Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia.
School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Eur J Pain. 2022 Mar;26(3):578-599. doi: 10.1002/ejp.1883. Epub 2021 Nov 14.
Nervous system, psychosocial and spinal tissue biomarkers are associated with non-specific low back pain (nsLBP), though relative contributions are unclear.
MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus were searched up to 25 March 2020. Related reviews and reference lists were also screened. Observational studies examining structural and functional nervous system biomarkers (e.g. quantitative sensory tests, structural and functional brain measures), psychosocial factors (e.g. mental health, catastrophizing) and structural spinal imaging biomarkers (e.g. intervertebral disc degeneration, paraspinal muscle size) between nsLBP and pain-free controls were included. For multivariate meta-analysis, two of three domains were required in each study. Random-effects pairwise and multivariate meta-analyses were performed. GRADE approach assessed evidence certainty. Newcastle-Ottawa scale assessed risk of bias. Main outcomes were the effect size difference of domains between nsLBP and pain-free controls.
Of 4519 unique records identified, 33 studies (LBP = 1552, referents = 1322) were meta-analysed. Psychosocial state (Hedges' g [95%CI]: 0.90 [0.69-1.10], p < 0.001) in nsLBP showed larger effect sizes than nervous system (0.31 [0.13-0.49], p < 0.001; difference: 0.61 [0.36-0.86], p < 0.001) and spine imaging biomarkers (0.55 [0.37-0.73], p < 0.001; difference: 0.36 [0.04-0.67], p = 0.027). The relationship between domains changes depending on if pain duration is acute or chronic.
Psychosocial effect sizes in nsLBP are greater than those for spinal imaging and nervous system biomarkers. Limitations include cross-sectional design of studies included and inference of causality. Future research should investigate the clinical relevance of these effect size differences in relation to pain intensity and disability.
PROSPERO-CRD42020159188.
Spinal structural lesions (e.g. intervertebral disc degeneration), psychosocial (e.g. depression) and nervous system factors (detected by e.g. quantitative sensory tests, structural and functional measures) contribute to non-specific low back pain. However, psychosocial factors may be more compromised than nervous system and spinal imaging biomarkers. This relationship depends on if the pain is acute or chronic. These findings underscore that the 'non-specific' label in back pain should be reconsidered, and more specific multidimensional categories evaluated to guide patient management.
神经系统、心理社会和脊柱组织生物标志物与非特异性下腰痛（nsLBP）相关，但相对贡献尚不清楚。
截至 2020 年 3 月 25 日，检索了 MEDLINE、EMBASE、CINAHL、PsycINFO 和 SPORTDiscus。还对相关综述和参考文献进行了筛选。纳入了观察性研究，这些研究检查了 nsLBP 与无疼痛对照之间的结构和功能神经系统生物标志物（例如定量感觉测试、结构和功能大脑测量）、心理社会因素（例如心理健康、灾难化）和结构脊柱成像生物标志物（例如椎间盘退变、脊柱旁肌肉大小）。对于多变量荟萃分析，每项研究中需要满足三个领域中的两个。进行了随机效应成对和多变量荟萃分析。GRADE 方法评估证据确定性。纽卡斯尔-渥太华量表评估偏倚风险。主要结局是 nsLBP 与无疼痛对照组之间各领域的域效应大小差异。
在 4519 个独特的记录中，有 33 项研究（LBP=1552，参照=1322）进行了荟萃分析。nsLBP 的心理社会状态（Hedges'g[95%CI]：0.90[0.69-1.10]，p<0.001）的效应大小大于神经系统（0.31[0.13-0.49]，p<0.001；差异：0.61[0.36-0.86]，p<0.001）和脊柱成像生物标志物（0.55[0.37-0.73]，p<0.001；差异：0.36[0.04-0.67]，p=0.027）。这些领域之间的关系变化取决于疼痛持续时间是急性还是慢性。
nsLBP 中的心理社会效应大小大于脊柱成像和神经系统生物标志物。局限性包括纳入研究的横断面设计和因果关系的推断。未来的研究应调查这些效应大小差异与疼痛强度和残疾的临床相关性。
PROSPERO-CRD42020159188。
脊柱结构病变（例如椎间盘退变）、心理社会因素（例如抑郁）和神经系统因素（通过定量感觉测试、结构和功能测量等检测）都会导致非特异性下腰痛。然而，与神经系统和脊柱成像生物标志物相比，心理社会因素可能更为受损。这种关系取决于疼痛是急性还是慢性。这些发现表明，背部疼痛的“非特异性”标签应该重新考虑，并评估更具体的多维类别，以指导患者管理。
