Neurological

Mechanism-based classification of musculoskeletal pain

A study in the Clinical Journal of Pain published last month examined the discriminative validity for the use a mechanism-based classification for musculoskeletal pain.   A mechanism-based classification system is a classification of pain based upon underlying neurophysiological mechanisms. 

The authors of this study found that there is preliminary evidence to suggest that we can use discriminatory clusters of signs and symptoms to classify the mechanism of low back pain as nociceptive, peripheral neuropathic and central sensitization.  Below I have included the suggested signs and symptoms related to classifying each:

1. Nociceptive:

—intermittant and sharp with movement or mechanical provocation.

—pain localized to the area of injury or dysfunction

—clear, proportionate mechanical/anatomical nature to aggrevating and easing factors

—pain described as shooting, burning, sharp, electric-like

—pain in association with other dysesthesias

—night pain/disturbed sleep

—antalgic postures/movements

2. Peripheral Neuropathic

—history of nerve injury, pathology or mechanical compromise

—pain in a dermatomal or cutaneous distribution

—pain/symptoms provocation with movement tests that move or compress neural tissue (ex. SLR)

3. Central Sentization:

—pain is disproportionate to the nature or extent of injury/pathology

—Disproportionate, non-mechanical, unpredictable pattern of pain provocation in response to aggrevating/easing factors

—strong association with maladaptive psychological factors

—Diffuse/non-anatomic areas of pain/tenderness to palpation

Smart KM, Blake C, Staines A, et al. The Discriminative Validity of “Nociceptive” “Peripheral Neuropathic” and “Central Sensitization” as Mechanism-Based Classifications of Musculoskeletal Pain. The Clinical Journal of Pain. 2011:27; 655-663.

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