Central Sensitization and Physical Functioning in patients with Chronic Low Back Pain

Physical functioning is individuals’ capacity to perform everyday tasks which are essential for an independent living and/or quality of life. A limited functioning, often manifested in patients with CLBP, has a negative effect on participation. Limited functioning and participation is one of the main reasons to refer patients for pain rehabilitation. Until now, there is limited evidence to explain the limited functioning, despite of hundreds of studies that have investigated biological, psychological and social variables. One of the few variables that is consistently related to functioning, although to a moderate extend, is pain intensity. In the past decennia there is growing evidence for sensitization in (a relevant subsample of) patients with chronic pain. Central Sensitization is produced by nociceptor inputs that trigger a prolonged, but reversible, increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways (“pain pathways”). This increase in neural signalling may lower the threshold to activate noxious stimulus and, as a result, previously innocuous inputs are now sufficient to be felt as damaging. Thus, Central Sensitization is manifested as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. Theoretically, sensitization can be plausible linked to pain intensity and to physical functioning. Some evidence is found for the relation between sensitization and intensity of pain, but:

- The relationship between the measures for Central Sensitization is unknown.

- The relationship between the Central Sensitization and Physical Functioning measures is unknown.

- Whether a decrease in Central Sensitization levels is related to improved Physical Functioning is unknown.

Theoretically, central sensitization can be plausible linked to pain intensity and to physical functioning. Some evidence is found for the relation between sensitisation and intensity of pain, but not with physical functioning.

T0=Intake measurements

T1=Discharge measurement

The study is designed as close as possible to ‘care as usual’ for the patients.



Patients follow regular procedures according to Pain Rehabilitation team of the Center for Rehabilitation of the UMCG.

For the purposes of the study, additionally they perform sensitization and physical functioning tests during intake and discharge assessments, and fill out questionnaires during treatment.