MasterclassDiagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism
Section snippets
The need to classify CLBP disorders
Low back pain (LBP) is common with up to 80% of people reporting LBP over their life time (Dillingham, 1995). The majority of acute LBP disorders resolve within a 4 week period although recurrence is common (Croft et al., 1998). A small number of disorders (10–40%) become chronic and represent a major cost burden for society (Dillingham, 1995; Croft et al., 1998). In spite of the small number of pathological conditions that can give rise to back pain, most cases (85%) are classified as
Models for the diagnosis and classification of CLBP
Current approaches or models used for the diagnosis and classification of CLBP have tended to only focus on a single dimension of the disorder, limiting their validity (Ford et al., 2003). The following overview is not designed to be exhaustive, but highlights to the clinician the strengths and weaknesses of these different approaches.
Diagnosis and classification of back pain
The Quebec task force classification system provides a logical approach for the diagnosis and classification of LBP disorders within a biopsychosocial framework (Spitzer, 1987; Abenhaim et al., 2000; Waddell, 2004). Under this framework red flags are considered in a diagnostic triage. The patient is screened for yellow flags or non-organic features suggestive of psychological and/or social factors dominating in the disorder. Under this classification system, disorders can be diagnosed as
Validity of the classification system
There is a growing concensus within the literature that current diagnostic and classification approaches for CLBP are limited, and a mechanism based classification of CLBP disorders from a biopsychosocial perspective is required (McCarthy et al., 2004). Although considerable research has documented the biopsychosocial nature of CLBP, further research is required to test the validity of this approach in management of CLBP disorders to determine whether it predicts and indeed improves patient
Summary
CLBP disorders must be considered within a biopsychosocial framework. The presence and dominance of the potential pathoanatomical, physical, neurophysiological, psychological and social factors that may impact on these disorders is different for each individual with CLBP. This highlights the enormous complexity and individual nature of the problem. It is critical that classification of CLBP pain disorders be based on the mechanism (s) underlying and driving the disorder. It is proposed that
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