Low Back Pain Diagnosis in www.ipainrelief.com

Low Back Pain Diagnosis in www.ipainrelief.com
http://www.ipainrelief.com/?post_type=post&p=108
Low back pain is one of the most troublesome and disabling musculo-skeletal conditions with very high costs and diagnosing it is tricky due to the large number of potential pain generators. Back pain is not one condition but a variety of inter-related syndromes which have been characterised as back pain subtypes, the identification of which may be crucial to effective intervention. The large number of potential diagnoses includes lumbar stenosis, pain of discal origin, trigger point syndromes, postural pain, facet joint syndrome, nerve root pain and neuropathic pain. Mechanical back pain is related to changes which occur in the spinal ligaments, facet joints, muscles and discs. An important distinction in diagnosis is between mechanical pain and neuropathic pain. In mechanical syndromes the pain is generated by the injured or altered tissues but in neuropathic pain it is the nervous system which generates the pain, often secondary to injury of some sort. Neuropathic pain examples are pain after shingles, pain after nerve root damage, pain from diabetic neuropathy and phantom pain. The nature of neuropathic pain is very unpleasant for the patients and is difficult to medically manage. In Cambridge, UK and Boston USA researchers from Addenbrooke's Hospital and Massachusetts General Hospital respectively have been looking at the difficulty of clear back pain diagnosis. They looked at the complex pain processes occurring in these syndromes and felt that the typical assessment of pain intensity and position did not reflect this complexity. They developed an assessment tool to allow for the complex nature of the conditions so that more secure diagnosis and more effective treatment could be developed. To identify the various potential pain subtypes they put together a standardised assessment tool. The researchers tested fifty-seven patients with typical low back pain and one hundred and thirty with peripheral neuropathic pain were investigated in a repeatable manner by a standardised group of sixteen questions then a physical examination consisting of 23 particular tests. Pain descriptors in terms of a series of words to describe pain were presented to patients who then chose the ones most applicable to their pain. Alteration in the ability to accurately sense pin-prick, light touch and vibration inputs is altered in chronic pain syndromes and the ability to accurately distinguish these modalities is also assessed. In neuropathic pain patients it was possible to identify six sub-groups and in non neuropathic patients two further subgroups were noted. Researchers were also able to distinguish the 6 questions and 10 physical tests which were best suited to making the most accurate discrimination between the pain subtypes. Testing this tool on one hundred and thirty seven further patients allowed the researchers to see it worked effectively and that patient acceptability was good. A particular group of neuropathic pain subtypes could be elucidated by a relatively low number of signs and symptoms which were not related to the presenting causative conditions. The most discriminating part of the testing was the physical examination and not the symptom recording of types and distributions of pain. The nature and quality of the pain were of lesser importance than often thought and testing by pinprick found to be of greater importance. The pain subtypes were linked by the researchers to the biological mechanisms of the underlying nerve pathways. Spontaneous burning pains were thought to reflect discharges in the pain nerves with heat sensitivity. Pain from brushing the skin was linked to heightened reactivity of the nerve cells in the spinal cord dorsal horn. The physical examination was more sensitive in delineating neuropathic diagnoses of pains than the recording of the types and nature of symptoms. The qualities of the pain were less helpful and the testing of pinprick more helpful. The researchers attempted to connect the underlying neural mechanisms with the pain subtypes. The heat sensitive pain nerves were linked to burning pains of a spontaneous type and heightened sensitivity of the spinal cord dorsal horn cells was linked to increased pain from brushing over the skin.