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Physiotherapy Theory and Practice
An International Journal of Physical Therapy
Volume 34, 2018 - Issue 8
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Case Report

Sensory dissociation in chronic low back pain: Two case reports

, MSc, , PhD, , MD & , Full Professor
Pages 643-651 | Received 19 Oct 2016, Accepted 27 Apr 2017, Published online: 11 Jan 2018
 

ABSTRACT

Patients with chronic low back pain often report that they do not perceive their painful back accurately. Previous studies confirmed that sensory dissociation and/or discrepancy between perceived body image and actual size is one of the specific traits of patients with chronic pain. Current approaches for measuring sensory dissociation are limited to two-point-discrimination or rely on pain drawings not allowing for quantitative analysis. This case study reports the sensory dissociation of two cases with chronic low back pain using a recently published test (point-to-point-test (PTP)) and a newly developed test (two-point-estimation (TPE)). Both patients mislocalized tactile stimuli delivered to the painful location compared to non-painful locations (PTP test). In addition, both patients perceived their painful lumbar region differently from non-painful sites above and below and contralateral to the painful site. TPE data showed two distinct clinical patterns of sensory dissociation: one patient perceived the two-point distance in the painful area as expanded, while the other patient perceived it as shrunk. The latter pattern of sensory dissociation (i.e., pattern shrunk) is likely to respond to sensory training. Whether enlarged patterns of sensory dissociation are more resistant to treatment remains unknown but would explain the low effectiveness of previous studies using sensory training in chronic low back pain populations. Subgrouping patients according to their sensory discrimination pattern could contribute to the choice and effectiveness of the treatment approach.

Declaration of interest

The authors report none.

Additional information

Funding

Wacław Adamczyk is supported by the scholarship awarded within grant #2014/14/E/HS6/00415 founded by the National Science Centre in Poland.

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