LBP-relateret UE smerte - Klassifikation​

Introduktion

Patienter med UE symptomer forårsagede af lumbale problematikker ses ofte i en klinisk hverdag. Præcis og specifik diagnosticering af involverede processer er ofte vanskelig, hvilket gør det til en udfordring at vælge korrekt behandlingsteknik for den individuelle patient. Diagnostisk usikkerhed kan medføre en tilbøjelighed til at vælge »favorit patologi« og tilhørende behandlingsintervention.

Teksten præsenterer en grundig undersøgelsesprotokol til patienter med LBP relaterede UE smerter, der klassificerer patienterne i forhold til smertemekanisme i en af fire mulige subgrupper. Korrekt klassificering vil optimere diagnostik, prognose, valg af behandlingsteknik samt den kliniske ræsonerings proces.

Klassifikationsmodellen er oprindeligt præsenteret som; Classification of low back related leg pain – A proposed patho-mechanism-based approach;

Axel Schäfer, Toby Hall, Kathy Briffab, Manual Therapy, April 2009 Nr. 2.

(Var optaget i Manual Therapy 2007).

Læs artiklen i Muskuloskeletal Fysioterapi 2009_1 (s. 3-7)

Referenceliste til artiklen:

​Adams MA, Bogduk N, Burton K, Patricia D. Biology of spinal tissues. The biomechanics of backpain. Edinburgh: Churchill Livingstone; 2002. p. 49–71.

Baron R, Binder A. Wie neuropathisch ist die Lumboischialgie. Das Mixed-pain-Konzept. Orthopade 2004;33(5):568–75.

Baumgartner U, Magerl W, Klein T, Hopf HC, Treede RD. Neurogenic hyperalgesia versus painful hypoalgesia: two distinct mechanisms of neuropathic pain. Pain 2002;96(1–2):141–51.

Beattie PF, Meyers SP, Stratford P, Millard RW, Hollenberg GM. Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging. Spine 2001;25(7):819–28.

Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 2001;92(1–2):147–57.

Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. Journal of Pain 2005;6(3): 149–58.

Bennett MI, Smith BH, Torrance N, Lee AJ. Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians. Pain 2006;122(3):289–94.

Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Journal of Bone and Joint Surgery—American Volume 1990;72(3):403–8.

Bogduk N, McGuirk B. Causes and sources of chronic low back pain, Medical management of acute and chronic low back pain. An evidence based approach. Amsterdam: Elsevier; 2002. p. 115–25.

Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M. Volvo award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine 1995;20(24): 2613–25.

Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron 2006;52(1):77–92.

Cavanaugh JM,Weinstein JN. Low back pain: epidemiology, anatomy and neurophysiology. In: Wall PD, Melzack R, editors. The textbook of pain. 3rd ed. Edinburgh; New York: Churchill Livingstone; 1994. p. 441–55.

Cornefjord M, Sato K, Olmarker K, Rydevik B, Nordborg C. A model for chronic nerve root compression studies: presentation of a porcine model for controlled, slow-onset compression with analyses of anatomic aspects, compression onset rate, and morphologic and neurophysiologic effects. Spine 1997;22(9):946–57.

Costigan M, Woolf CJ. Pain: molecular mechanisms. Journal of Pain 2000;1(3):35–44.

Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine 1997;22(10): 1115–22.

Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Archives of Neurology 2003;60(11):1524–34.

Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. Journal of Hand Therapy 1997;10(2):122–9.

Feinstein B, Langton JN, Jameson RM, Schiller F. Experiments on pain referred from deep somatic tissues. Journal of Bone and Joint Surgery—American Volume 1954;36-A(5):981–97.

Fortin JD, Aprill CN, Ponthieux B, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine 1994;19(13):1483–9.

Gardell LR, Vanderah TW, Gardell SE, Wang R, Ossipov MH, Lai J, et al. Enhanced evoked excitatory transmitter release in experimental neuropathy requires descending facilitation. Journal of Neuroscience 2003;23(23):8370–9.

Greening J. How inflammation and minor nerve injury contribute to pain in nerve root and peripheral neuropathies. In: Boyling JD, Jull G, editors. Grieve’s modern manual therapy: the vertebral column. 2nd

ed. Edinburgh, New York: Churchill Livingstone; 2004. p. 205–14.

Hall TM, Elvey RL. Nerve trunk pain: physical diagnosis and treatment. Manual Therapy 1999;4(2):63–73.

Hall TM, Elvey RL. Management of mechanosensitivity of the nervous system in spinal pain syndromes. In: Boyling JD, Jull G, editors. Grieves modern manual therapy. 3rd ed. Edinburgh: Churchill Livingstone; 2004. p. 413–33.

Heliovaara M, Impivaara O, Sievers K. Lumbar disc syndrome in Finland. Journal of Epidemiology and Communication Health 1987(41):251–8

Igarashi T, Yabuki S, Kikuchi S, Myers RR. Effect of acute nerve root compression on endoneurial fluid pressure and blood flow in rat dorsal root ganglia. Journal of Orthopaedic Research 2005;23(2): 420–4.​


Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping. Pain 2004;111(1–2):84–95.

Jinkins JR. The anatomic and physiologic basis of local, referred and radiating lumbosacral pain syndromes related to disease of the spine. Journal of Neuroradiology 2004;31(3):163–80.

Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T. Magnetic resonance imaging and low back pain in adults: adiagnostic imaging study of 40-year-old men and women. Spine 2005;30(10):1173–80.

Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical compression. Journal of Orthopaedic Research 2004;22(1):170–9.

Kobayashi S, Baba H, Uchida K, Kokubo Y, Kubota C, Yamada S, et al. Effect of mechanical compression on the lumbar nerve root: localization and changes of intraradicular inflammatory cytokines, nitric oxide, and cyclooxygenase. Spine 2005;30(15):1699–705.

Laslett M, Oberg B, Aprill CN, McDonald B. Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power. Spine Journal 2005;5(4):370–80.

Lundborg G. Nerve and nerve injuries. 2nd ed. Oxford: Elsevier, 2005.

Mannion RJ, Doubell TP, Coggeshall RE, Woolf CJ. Collateral sprouting of uninjured primary afferent A-fibers into the superficial dorsal horn of the adult rat spinal cord after topical capsaicin treatment to the sciatic nerve. Journal of Neuroscience 1996;16(16): 5189–95.

McNab I. The mechanism of spondylogenic pain. In: Hirsch C, Zotterman Y, editors. Cervical pain. New York: Pergamon Press; 1972. p. 89–95.

Mooney V, Robertson J. The facet syndrome. Clinical Orthopedics and Related Research 1976(115):149–56.

O’Neill CW, Kurgansky ME, Derby R, Ryan DP. Disc stimulation and patterns of referred pain. Spine 2002;27(24):2776–81.

Ohnmeiss DD, Vanharanta H, Ekholm J. Degree of disc disruption and lower extremity pain. Spine 1997;22(14):1600–5.

Olmarker K, Holm S, Rydevik B. Importance of compression onset rate for the degree of impairment of impulse propagation in experimental compression injury of the porcine cauda equina. Spine 1990;15(5):416–9.

Olmarker K, Rydevik B, Holm S, Bagge U. Effects of experimental graded compression on blood flow in spinal nerve roots. A vital microscopic study on the porcine cauda equina. Journal of Orthopaedic Research 1989;7(6):817–23.

Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. Journal of Bone and Joint Surgery— British Volume 2005;87(1):62–7.

Ren K, Dubner R. Enhanced descending modulation of nociception in rats with persistent hindpaw inflammation. Journal of Neurophysiology 1996;76(5):3025–37.

Ren K, Dubner R. Descending modulation in persistent pain: an update. Pain 2002;100(1–2):1–6.

Rydevik B, Brown MD, Lundborg G. Pathoanatomy and pathophysiology of nerve root compression. Spine 1984;9(1):7–15.

Rydevik BL, Pedowitz RA, Hargens AR, Swenson MR, Myers RR, Garfin SR. Effects of acute, graded compression on spinal nerve root function and structure. An experimental study of the pig cauda equina. Spine 1991;16(5):487–93.

Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The relative contributions of the disc and zygapophyseal joint in chronic low back pain. Spine 1994;19(7):801–6.

Selim AJ, Ren XS, Fincke G, Deyo RA, Rogers W, Miller D, et al. The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans

Health Study. Spine 1998;23(4):470–4.

Stewart JD, Eisen A. Tinel’s sign and the carpal tunnel syndrome. BMJ 1978;2(6145):

1125–6.

​Taylor JR, Twomey LT. Age changes in lumbar zygapophyseal joints. Observations on structure and function. Spine 1986;11(7): 739–45.

Travell JG, Simons DG. The lower extremities, vol. 2. Philadelphia: Lippincott Williams & Wilkins; 1983.

Videman T, Nurminen M. The occurrence of anular tears and their relation to lifetime back pain history: a cadaveric study using barium sulfate discography. Spine 2004;29(23):2668–76.

Wiesel SW, Tsourmas N, Feffer HL, Citrin CM, Patronas N. A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 1984;9(6): 549–51.

Woolf CJ, Doubell TP. The pathophysiology of chronic pain-increased sensitivity to low threshold A beta-fibre inputs. Current Opinion in Neurobiology 1994;4(4):525–34.

Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. The Lancet 1999;353(9168): 1959–64.

Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science 2000;288:1765–8.

Yoshizawa H, Kobayashi S, Morita T. Chronic nerve root compression. Pathophysiologic mechanism of nerve root dysfunction. Spine 1995;20(4):397–407.

Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine Journal 2003;3(6):460–5.

Yucel A, Senocak M, Kocasoy Orhan E, Cimen A, Ertas M. Results of the Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. Journal of Pain 2004;5(8): 427–32.

Zusman M. Forebrain-mediated sensitization of central pain pathways: ‘non-specific’ pain and a new image for MT. Manual Therapy 2002;7(2):80–8.

Zusman M, Wright A. In: Boyling JD, Jull G, editors. Grieves modern manual therapy. 3rd ed. Edinburgh: Churchill Livingstone; 2004. p. 413–33.​​

Quadriceps atrofi hos mennesker med pattellofemoral smerte
Quadriceps atrofi hos mennesker med pattellofemoral smerte
Læs hele nyheden
Er maksimal styrke træning er mere effektivt end "standart rehabilitering" til borgere som har fået foretaget total knæ alloplastik?
Er maksimal styrke træning er mere effektivt end "standart rehabilitering" til borgere som har fået foretaget total knæ alloplastik?
Læs hele nyheden
Taping til carpal tunnel syndrom
Taping til carpal tunnel syndrom
Læs hele nyheden

Dansk Selskab for Muskuloskeletal Fysioterapi​

Redaktion

​Rasmus Bach Jønsson - E-mail

Michael Smærup- E-mail

Formand

Martin B. Josefsen

Tlf.: 61 70 66 29 - E-mail

Kasserer

Lene W. ​Johansen​​​ - E-mail

Sekretær

Line Thomassen ​- ​​E-mail

Uddannelse ​og kurser

Muskuloskeletalfysioterapi@gmail.com