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Title: Characterisation of low back pain
Author: Spahr, Nicolas Marc
ISNI:       0000 0004 5368 176X
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2014
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Chronic low back pain (CLBP) causes ongoing pain, disability and psychological suffering, at a huge personal and socio-economic cost. CLBP is a heterogeneous condition and its mechanisms are poorly understood. Characterisation and classification of low back pain (LBP) is controversial, there is disagreement on the characterisation and diagnosis of neuropathic low back pain (NuLBP) in relation to mechanical LBP (MLBP). Diagnostic uncertainty is coupled with poor clinical outcomes for treatment. There is therefore an urgent need to develop more effective assessment strategies to identify and better differentiate NuLBP from MLBP in order to facilitate a better understanding of underlying mechanisms and more successful treatments. The primary aim of this study was to establish clinical profiles of CLBP, in particular, differences between MLBP and NuLBP using Questionnairebased behavioural evaluation and sensory testing, structural neuroimaging (voxel based morphometry) and functional neuroimaging (arterial spin labelling). Significant differences were identified between CLBP patients and healthy controls and between NuLBP and MLBP patients in multiple behavioural domains measuring pain, function and psychological well-being. Significant differences were demonstrated in CLBP patients compared to controls in both tactile threshold discrimination and two-point discrimination and between NuLBP and MLBP in tactile threshold discrimination. Functional and structural neuroimaging showed significant differences between all groups in widespread brain regions involved in the evaluation of decision making and planning, mood and emotion, modulation of pain and representation of body schema. This study has demonstrated the ability to characterise CLBP using a battery of behavioural, examination and functional and structural neuroimaging methodologies and has been able to differentiate between CLBP patients and controls and importantly, between NuLBP and MLBP patients. This work demonstrates the impact of CLBP across sensory-discriminative, affectivemotivational and cognitive-evaluative dimensions of the pain experience and shows the increased impact and burden on those who suffer with NuLBP compared to MLBP.
Supervisor: Howard, Matthew Alexander ; Thacker, Michael Andrew Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available