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Classifying Low Back Pain Through Pain Mechanisms: A Scoping Review for Physiotherapy Practice
Roberto Tedeschi1, Federica Giorgi2, Daniela Platano1,3
1Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40136 Bologna, Italy.
Journal of Clinical Medicine
|January 25, 2025
Summary
Classifying low back pain (LBP) mechanisms—nociceptive, neuropathic, and central sensitization—is key for effective treatment. This review synthesizes criteria to improve LBP pain classification accuracy in clinical practice.
Area of Science:
- Physiotherapy
- Pain Management
- Clinical Diagnostics
Background:
- Low back pain (LBP) is a major global cause of disability.
- Distinct pain mechanisms (nociceptive, neuropathic, central sensitization) underlie LBP.
- Accurate classification is essential for targeted LBP treatment.
Purpose of the Study:
- To provide a historical overview of LBP pain mechanism classifications.
- To explore the influence of past frameworks on current physiotherapy diagnostic concepts.
- To synthesize clinical criteria for differentiating LBP pain mechanisms.
Main Methods:
- A scoping review following Joanna Briggs Institute methodology.
- Comprehensive literature search across multiple databases (MEDLINE, Cochrane, Scopus, etc.).
- Inclusion of studies on adult LBP and pain mechanism classification criteria.
Main Results:
- Nine studies were included, detailing criteria for nociceptive, neuropathic, and central sensitization pain.
- Neuropathic pain: burning, dysaesthesia, positive SLR test. Central sensitization: widespread pain, hyperalgesia.
- Validated tools (painDETECT, DN4, CSI) exist for neuropathic and central sensitization.
- Central sensitization and neuropathic pain correlate with higher disability and psychological distress.
Conclusions:
- This review synthesizes key clinical criteria for differentiating LBP pain mechanisms.
- It proposes a practical framework to enhance pain classification accuracy in physiotherapy.
- Improved classification supports more effective, individualized LBP management.
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