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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

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1877-8879
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Chronic low back pain is highly individualised: patterns of classification across three unidimensional subgrouping analyses

Martin RabeyORCID iD: https://orcid.org/0000-0003-3814-909X / Anne Smith / Peter Kent / Darren Beales / Helen Slater / Peter O’Sullivan
Published Online: 2019-06-29 | DOI: https://doi.org/10.1515/sjpain-2019-0073

Abstract

Background and aims

Chronic low back pain (CLBP) is a complex disorder where central and peripheral nociceptive processes are influenced by factors from multiple dimensions associated with CLBP (e.g. movement, pain sensitivity, psychological). To date, outcomes for treatments matched to unidimensional subgroups (e.g. psychologically-based) have been poor. Therefore, unidimensional subgrouping may not reflect the complexity of CLBP presentations at an individual level. The aim of this study was therefore to explore patterns of classification at an individual level across the three previously-published, data-driven, within-dimension subgrouping studies.

Methods

Cross-sectional, multidimensional data was collected in 294 people with CLBP. Statistical derivation of subgroups within each of three clinically-important dimensions (pain sensitivity, psychological profile, pain responses following repeated spinal bending) was briefly reviewed. Patterns of classification membership were subsequently tabulated across the three dimensions.

Results

Of 27 possible patterns across these dimensions, 26 were represented across the cohort.

Conclusions

This result highlights that while unidimensional subgrouping has been thought useful to guide treatment, it is unlikely to capture the full complexity of CLBP. The amount of complexity important for best patient outcomes is currently untested.

Implications

For clinicians this study highlights the high variability of presentations of people with CLBP at the level of the individual. For example, clinician’s should not assume that those with high levels of pain sensitivity will also have high psychological distress and have pain summation following repeated spinal bending. A more flexible, multidimensional, clinically-reasoned approach to profile patient complexity may be required to inform individualised, patient-centred care. Such individualised care might improve treatment efficacy. This study also has implications for researchers; highlighting the inadequacy of unidimensional subgrouping processes and methodological difficulties in deriving subgroups across multidimensional data.

Keywords: low back pain; subgrouping; biopsychosocial; pain sensitivity; movement

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About the article

Corresponding author: Martin Rabey, PT, PhD, School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Phone: +447781168108


Received: 2019-05-08

Accepted: 2019-06-12

Published Online: 2019-06-29


Authors’ statements

Research funding: MR was supported by: Australian Postgraduate Award, Curtin University Postgraduate Scholarship, Musculoskeletal Association of Chartered Physiotherapists Doctoral Award, Chartered Society of Physiotherapy Charitable Trust. DB was supported by: National Health and Medical Research Council, Australia.

Conflict of interest: Authors state no conflict of interest.

Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and was approved by the Curtin University Human Research Ethics Committee (EC00262), Approval Number: HR112/2012; Royal Perth Hospital Human Research Ethics Committee, Approval Number: EC 2012-148; Sir Charles Gairdner Hospital Human Research Ethics Committee, Approval Number: 2012-197; and Fremantle Hospital Human Research Ethics Committee, Approval Number: AR/13/1.

Declarations of interest: None.


Citation Information: Scandinavian Journal of Pain, 20190073, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2019-0073.

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