High intensity training improves symptoms of central sensitization at six-month follow-up in persons with chronic nonspecific low back pain: Secondary analysis of a randomized controlled trial

Jonas Verbrugghe, Anouk Agten, Sjoerd Stevens, Frank Vandenabeele, Nathalie Roussel, Jeanine Verbunt, Nina Goossens, Annick Timmermans, Jonas Verbrugghe, Anouk Agten, Sjoerd Stevens, Frank Vandenabeele, Nathalie Roussel, Jeanine Verbunt, Nina Goossens, Annick Timmermans

Abstract

Background: High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors.

Objective: To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP.

Methods: This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale).

Results: Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success.

Conclusion: HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress.

Keywords: Central sensitization; Chronic low back pain; High intensity training; Long term effects; Rehabilitation.

Conflict of interest statement

Conflicts of interest The authors report no conflict of interest.

Copyright © 2023 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.

Figures

Fig. 1
Fig. 1
CONSORT Flowchart of the research design.
Fig. 2
Fig. 2
A. PRE-FU (time) analysis of CSI (left) and PSS (right). B. PRE-FU (group) analysis of CSI (left) and PSS (right) in high and low scores. C. between-group (interaction) analysis (low-CSI/high-CSI) of CSI change (PRE-FU) scores.

References

    1. Maher C., Underwood M., Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–747.
    1. Hoy D., March L., Brooks P., et al. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974.
    1. Oliveira C.B., Maher C.G., Pinto R.Z., et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eu Spine J. 2018:1–13.
    1. Searle A., Spink M., Ho A., Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015;29(12):1155–1167.
    1. MüLLER G., Lyssenko L., Giurgiu M., et al. How effective and efficient are different exercise patterns in reducing back pain? Eu J Phys Rehabil Med. 2020
    1. Verbrugghe J., Agten A., Stevens S., et al. Exercise intensity matters in chronic nonspecific low back pain rehabilitation. MSSE. 2019 Publish Ahead of Print.
    1. Hildebrandt J., Pfingsten M., Saur P., Jansen J. Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine. 1997;22(9):990–1001.
    1. Buchbinder R., Blyth F.M., March L.M., Brooks P., Woolf A.D., Hoy D.G. Placing the global burden of low back pain in context. Best Prac Res Clin Rheum. 2013;27(5):575–589.
    1. Chiarotto A., Boers M., Deyo R.A., et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain. 2018;159(3):481–495.
    1. Nijs J., Leysen L., Vanlauwe J., et al. Treatment of central sensitization in patients with chronic pain: time for change? Exp Opin Pharmacother. 2019;20(16):1961–1970.
    1. Roussel N.A., Nijs J., Meeus M., Mylius V., Fayt C., Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth? Clin J Pain. 2013;29(7):625–638.
    1. Tanaka K., Murata S., Nishigami T., et al. The central sensitization inventory predicts pain-related disability for musculoskeletal disorders in the primary care setting. Eu J Pain. 2019;23(9):1640–1648.
    1. Hartvigsen J., Hancock M.J., Kongsted A., et al. What low back pain is and why we need to pay attention. Lancet. 2018
    1. Adams L.M., Turk D.C. Central sensitization and the biopsychosocial approach to understanding pain. J Appl Biobehav Res. 2018;23(2):e12125.
    1. Smart K.M., Blake C., Staines A., Doody C. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’,‘peripheral neuropathic'and ‘central sensitisation'pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain. Man Ther. 2012;17(2):119–125.
    1. Nijs J., Goubert D., Ickmans K. Recognition and treatment of central sensitization in chronic pain patients: not limited to specialized care. JOSPT. 2016;46(12):1024–1028.
    1. Buscemi V., Chang W.-.J., Liston M.B., McAuley J.H., Schabrun S.M. The role of perceived stress and life stressors in the development of chronic musculoskeletal pain disorders: a systematic review. J Pain. 2019;20(10):1127–1139.
    1. Alhowimel A., AlOtaibi M., Radford K., Coulson N. Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: a systematic review. SAGE Open Med. 2018;6
    1. Nijs J., Loggia M.L., Polli A., et al. Sleep disturbances and severe stress as glial activators: key targets for treating central sensitization in chronic pain patients? Exp Opin Therap Targ. 2017;21(8):817–826.
    1. Williams D.A. Phenotypic features of central sensitization. J Appl Biobehav Res. 2018;23(2)
    1. Hall A.M., Kamper S.J., Maher C.G., Latimer J., Ferreira M.L., Nicholas M.K. Symptoms of depression and stress mediate the effect of pain on disability. Pain. 2011;152(5):1044–1051.
    1. Vaegter H.B., Jones M.D. Exercise-induced hypoalgesia after acute and regular exercise: experimental and clinical manifestations and possible mechanisms in individuals with and without pain. Pain Rep. 2020;5(5)
    1. Geneen L.J., Moore R.A., Clarke C., Martin D., Colvin L.A., Smith B.H. Physical activity and exercise for chronic pain in adults: an overview of cochrane reviews. Cochr Datab Syst Rev. 2017;(4)
    1. Saanijoki T., Tuominen L., Tuulari J.J., et al. Opioid release after high-intensity interval training in healthy human subjects. NPP. 2018;43(2):246–254.
    1. Schmitt A., Wallat D., Stangier C., Martin J.A., Schlesinger-Irsch U., Boecker H. Effects of fitness level and exercise intensity on pain and mood responses. Eu J Pain. 2020;24(3):568–579.
    1. Verbrugghe J., Agten A., Stevens S., et al. High intensity training to treat chronic nonspecific low back pain: effectiveness of various exercise modes. J Clin Med. 2020;9(8):2401.
    1. Balagué F., Mannion A.F., Pellisé F., Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–491.
    1. Airaksinen O., Brox J.I., Cedraschi C., et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–S300.
    1. Swinkels-Meewisse E., Swinkels R., Verbeek A., Vlaeyen J., Oostendorp R. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Man Ther. 2003;8(1):29–36.
    1. Washburn R.A., Zhu W., McAuley E., Frogley M., Figoni S.F. The physical activity scale for individuals with physical disabilities: development and evaluation. Arch Phys Med Rehabil. 2002;83(2):193–200.
    1. Chapman J.R., Norvell D.C., Hermsmeyer J.T., et al. Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine. 2011;36:S54–S68.
    1. Fairbank J.C., Pynsent P.B. The Oswestry disability index. Spine. 2000;25(22):2940–2953.
    1. Childs J.D., Piva S.R., Fritz J.M. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine. 2005;30(11):1331–1334.
    1. Scerbo T., Colasurdo J., Dunn S., Unger J., Nijs J., Cook C. Measurement properties of the central sensitization inventory: a systematic review. Pain Pract. 2018;18(4):544–554.
    1. Neblett R., Cohen H., Choi Y., et al. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain. 2013;14(5):438–445.
    1. Kregel J., Schumacher C., Dolphens M., et al. Convergent validity of the Dutch central sensitization inventory: associations with psychophysical pain measures, quality of life, disability, and pain cognitions in patients with chronic spinal pain. Pain Pract. 2018;18(6):777–787.
    1. Lee E.-.H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121–127.
    1. Hawker G.A., Mian S., Kendzerska T., French M. Measures of adult pain: visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short-form mcgill pain questionnaire (sf-mpq), chronic pain grade scale (cpgs), short form-36 bodily pain scale (sf-36bps), and measure of intermittent and constant osteoarthritis pain (icoap) Arthr Care Res. 2011;63(S11)
    1. Taylor R. Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonogr. 1990;6(1):35–39.
    1. Dunkler D., Plischke M., Leffondre K., Heinze G. Augmented backward elimination: a pragmatic and purposeful way to develop statistical models. PLoS One. 2014;9(11)
    1. Medicine ACoS . Lippincott Williams & Wilkins; 2013. ACSM's Guidelines for Exercise Testing and Prescription.
    1. Wun A., Kollias P., Jeong H., et al. Why is exercise prescribed for people with chronic low back pain? A review of the mechanisms of benefit proposed by clinical trialists. Musculoskel Sci Pract. 2020
    1. Steiger F., Wirth B., de Bruin E.D., Mannion A.F. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. Eur Spine J. 2012;21(4):575–598.
    1. Sanzarello I., Merlini L., Rosa M.A., et al. Central sensitization in chronic low back pain: a narrative review. J Back Musculoskelet Rehabil. 2016;29(4):625–633.
    1. Shala R., Roussel N., Lorimer Moseley G., Osinski T., Puentedura E.J. Taylor & Francis; 2021. Can We Just Talk Our Patients Out of pain? Should pain Neuroscience Education be Our Only Tool?
    1. Smith B.E., Hendrick P., Bateman M., et al. Musculoskeletal pain and exercise—challenging existing paradigms and introducing new. BJSM. 2019;53(14):907–912.
    1. Rice D., Nijs J., Kosek E., et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. J Pain. 2019;20(11):1249–1266.
    1. Neblett R., Hartzell M.M., Cohen H., et al. Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample. Clin J Pain. 2015;31(4):323–332.
    1. Jung M.E., Bourne J.E., Little J.P. Where does HIT fit? An examination of the affective response to high-intensity intervals in comparison to continuous moderate-and continuous vigorous-intensity exercise in the exercise intensity-affect continuum. PLoS One. 2014;9(12)
    1. Bilberg A., Sveaas S.H., Dagfinrud H., Mannerkorpi K. How Do Patients With Axial Spondyloarthritis Experience High-Intensity Exercise? ACR Open Rheum. 2020;2(4):207–213.
    1. Costigan S.A., Eather N., Plotnikoff R.C., Hillman C.H., Lubans D.R. High-intensity interval training for cognitive and mental health in adolescents. MSSE. 2016;48(10):1985–1993.
    1. Borrega-Mouquinho Y., Sánchez-Gómez J., Fuentes-García J.P., Collado-Mateo D., Villafaina S. Effects of high-intensity interval training and moderate-intensity training on stress, depression, anxiety, and resilience in healthy adults during coronavirus disease 2019 confinement: a randomized controlled trial. Front Psychol. 2021;12:270.
    1. Cerqueira É., Marinho D.A., Neiva H.P., Lourenço O. Inflammatory effects of high and moderate intensity exercise—a systematic review. Front Psychol. 2020;10:1550.
    1. Hysing E.-.B., Smith L., Thulin M., Karlsten R., Bothelius K., Gordh T. Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program. Scan J Pain. 2019;19(2):235–244.
    1. Klyne D.M., Moseley G.L., Sterling M., Barbe M.F., Hodges P.W. Are signs of central sensitization in acute low back pain a precursor to poor outcome? J Pain. 2019;20(8):994–1009.
    1. Vinstrup J., Jakobsen M.D., Andersen L.L. Perceived stress and low-Back pain among healthcare workers: a multi-center prospective cohort study. Front Public Health. 2020;8:297.
    1. Puschmann A.-.K., Drießlein D., Beck H., et al. Stress and self-efficacy as long-term predictors for chronic low back pain: a prospective longitudinal study. J Pain Res. 2020;13:613.
    1. Magalhaes Das Neves M.K., Loots J.M., van Niekerk R.L. The effect of various physical exercise modes on perceived psychological stress. SA J Sports Med. 2014;26:104–108.
    1. Berlowitz J., Hall D.L., Joyce C., et al. Changes in perceived stress after yoga, physical therapy, and education interventions for chronic low back pain: a secondary analysis of a randomized controlled trial. Pain Med. 2020;21(10):2529–2537.
    1. Chang D.G., Holt J.A., Sklar M., Groessl E.J. Yoga as a treatment for chronic low back pain: a systematic review of the literature. J Orthop Rheumy. 2016;3(1):1.
    1. Hartfiel N., Burton C., Rycroft-Malone J., et al. Yoga for reducing perceived stress and back pain at work. Occupl Med. 2012;62(8):606–612.
    1. Eskildsen A., Dalgaard V.L., Nielsen K.J., et al. Cross-cultural adaptation and validation of the Danish consensus version of the 10-item perceived stress scale. Scan J Work Environ Health. 2015:486–490.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit