Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain

Facilitated pain mechanisms and impaired pain inhibition are often found in chronic pain patients. This study compared clinical pain profiles, pain sensitivity, as well as pronociceptive and antinociceptive mechanisms in patients with localized low back pain (n = 18), localized neck pain (n = 17), low back and radiating leg pain (n = 18), or neck and radiating arm pain (n = 17). It was hypothesized that patients with radiating pain had facilitated pain mechanisms and impaired pain inhibition compared with localized pain patients. Cuff algometry was performed on the nonpainful lower leg to assess pressure pain threshold, tolerance, temporal summation of pain (increase in pain scores to 10 repeated stimulations at pressure pain tolerance intensity), and conditioning pain modulation (increase in pressure pain threshold during pain conditioning on the contralateral leg). Heat detection and heat pain threshold at the nonpainful hand were also assessed. Clinical pain intensity, psychological distress, and disability were assessed with questionnaires. Temporal summation of pain was increased in patients with radiating back pain compared with localized back pain (P