The Identification of Pain Phenotypes in Individuals With Low Back Pain in Response to Dynamic Resistance Exercise

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-09-26 DOI:10.1002/ejp.70136

Kaitlyn M. Lyons, Jeffrey R. Stout, Matt S. Stock, William J. Hanney, Abigail W. Anderson

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Abstract

Background

Exercise-induced hypoalgesia (EIH) describes an acute reduction in pain following exercise. Individuals with low back pain (LBP) demonstrate variable EIH responses, such as increased pain sensitivity (hyperalgesia). Pain phenotyping, classifying individuals with pain sensitivity and psychological characteristics, may explain this variability. LBP phenotypes were classified using pain sensitivity, psychological variables, and EIH response to dynamic resistance exercise.

Methods

In this observational cohort study, 78 individuals with LBP (mean age = 21.7 ± 2.6 years, 59% female) completed clinical pain ratings (Numeric Pain Rating Scale [NPRS]), temporal summation (TS), conditioned pain modulation (CPM), psychological questionnaires (Fear-Avoidance Beliefs Questionnaire-Physical Activity subscale [FABQ-PA]), and a 45-degree Roman chair back extension exercise. Pressure pain threshold (PPT) pre- and post-exercise determined EIH. Ward's hierarchical cluster analysis was performed with five variables (NPRS, TS, CPM, FABQ-PA, EIH). One-way ANOVA examined differences in demographic, clinical, and psychosocial factors by cluster.

Results

Three distinct clusters emerged: (1) efficient pain modulation with low fear-avoidance and high EIH (n = 40); (2) impaired pain modulation with moderate fear-avoidance and hyperalgesia (n = 19); (3) moderate pain modulation with high fear-avoidance and moderate EIH (n = 19). Clusters differed significantly by age (p = 0.02, η_p² = 0.098), disability (p = 0.004, η_p² = 0.138), psychosocial burden (p = 0.03, η_p² = 0.086), and pain catastrophizing (p = 0.03, η_p² = 0.09).

Conclusion

Individuals with LBP exhibit heterogeneous pain phenotypes. Psychological factors may diminish EIH, and impaired modulation may produce hyperalgesia post-exercise. Identifying pain phenotypes may enhance personalised rehabilitation strategies, optimising interventions for LBP.

Significance

This study provides novel evidence that biopsychosocial phenotypes influence pain responses to resistance exercise, offering a potential pathway to personalised rehabilitation for LBP.

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动态阻力运动对腰痛患者疼痛表型的影响

运动诱发的痛觉减退（EIH）描述了运动后疼痛的急性减轻。腰痛（LBP）患者表现出不同的EIH反应，如疼痛敏感性增加（痛觉过敏）。疼痛表型，根据疼痛敏感性和心理特征对个体进行分类，可以解释这种差异。使用疼痛敏感性、心理变量和EIH对动态阻力运动的反应对LBP表型进行分类。方法在这项观察性队列研究中，78例腰痛患者（平均年龄21.7±2.6岁，59%为女性）完成了临床疼痛评分（数字疼痛评定量表[NPRS]）、时间总和（TS）、条件疼痛调节（CPM）、心理问卷（恐惧-回避信念问卷-身体活动子量表[FABQ-PA]）和45度罗马椅背部伸展练习。压痛阈值（PPT）运动前后确定EIH。采用5个变量（NPRS、TS、CPM、FABQ-PA、EIH）进行Ward分层聚类分析。单因素方差分析分析了人口统计学、临床和社会心理因素的差异。结果：(1)低恐惧回避和高EIH的有效疼痛调节组（n = 40）；(2)疼痛调节障碍伴中度恐惧回避和痛觉过敏（n = 19）；(3)中度疼痛调节伴高恐惧回避和中度EIH （n = 19）。年龄（p = 0.02, ηp2 = 0.098）、残疾（p = 0.004, ηp2 = 0.138）、心理社会负担（p = 0.03, ηp2 = 0.086）和疼痛灾难化（p = 0.03, ηp2 = 0.09）的聚类差异显著。结论腰痛患者表现出不同的疼痛表型。心理因素可能降低EIH，调节功能受损可能导致运动后痛觉过敏。识别疼痛表型可以增强个性化的康复策略，优化LBP的干预措施。这项研究提供了新的证据，证明生物心理社会表型会影响阻力运动对疼痛的反应，为LBP的个性化康复提供了潜在的途径。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.