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The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back
Ingrid Schuttert1, Hans Timmerman1, Kristian K Petersen2
1Pain Center, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, 9750 RA Groningen, The Netherlands.
Insights
Central sensitisation, a key factor in chronic low back pain, is challenging to measure directly in humans. This review explores definitions, assessment methods, and prevalence of human assumed central sensitisation (HACS).
Area of Science:
- Pain research
- Neurology
- Rehabilitation medicine
Background:
- Central sensitisation is a proposed mechanism for chronic low back pain (CLBP).
- Direct assessment of central sensitisation in humans is not feasible, leading to the concept of human assumed central sensitisation (HACS).
Purpose of the Study:
- To identify definitions used for HACS.
- To evaluate methods for assessing HACS.
- To assess the validity of HACS assessment methods.
- To estimate the prevalence of HACS in CLBP patients.
Main Methods:
- Systematic literature search identifying 34 relevant studies.
- Analysis of definitions and quantitative methods (questionnaires and quantitative sensory testing) used to assess HACS.
- Review of studies estimating HACS prevalence in CLBP.
Main Results:
- Forty different definitions for HACS were identified.
- Twenty quantitative methods for HACS assessment were found, including 4 questionnaires and 16 quantitative sensory testing measures.
- Only three studies estimated HACS prevalence in CLBP patients.
- Most HACS assessment methods lack validation, though reliability and repeatability have been tested.
Conclusions:
- Significant heterogeneity exists in definitions, assessment methods, and prevalence estimates for HACS in CLBP.
- The lack of validated methods and a gold standard necessitates standardization.
- A proposed grading system aims to standardize HACS assessment in clinical and research settings for CLBP.
Abstract:
Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term 'human assumed central sensitisation' (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.
