305: Structured Sensory Acuity Training in Chronic Low Back Pain: A Pilot Randomized Controlled Study

Topic: Clinical Science

Please choose one of the following: Pain category (ICD-11)

Choose one of the following: Chronic primary musculoskeletal pain

Please choose one to three of the following: Non-pharmacological treatments, Assessment and Measurement of Pain/Nociception, Physiotherapy (e.g. exercise, rehab)

Background and Aims: Non-specific chronic low back pain (NCLBP) is a chronic and fluctuating condition with biopsychosocial etiology. It constitutes a significant global burden due to increasing healthcare costs, rehabilitation needs, and loss of workforce (1, 2). In NCLBP, impaired cortical body representations are associated with decreased sensory acuity, central sensitization, and functional impairment. Sensory acuity training (SAT), which targets cortical restructuring, is a promising approach in chronic pain management (3). The aim of this study was to investigate the effects of structured SAT on pain, functionality, and pain-related sensory and psychosocial outcomes.

Methods: All participants with NCLBP received conventional physiotherapy, including motor control exercises (MCE) (30 minutes) (8, 9), three times a week for four weeks. In addition, the experimental group (EG, n=5) received structured SAT (30 minutes), consisting of progressive tactile tasks involving localization (3, 4), orientation (5, 6), temporal acuity (7), and graphesthesia (3). The control group (CG, n=5) received MCE. Assessments were performed at baseline and post-intervention. Primary outcomes were pain (VAS) and Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes were Tampa Kinesiophobia Scale (TKS), Fremantle Back Awareness Questionnaire (FBAQ), Two-Point Discrimination Test (2PDT), range of motion (ROM), and Central Sensitization Inventory (CSI).

Results: The groups were initially comparable in terms of age and BMI (p>0.05). While VAS decreased significantly in both groups (EG: p<0.001; CG: p=0.001), the difference between the groups was significant after treatment (p=0.005). RMDQ (p=0.043), TKS (p=0.022), and FBAQ (p=0.037) showed significant improvement only in the experimental group; CSI decreased only in the control group (p=0.006). 2PDT (EG and CG: p<0.001) and lumbar flexion ROM (EG: p<0.001; CG: p=0.020) improved in both groups. There was no significant difference between the groups in these parameters after treatment (p>0.05).

Conclusions: While the SAT in NCLBP primarily focuses on localization, this study implemented a multidimensional program including orientation, temporal acuity, and graphesthesia. The greater pain reduction in the EG may relate to SAT-induced somatosensory reorganization. Improvement in disability, kinesiophobia, and lower back awareness in the EG suggests the intervention may affect maladaptive pain-related cognitions. The absence of intergroup differences in measures other than VAS, 2PDT, and ROM may reflect limited sample size and short duration. In addition, between-group similarities might partially reflect sensorimotor adaptations associated with MCE in both groups. Larger samples and longer follow-up are needed to confirm these findings.

References: 1. International Association for the Study of Pain (IASP). “The Global Burden of Low Back Pain”. International Association for the Study of Pain. https://www.iasppain.org/resources/fact-sheets/the-global-burden-of-low-back-pain/
2. Içağasıoğlu A, Yumuşakhuylu Y, Ketenci A, Toraman NF, Kaymak Karataş G, Kuru Ö, Kirazlı Y, Çapacı K, Eriman E, Haliloğlu S. Burden of chronic low back pain in the Turkish population. Turk J Phys Med Rehabil. 2015.
3. Moseley, G.L., Flor, H. 2012. “Targeting cortical representations in the treatment of chronic pain: a review”, Neurorehabilitation and Neural Repair, 26(6), 646–652.
Lluch-Girbés, E., Dueñas, L., Mena-Del Horno, S., Luque-Suarez, A., Navarro-Ledesma, S., Louw, A. 2019. “A central nervous system-focused treatment approach for people with frozen shoulder: Protocol for a randomized clinical trial”, Trials, 20(1), 1–12.
4. Wälti, P., Kool, J., Luomajoki, H. 2015. “Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial”, BMC Musculoskeletal Disorders, 16(1), 83.
5. Olthof, N.A., Coppieters, M.W., Moseley, G.L., Sterling, M., Chippindall, D.J., Harvie, D.S. 2021a. “Modernising tactile acuity assessment; clinimetrics of semi-automated tests and effects of age, sex and anthropometry on performance”, PeerJ, 9, e12192.
6. Olthof, N.A., Harvie, D.S., Henderson, C., Thompson, B., Sharp, R., Craig-Ward, L., Weermeijer, J.D., Sterling, M., Moseley, G.L., Coppieters, M.W. 2021b. “Description and psychometric properties of a prototype to test tactile acuity in the neck”, Musculoskeletal Science and Practice, 51, 102259.
7. Demoulin, C., Jodogne, L., David, C., Kaux, J. F., Vanderthommen, M. 2024. “Assessment of temporal somatosensory discrimination in females with fibromyalgia: Reliability and discriminative ability of a new assessment tool”, Sensors, 24(11), 3300.
8. Xu HR, Zhang Y, Zheng YL. The effect and mechanism of motor control exercise on low back pain: A narrative review. EFORT Open Rev. 2023;8:581-591. Available from: https://doi.org/10.1530/EOR-23-0057
9. Costa LO, Maher CG, Latimer J, et al. Motor control exercise for chronic low back pain: A randomized placebo-controlled trial. Phys Ther. 2009;89:1275-1286. Available from: https://doi.org/10.2522/ptj.20090218

Who is the presenting author?: Ayse GURLUK

Who is the senior author?: Ayse GURLUK

Special Interest Group (SIG) Poster/Travel Awards: Musculoskeletal Pain SIG

Is your abstract directly related to the IASP 2026 Global Year theme of Neuropathic Pain?: Yes
Co-Authors:

• PINAR KAYA SARIBAS: Associate Professor - Istanbul Medipol University
• EMRE DUNDER: Associate Professor - ONDOKUZ MAYIS UNIVERSITY