Pain Sensitivity Subgroups in Individuals With Spine Pain: Potential Relevance to Short-Term Clinical Outcome

Rogelio A. Coronado; Joel E. Bialosky; Michael E. Robinson; Steven Z. George

doi:10.2522/ptj.20130372

Abstract

Background Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain.

Objective The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes.

Design A secondary analysis of data from 2 randomized trials was conducted.

Methods Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined.

Results Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes.

Limitations Only 2-week outcomes are reported.

Conclusions Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings.

Footnotes

All authors provided concept/idea/research design and writing. Dr Bialosky provided data collection. Dr Coronado, Dr Bialosky, and Dr George provided data analysis. Dr Coronado provided project management and clerical support. Dr Robinson provided facilities/equipment. Dr Robinson and Dr George provided consultation (including review of manuscript before submission). The authors acknowledge Maggie Horn, PT, PhD, for her assistance with data collection and Jason Beneciuk, PT, PhD, FAAOMPT, and Mark D. Bishop, PT, PhD, for assistance with statistical analyses.
The study protocols for these analyses were approved by the University of Florida Institutional Review Board.
This research was presented at the International Association for the Study of Pain World Congress on Pain; August 27–31, 2012; Milan, Italy, and the Combined Sections Meeting of the American Physical Therapy Association; February 3–6, 2014; Las Vegas, Nevada.
This study was supported by the University of Florida Research Opportunity Fund. Dr Coronado was supported by NIH T32 Interdisciplinary Training in Rehabilitation and Neuromuscular Plasticity grant 5T32HD043730. Dr Bialosky received support from the Rehabilitation Research Career Development Program (5K12HD055929-02).