MWerneke et al. Spine. April (2001) Vol. 26 #7 p 758
A proposed new method for predicting chronicity of low back pain following an acute attack.
The authors propose that centralisation of pain within weeks of the acute attack may indicate a better outcome.
Centralisation phenomenon is where the pain migrates from the distal or peripheral to the proximal or central.
The authors conclude that the negative assessment of centralisation in the first few weeks is a useful predictor of continuing (long-term) pain and disability. However, the study was either not well designed or poorly reported.
Comment
A semi objective test would be very useful in selecting back pain cases that ought to be managed more closely. The method proposed here is not validated by this study, but it is likely (given the desire to find a physical explanation for disability) to be included in more comprehensive assessment of prognostic indicators.
A method for assessing centralisation needs to be fully validated before the proposal can be tested further. In our view it is too early to rely on centralisation phenomenon for clinical decisions.