411: Associations between quantitative sensory testing parameters and pain extent in low back pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Assessment and Measurement of Pain/Nociception, Physiotherapy, Quantitative Sensory testing (static and dynamic, e.g., HPT, PPT, CPM, TSP, offset analgesia)

Background and Aims: Low back pain (LBP) is a leading cause of years lived with disability worldwide (1). Previous studies indicate that patients with LBP often exhibit altered sensory thresholds in quantitative sensory testing (QST), frequently interpreted as proxies for central sensitization (2). Clinically, central sensitization is often linked to diffuse, non-anatomical, and widespread pain patterns (4). However, the relationship between markers of altered sensory processing and spatial pain extent remains unclear. This cross-sectional study examined whether QST parameters are associated with digitally quantified pain drawing area in adults with LBP and whether these associations differ across diagnostic categories.

Methods: A cross-sectional design was employed. QST parameters comprised pressure pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and cold pressor tolerance (CPT). Spatial pain extent was quantified using digital pain drawings with log-transformed area. Separate multiple linear regression models examined associations between each QST parameter and pain area, adjusted for age, sex, and pain duration. Interaction terms assessed whether associations differed between specific and non-specific LBP.

Results: Among 446 patients with LBP (mean age 57 years, 52% female), most QST parameters were not associated with pain area. PPT (β = −0.02, p = 0.52), TS (β = −0.003, p = 0.49), and CPM (β = −0.008, p = 0.16) showed no significant effects. Only CPT demonstrated a small main effect (β = −0.005, p = 0.014), indicating lower cold tolerance with slightly larger pain areas. This association appeared in non-specific LBP but not specific LBP; however, the interaction was non-significant. All models explained minimal variance (R² = 0.01–0.03).

Conclusions: Contrary to clinical assumptions, we found no convincing linear associations between QST parameters and spatial pain extent in LBP patients. The single significant finding, a minimal CPT effect in non-specific LBP, explained less than 3% of variance and requires independent replication before clinical interpretation. These findings suggest that pain drawings and QST parameters capture largely independent dimensions of the pain experience. Extensive pain patterns may therefore not directly reflect sensory hypersensitivity or altered nociceptive processing. Future research should investigate potential non-linear relationships, explore subgroup-specific mechanisms, and examine alternative metrics for quantifying pain extent.

References: (1) Ferreira, M. L., De Luca, K., Haile, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., ... & Mahmoodpoor, A. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. *The Lancet Rheumatology*, *5*(6), e316-e329.

(2) den Bandt, H. L., Paulis, W. D., Beckwée, D., Ickmans, K., Nijs, J., & Voogt, L. (2019). Pain mechanisms in low back pain: a systematic review with meta-analysis of mechanical quantitative sensory testing outcomes in people with nonspecific low back pain. *journal of orthopaedic & sports physical therapy*, *49*(10), 698-715.

(3) Nijs, J., Kosek, E., Chiarotto, A., Cook, C., Danneels, L. A., Fernández-de-Las-Peñas, C., ... & George, S. Z. (2024). Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. *The Lancet Rheumatology*, *6*(3), e178-e188.

Presenting Author: Nils Lennart Reiter
Submitting Author: Nils Lennart Reiter

Senior Author: Anders Hansen PhD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Nils Lennart Reiter: BSc - Bern University of Applied Sciences, School of Health Professions, Department of Physiotherapy, Bern, Switzerland
• Janik Schönbeck: BSc - Bern University of Applied Sciences, School of Health Professions, Department of Physiotherapy, Bern, Switzerland
• Søren O'Neill: PhD - Medical Spinal Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
• Casper Nim: PhD - Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense M, Denmark
• Steen Harsted: PhD - Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense M, Denmark
• Anders Hansen: PhD - Medical Research Unit, Spine Centre of Southern Denmark, Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark