Kristian Stengaard-Pedersen

Digital tender point examination may be helpful in the evaluation of low back pain: clinical signs vs. magnetic resonance imaging

Research output: Contribution to conferencePosterResearchpeer-review

Background:
Low back pain (LBP) may occur both in patients with and without degenerative changes of the lumbar spine. Diffuse musculoskeletal tenderness may be estimated by digital tender point (TP) examination, a method also validated in LBP patients showing 70% agreement within +/-3 TPs. In a cross-sectional study including LBP patients with sickness absence, TPs were shown to be negatively associated with disc height reduction on X-rays as well as radiculopathy. TPs were positively associated with the intensity of back pain.
Methods:
In a subset including 141 of these patients, who were examined consecutively by magnetic resonance imaging (MRI) of the lumbar spine, we aimed 1) at analyzing these associations further to find out which association was more important, the association with degenerative changes or with radiculopathy and 2) at clarifying whether TP examination in LBP patients can contribute with useful information in LBP patients. Baseline clinical measures included back pain, leg pain and widespread pain for the preceding two weeks, a clinical LBP examination and a standardised TP examination. A blinded, standardised description of the degenerative MRI findings of the lumbar spine was performed. Associations were analyzed by linear regression analyses.
Results:
TPs were negatively associated with radiculopathy and with most degenerative manifestations on MRI, but the negative associations were primarily due to the presence of radiculopathy and/or nerve root compromise on MRI. After adjustment for age, sex and widespread pain, the number of TPs was still significantly reduced in patients with clinical radiculopathy. More than 8 and 11 TPs in men and women, respectively, made the diagnosis of radiculopathy less probable. The intensity of back pain, but not leg pain, was positively associated with the number of TPs in all subgroups.
Discussion and conclusions:
As radiculopathy was infrequent in patients with many TPs, a high number of TPs may help excluding radiculopathy. As back pain intensity was positively associated with the number of TPs in all subgroups, i.e. patients with and without degenerative changes and patients with and without radiculopathy, a TP count may help understanding LBP patients better, especially patients with normal or near normal MRI. Accordingly, digital TP examination may be a valuable supplemental tool in the clinical assessment of LBP patients.
Original languageEnglish
Publication year15 Sep 2017
Publication statusPublished - 15 Sep 2017
EventInternational back and neck pain research forum 2017 - Gamle Logen, Oslo, Norway
Duration: 12 Sep 201715 Sep 2017

Conference

ConferenceInternational back and neck pain research forum 2017
LocationGamle Logen
CountryNorway
CityOslo
Period12/09/201715/09/2017

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