-021-00367-.

52.

Luomajoki H, Moseley GL. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. Br J Sports Med. 2011;45(5):437–40. https://doi.org/10.1136/bjsm.2009.060731.

53.

Corrêa JB, Costa LO, de Oliveira NT, Sluka KA, Liebano RE. Central sensitization and changes in conditioned pain modulation in people with chronic nonspecific low back pain: a case-control study. Exp Brain Res. 2015;233(8):2391–9. https://doi.org/10.1007/s00221-015-4309-6.

54.

Brumagne S, Cordo P, Verschueren S. Proprioceptive weighting changes in persons with low back pain and elderly persons during upright standing. Neurosci Lett. 2004;366(1):63–6. https://doi.org/10.1016/j.neulet.2004.05.013.

55.

O'Neill S, Manniche C, Graven-Nielsen T, Arendt-Nielsen L. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain. 2007;11(4):415–20. https://doi.org/10.1016/j.ejpain.2006.05.009.

56.

Marcuzzi A, Dean C, Wrigley P, Chakiath R, Hush J. Prognostic value of quantitative sensory testing in low back pain: a systematic review of the literature. J Pain Res. 2016;9:599–607.

57.

Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019:ED000142. https://doi.org/10.1002/14651858.ED000142.

58.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647. https://doi.org/10.1136/bmj.g7647.

59.

Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org. Accessed on 29 Mar 2022.

60.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https://doi.org/10.1136/bmj.l4898.

61.

Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research. Finding What Works in Health Care: Standards for Systematic Reviews. Eden J, Levit L, Berg A, Morton S, editors. Washington (DC): National Academies Press (US); 2011.

62.

Review Manager 5 (RevMan 5) [Computer program]. Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration; 2014. Available from https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman/revman-5-download. Accessed 29 Mar 2022.

63.

Schünemann H, Brożek J, Guyatt G, Oxman A. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. GRADE Working Group; 2013. Available from https://training.cochrane.org/resource/grade-handbook. Accessed 29 Mar 2022.

Title: Nonoperative treatment for pain sensitization in patients with low back pain: protocol for a systematic review
Authors: Tanawin Nopsopon
Areerat Suputtitada
Irin Lertparinyaphorn
Krit Pongpirul
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Back Pain
Back Pain
Back Pain
Published in: Systematic Reviews / Issue 1/2022
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-022-01927-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nonoperative treatment for pain sensitization in patients with low back pain: protocol for a systematic review

Abstract

Background

Methods

Discussion

Systematic review registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Systematic review registration

Please log in to get access to this content

Other articles of this Issue 1/2022

Efficacy and safety of Tripterygium wilfordii polyglycosides for diabetic kidney disease: an overview of systematic reviews and meta-analyses

Medications for preventing hypertensive disorders in high-risk pregnant women: a systematic review and network meta-analysis

Efficacy and safety of AYUSH-64 as standalone or adjunct to standard care in COVID-19: a structured summary of protocol for a systematic review

Racism in Australia: a protocol for a systematic review and meta-analysis

REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with severe mental illness (SMI)

Evaluation of efficacy and safety of intradermal delivery of vaccines through microneedle(s) in human beings: a protocol for a systematic review