Tactile acuity, body schema and motor control impairment in adults with chronic low back pain – A systematic review and comparison of chronic low back pain and pain free subjects

Authors: Glithro, S., Clark, C., Osborne,, N., Newell,, D. and Docherty, S.

Start date: 26 September 2016

Journal: International Association for the Study of Pain

Place of Publication: Online

Title Tactile acuity, body schema and motor control impairment in adults with chronic low back pain – A systematic review and comparison of chronic low back pain and pain free subjects Aim of Investigation Chronic low back pain (CLBP) is a common, long term condition. In addition to pain, it contributes to morbidity and low quality of life. Most CLBP is nonspecific lacking in discernible aetiology. Treatments often focus on pain relief and improving motor function but outcomes remain moderate and many sufferers experience ongoing pain. Other chronic pain conditions such as Complex Regional Pain Syndrome and Phantom Limb Pain may provide insights into CLBP. In these conditions, the cortical neurophysiology and corresponding efferent outputs to specific sensory functions are altered. Interventions to reverse these impairments coincide with a reduction in pain intensity. It is plausible that similar approaches improve pain outcomes in adults with CLBP so identification of similar features in this group is needed. The first part of the study aimed to conduct a systematic search of the evidence relating to the question: Are two-point discrimination threshold (TPDT) and body schema altered in adults with CLBP and do they relate to impaired lumbopelvic motor control (LMC)? This review initiated stage two; data collection to investigate TPDT, body schema, LMC and clinical outcome measures in adults with CLBP and a matched pain free group.

Methods A systematic literature search of 12 bibliographic databases, grey literature, Google Scholar and the reference lists of included articles was undertaken over 5 months to Feb 2016. Two independent reviewers’ assessed for quality. Studies of high (≥70%) or medium (60-69%) quality involving adults with CLBP ≥3 month’s duration were included. Varied research designs led to a narrative data synthesis. Stage two data collection was undertaken in two matched groups (CLBP and control) using established measures of TPDT (on the low back), low back laterality discrimination, LMC and outcome measures (disability, kinesiophobia, chronicity, pain). Results The review identified 334 studies. Following inclusion and exclusion screening, eight met the selection criteria and were included in the data extraction process. Assessment revealed similar quality strengths with seven of high and one of medium quality. Only one reported power. Sample sizes ranged from six to 51 with a total of 398 participants. All included male and female participants with a mean age of 44.2 years. The studies utilised different techniques and populations to explore tactile discrimination, body schema and motor function but critically; none explored all three.

As the data collection for stage two is presently being undertaken, the results will be presented in the final poster as; a) differences between groups and b) relationships to outcome measures.

Conclusions Previous research indicates that TPDT is altered in those with CLBP but only within the area of their typical pain. Sub-groups reported within this group may be related to altered body schema.

Tasks relating to the low back that were dependent on an intact body schema were impaired in CLBP sufferers. Bilateral CLBP participants performed more poorly than unilateral sufferers, who performed worse than pain-free groups.

TPDT was negatively correlated with LMC but the relationship between BS and LMC remains unknown.

Our review revealed insufficient evidence to answer our question and highlighted specific knowledge gaps to be explored in stage two.

Conclusions for stage two will be presented on our poster once data collection and analysis is complete.

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