Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2012

Open Access 01-12-2012 | Research article

Enhanced sensitivity to punctate painful stimuli in female patients with chronic low back pain

Authors: Christian Puta, Birgit Schulz, Saskia Schoeler, Walter Magerl, Brunhild Gabriel, Holger H W Gabriel, Wolfgang H R Miltner, Thomas Weiss

Published in: BMC Neurology | Issue 1/2012

Login to get access

Abstract

Background

Chronic low back pain (CLBP) has been shown to be associated with various pathophysiological changes at several level of the sensorimotor system, pointing to a general hypersensitivity in CLBP patients. The aim of the present study was to investigate signs of generalized mechanical pain hypersensitivity in CLBP patients on the hand and on the painful site of the back.

Methods

Pinprick stimulation according to a validated standardized quantitative sensory testing protocol was used in 14 female CLBP patients and 14 healthy controls (HC) matched for sex and age. Stimulus response functions to pinprick stimulation on the skin were examined at the affected back and reference sites (hand palmar and hand dorsum). Data from CLBP patients were compared with HC and with reference data from the German Research Network on Neuropathic Pain.

Results

We found significant differences in the stimulus response functions between CLBP patients and HC. Pain ratings to the pinpricks were increased for low and moderate pinprick stimuli in CLBP patients. Importantly, this kind of specific pinprick hyperalgesia was found not only for the affected body site (back), but also for the remote reference sites (hand dorsum and hand palmar).

Conclusions

We interpret our results as pointing to changes in the nociceptive processing in CLBP at higher levels of the neuraxis, possibly thalamus and/or attentional control, rather than changes of spinal processing. Alternatively, there might be a higher vulnerability to noxious stimulation in CLBP patients.
Appendix
Available only for authorised users
Literature
1.
Balagué F, Mannion AF, Pellisé F, Cedraschi C: Clinical update: low back pain. Lancet. 2007, 369 (9563): 726-728. 10.1016/S0140-6736(07)60340-7.CrossRefPubMed
2.
Carragee EJ: Clinical practice. Persistent low back pain. NEJM. 2005, 352 (18): 1891-1898. 10.1056/NEJMcp042054.CrossRefPubMed
3.
4.
Wand BM, Parkitny L, O’Connell NE, Luomajoki H, McAuley JH, Thacker M, Moseley GL: Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manual Ther. 2011, 16 (1): 15-20. 10.1016/j.math.2010.06.008.CrossRef
5.
Tagliazucchi E, Balenzuela P, Fraiman D, Chialvo DR: Brain resting state is disrupted in chronic back pain patients. Neurosci Lett. 2010, 485 (1): 26-31. 10.1016/j.neulet.2010.08.053.CrossRefPubMedPubMedCentral
6.
Flor H, Braun C, Elbert T, Birbaumer N: Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett. 1997, 224 (1): 5-8. 10.1016/S0304-3940(97)13441-3.CrossRefPubMed
7.
Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ: Corticospinal excitability in patients with chronic low back pain. J Spinal Disord Tech. 2005, 18 (5): 420-424. 10.1097/01.bsd.0000169063.84628.fe.CrossRefPubMed
8.
Tsao H, Druitt TR, Schollum TM, Hodges PW: Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010, 11 (11): 1120-1128. 10.1016/j.jpain.2010.02.004.CrossRefPubMed
9.
Tsao H, Galea MP, Hodges PW: Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain. 2010, 14 (8): 832-839. 10.1016/j.ejpain.2010.01.001.CrossRefPubMed
10.
Haggman SP, Sharpe LA, Nicholas MK, Refshauge KM: Attentional biases toward sensory pain words in acute and chronic pain patients. J Pain. 2010, 11 (11): 1136-1145. 10.1016/j.jpain.2010.02.017.CrossRefPubMed
11.
Grisart J, Plaghki L: Impaired selective attention in chronic pain patients. Eur J Pain. 1999, 3 (4): 325-333. 10.1016/S1090-3801(99)90014-9.CrossRefPubMed
12.
Flor H, Knost B, Birbaumer N: The role of operant conditioning in chronic pain: an experimental investigation. Pain. 2002, 95 (1–2): 111-118.CrossRefPubMed
13.
Moseley GL, Nicholas MK, Hodges PW: Does anticipation of back pain predispose to back trouble?. Brain. 2004, 127 (10): 2339-2347. 10.1093/brain/awh248.CrossRefPubMed
14.
Martel MO, Thibault P, Sullivan MJL: The persistence of pain behaviors in patients with chronic back pain is independent of pain and psychological factors. Pain. 2010, 151 (2): 330-336. 10.1016/j.pain.2010.07.004.CrossRefPubMed
15.
MacDonald D, Moseley GL, Hodges PW: Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain. 2009, 142 (3): 183-188. 10.1016/j.pain.2008.12.002.CrossRefPubMed
16.
MacDonald D, Moseley GL, Hodges PW: People with recurrent low back pain respond differently to trunk loading despite remission from symptoms. Spine. 2010, 35 (7): 818-824.CrossRefPubMed
17.
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): 437-440. 10.1136/bjsm.2009.060731.CrossRefPubMed
18.
Luoto S, Taimela S, Hurri H, Alaranta H: Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up. Spine. 1999, 24 (3): 255-261. 10.1097/00007632-199902010-00011.CrossRefPubMed
19.
Taimela S, Kankaanpää M, Luoto S: The effect of lumbar fatigue on the ability to sense a change in lumbar position. A controlled study. Spine. 1999, 24 (13): 1322-1327. 10.1097/00007632-199907010-00009.CrossRefPubMed
20.
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): 63-66. 10.1016/j.neulet.2004.05.013.CrossRefPubMed
21.
Blumenstiel K, Gerhardt A, Rolke R, Bieber C, Tesarz J, Friederich H-C, Eich W, Treede R-D: Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia. Clin J Pain. 2011, 27 (8): 682-690. 10.1097/AJP.0b013e3182177654.CrossRefPubMed
22.
Flor H, Diers M, Birbaumer N: Peripheral and electrocortical responses to painful and non-painful stimulation in chronic pain patients, tension headache patients and healthy controls. Neurosci Lett. 2004, 361 (1–3): 147-150.CrossRefPubMed
23.
Kleinbohl D, Holzl R, Moltner A, Rommel C, Weber C, Osswald PM: Psychophysical measures of sensitization to tonic heat discriminate chronic pain patients. Pain. 1999, 81 (1–2): 35-43.CrossRefPubMed
24.
Flor H: Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med. 2003, 35 (41 Suppl): 66-72.CrossRef
25.
Diers M, Koeppe C, Diesch E, Stolle AM, Holzl R, Schiltenwolf M, van Ackern K, Flor H: Central processing of acute muscle pain in chronic low back pain patients: an EEG mapping study. J Clin Neurophysiol. 2007, 24 (1): 76-83. 10.1097/01.wnp.0000241093.00844.0e.CrossRefPubMed
26.
Rolke R, Baron R, Maier C, Tölle TR, Treede R-D, Beyer A, Binder A, Birbaumer N, Birklein F, Bötefür IC, et al: Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006, 123 (3): 231-243. 10.1016/j.pain.2006.01.041.CrossRefPubMed
27.
Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, Treede R-D: Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006, 10 (1): 77-88. 10.1016/j.ejpain.2005.02.003.CrossRefPubMed
28.
Magerl W, Fuchs PN, Meyer RA, Treede R-D: Roles of capsaicin-insensitive nociceptors in cutaneous pain and secondary hyperalgesia. Brain. 2001, 124 (9): 1754-1764. 10.1093/brain/124.9.1754.CrossRefPubMed
29.
Klein T, Magerl W, Hopf HC, Sandkühler J, Treede R-D: Perceptual correlates of nociceptive long-term potentiation and long-term depression in humans. J Neurosci. 2004, 24 (4): 964-971. 10.1523/JNEUROSCI.1222-03.2004.CrossRefPubMed
30.
Hautzinger M, Bailer M, Worall H: Beck-depressions-inventar (BDI). 1994, Testhandbuch: Bern: Huber, Bearbeitung der deutschen Ausgabe
31.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiat. 1961, 4: 561-571. 10.1001/archpsyc.1961.01710120031004.CrossRefPubMed
32.
Roland M, Fairbank J: The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000, 25 (24): 3115-3124. 10.1097/00007632-200012150-00006.CrossRefPubMed
33.
Roland M, Morris R: A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983, 8 (2): 141-144. 10.1097/00007632-198303000-00004.CrossRefPubMed
34.
Roland M, Morris R: A study of the natural history of low-back pain. Part II: development of guidelines for trials of treatment in primary care. Spine. 1983, 8 (2): 145-150. 10.1097/00007632-198303000-00005.CrossRefPubMed
35.
Magerl W, Wilk SH, Treede R-D: Secondary hyperalgesia and perceptual wind-up following intradermal injection of capsaicin in humans. Pain. 1998, 74 (2–3): 257-268.CrossRefPubMed
36.
Magerl W, Krumova EK, Baron R, Tölle T, Treede R-D, Maier C: Reference data for quantitative sensory testing (QST): refined stratification for age and a novel method for statistical comparison of group data. Pain. 2010, 151 (3): 598-605. 10.1016/j.pain.2010.07.026.CrossRefPubMed
37.
LaMotte RH, Shain CN, Simone DA, Tsai EF: Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. J Neurophysiol. 1991, 66 (1): 190-211.PubMed
38.
Ziegler EA, Magerl W, Meyer RA, Treede R-D: Secondary hyperalgesia to punctate mechanical stimuli. Central sensitization to A-fibre nociceptor input. Brain. 1999, 122 (12): 2245-2257. 10.1093/brain/122.12.2245.CrossRefPubMed
39.
Klein T, Stahn S, Magerl W, Treede R-D: The role of heterosynaptic facilitation in long-term potentiation (LTP) of human pain sensation. Pain. 2008, 139 (3): 507-519. 10.1016/j.pain.2008.06.001.CrossRefPubMed
40.
Lang S, Klein T, Magerl W, Treede R-D: Modality-specific sensory changes in humans after the induction of long-term potentiation (LTP) in cutaneous nociceptive pathways. Pain. 2007, 128 (3): 254-263. 10.1016/j.pain.2006.09.026.CrossRefPubMed
41.
Magerl W, Klein T: Chapter 33 Experimental human models of neuropathic pain. Handbook of clinical neurology. Edited by: Vinken PJ, Bruyn GW. 2006, 503-516. 81
42.
Klein T, Magerl W, Rolke R, Treede R-D: Human surrogate models of neuropathic pain. Pain. 2005, 115 (3): 227-233. 10.1016/j.pain.2005.03.021.CrossRefPubMed
43.
Baumgärtner U, Magerl W, Klein T, Hopf HC, Treede R-D: Neurogenic hyperalgesia versus painful hypoalgesia: two distinct mechanisms of neuropathic pain. Pain. 2002, 96 (1–2): 141-151.CrossRefPubMed
44.
Maier C, Baron R, Tölle TR, Binder A, Birbaumer N, Birklein F, Gierthmühlen J, Flor H, Geber C, Huge V, et al: Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain. 2010, 150 (3): 439-450. 10.1016/j.pain.2010.05.002.CrossRefPubMed
45.
Stiasny-Kolster K, Magerl W, Oertel WH, Möller JC, Treede R-D: Static mechanical hyperalgesia without dynamic tactile allodynia in patients with restless legs syndrome. Brain. 2004, 127 (4): 773-782. 10.1093/brain/awh079.CrossRefPubMed
46.
Fields HL, Rowbotham M, Baron R: Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis. 1998, 5 (4): 209-227. 10.1006/nbdi.1998.0204.CrossRefPubMed
47.
Burstein R, Cutrer MF, Yarnitsky D: The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain. 2000, 123 (8): 1703-1709. 10.1093/brain/123.8.1703.CrossRefPubMed
48.
Neugebauer V, Li W, Bird GC, Han JS: The amygdala and persistent pain. Neuroscientist. 2004, 10 (3): 221-234. 10.1177/1073858403261077.CrossRefPubMed
49.
Pertovaara A: A neuronal correlate of secondary hyperalgesia in the rat spinal dorsal horn is submodality selective and facilitated by supraspinal influence. Exp Neurol. 1998, 149 (1): 193-202. 10.1006/exnr.1997.6688.CrossRefPubMed
50.
Simone DA, Sorkin LS, Oh U, Chung JM, Owens C, LaMotte RH, Willis WD: Neurogenic hyperalgesia: central neural correlates in responses of spinothalamic tract neurons. J Neurophysiol. 1991, 66 (1): 228-246.PubMed
51.
Lenz FA, Weiss N, Ohara S, Lawson C, Greenspan JD: The role of the thalamus in pain. Suppl Clin Neurophys. 2004, 57: 50-61.CrossRef
52.
Burstein R, Jakubowski M, Garcia-Nicas E, Kainz V, Bajwa Z, Hargreaves R, Becerra L, Borsook D: Thalamic sensitization transforms localized pain into widespread allodynia. Annals Neurol. 2010, 68 (1): 81-91. 10.1002/ana.21994.CrossRef
53.
Eaton SA, Salt TE: Thalamic NMDA receptors and nociceptive sensory synaptic transmission. Neurosci Lett. 1990, 110 (3): 297-302. 10.1016/0304-3940(90)90863-5.CrossRefPubMed
54.
Kolhekar R, Murphy S, Gebhart GF: Thalamic NMDA receptors modulate inflammation-produced hyperalgesia in the rat. Pain. 1997, 71 (1): 31-40. 10.1016/S0304-3959(97)03334-4.CrossRefPubMed
55.
Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA: Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011, 15 (1): 61-69. 10.1016/j.ejpain.2010.09.002.CrossRefPubMed
56.
Sang CN, Gracely RH, Max MB, Bennett GJ: Capsaicin-evoked mechanical allodynia and hyperalgesia cross nerve territories. Evidence for a central mechanism. Anesthesiology. 1996, 85 (3): 491-496. 10.1097/00000542-199609000-00007.CrossRefPubMed
Metadata
Title
Enhanced sensitivity to punctate painful stimuli in female patients with chronic low back pain
Authors
Christian Puta
Birgit Schulz
Saskia Schoeler
Walter Magerl
Brunhild Gabriel
Holger H W Gabriel
Wolfgang H R Miltner
Thomas Weiss
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2012
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-12-98

Other articles of this Issue 1/2012

BMC Neurology 1/2012 Go to the issue

Research article

An olfactory ‘stress test’ may detect preclinical Alzheimer’s disease

Case report

Minocycline-associated rimmed vacuolar myopathy in a patient with rheumatoid arthritis

Research article

Huntington's Disease and its therapeutic target genes: a global functional profile based on the HD Research Crossroads database

Research article

Temporal profile of body temperature in acute ischemic stroke: relation to stroke severity and outcome

Case report

Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

Case report

An emboligenic pulmonary abscess leading to ischemic stroke and secondary brain abscess