Omponents are prevalent in axial low back pain patients in more

Omponents are prevalent in axial low back pain patients in more than 10 and co-morbidities occur to a large extent. (2) Patients with chronic axial low back pain can be subdivided into subgroups with distinct patterns of perceived sensory abnormalities (sensory profiles). (3) IVD-surgery influences the pain experience towards a more neuropathic perception.*mean 6 standard deviation: **score .3 (strongly, very strongly). doi:10.1371/journal.pone.0068273.tPD-Q-score “positive” was found with the highest frequency in ASP015K clusters 3 and 4, while clusters 1 and 2 scored significantly lower (24.7 and 17.14 in clusters 3 and 4, respectively, 3.4 and 4.8 in clusters 1 and 2, respectively; see figure 1). Patients from cluster 4 had the highest values of spontaneous pain, while those from cluster 5 had the lowest values.Neuropathic Pain and Constellation of Sensory SymptomsIn this study 12.1 of axial low back pain patients scored positive on the PD-Q, i.e. suffered from sensory symptoms which are indicative of neuropathic pain components [17]. While others have found a higher proportion (36?5 ) of neuropathic pain in back pain cohorts [1,2,11,17] our finding matches studies that have been published previously [19]. Higher prevalence can be accounted by an overrepresentation of neuropathic pain patients in specialist centers comparable to the above mentioned studies [26]. Our study revealed that patients with axial lumbar back pain are characterized by a variety of different pain types and sensory symptoms that are mechanistically distinct. We performed a cluster analysis to identify relevant subgroups of patients who demonstrate characteristic sensory profiles (Fig. 3). In order to tailor an individual therapeutic concept relying on symptom assessment the underlying pain-generating pathological mechanisms need to be elucidated [8,21,22]. Nociceptive back pain is evoked by noxious stimulation of deep somatic structures in the lumbar spine, often induced by ingrowth of small nociceptive nerve-fibers into degenerated intervertebralCo-morbiditiesAll patients were PD-1/PD-L1 inhibitor 1 site screened for severity of depression and panic/ anxiety disorders as well as noticeable problems in their sleep behaviour. These co-morbidity data are depicted in table 1. Additionally, descriptive analysis on co-morbidities between the clusters was performed. The severity and frequencies of the investigated disorders are shown in table 3. Statistical significance was achieved between clusters 5 and 2 and 4 for sleep disturbance, between 5 and 4 for somnolence, between 5 and 2 and 3 for sleep quantity and between 5 and 2 for sleep adequacy (for all of the above: Tukey’s studentized range HSD test p,0.05). From these data it can be concluded that subgroup 5 is affected by comorbidities to the smallest extent of all groups that were analysed.Figure 1. Differences in PD-Q scores in the subgroups. The different scores calculated from the PD-Q are shown, revealing the proportion of positive, i.e. neuropathic and negative, i.e. non-neuropathic as well as unclear results. Patients from clusters 3 and 4 showed the tendency to score more neuropathic than those from clusters 1, 2 and 5. doi:10.1371/journal.pone.0068273.gSensory Profiles in Axial Low Back PainSensory Profiles in Axial Low Back PainFigure 2. Subgroups of patients based on their sensory symptoms. To identify relevant subgroups of patients who are characterized by a characteristic symptom constellation a hierarchical cluster analysis w.Omponents are prevalent in axial low back pain patients in more than 10 and co-morbidities occur to a large extent. (2) Patients with chronic axial low back pain can be subdivided into subgroups with distinct patterns of perceived sensory abnormalities (sensory profiles). (3) IVD-surgery influences the pain experience towards a more neuropathic perception.*mean 6 standard deviation: **score .3 (strongly, very strongly). doi:10.1371/journal.pone.0068273.tPD-Q-score “positive” was found with the highest frequency in clusters 3 and 4, while clusters 1 and 2 scored significantly lower (24.7 and 17.14 in clusters 3 and 4, respectively, 3.4 and 4.8 in clusters 1 and 2, respectively; see figure 1). Patients from cluster 4 had the highest values of spontaneous pain, while those from cluster 5 had the lowest values.Neuropathic Pain and Constellation of Sensory SymptomsIn this study 12.1 of axial low back pain patients scored positive on the PD-Q, i.e. suffered from sensory symptoms which are indicative of neuropathic pain components [17]. While others have found a higher proportion (36?5 ) of neuropathic pain in back pain cohorts [1,2,11,17] our finding matches studies that have been published previously [19]. Higher prevalence can be accounted by an overrepresentation of neuropathic pain patients in specialist centers comparable to the above mentioned studies [26]. Our study revealed that patients with axial lumbar back pain are characterized by a variety of different pain types and sensory symptoms that are mechanistically distinct. We performed a cluster analysis to identify relevant subgroups of patients who demonstrate characteristic sensory profiles (Fig. 3). In order to tailor an individual therapeutic concept relying on symptom assessment the underlying pain-generating pathological mechanisms need to be elucidated [8,21,22]. Nociceptive back pain is evoked by noxious stimulation of deep somatic structures in the lumbar spine, often induced by ingrowth of small nociceptive nerve-fibers into degenerated intervertebralCo-morbiditiesAll patients were screened for severity of depression and panic/ anxiety disorders as well as noticeable problems in their sleep behaviour. These co-morbidity data are depicted in table 1. Additionally, descriptive analysis on co-morbidities between the clusters was performed. The severity and frequencies of the investigated disorders are shown in table 3. Statistical significance was achieved between clusters 5 and 2 and 4 for sleep disturbance, between 5 and 4 for somnolence, between 5 and 2 and 3 for sleep quantity and between 5 and 2 for sleep adequacy (for all of the above: Tukey’s studentized range HSD test p,0.05). From these data it can be concluded that subgroup 5 is affected by comorbidities to the smallest extent of all groups that were analysed.Figure 1. Differences in PD-Q scores in the subgroups. The different scores calculated from the PD-Q are shown, revealing the proportion of positive, i.e. neuropathic and negative, i.e. non-neuropathic as well as unclear results. Patients from clusters 3 and 4 showed the tendency to score more neuropathic than those from clusters 1, 2 and 5. doi:10.1371/journal.pone.0068273.gSensory Profiles in Axial Low Back PainSensory Profiles in Axial Low Back PainFigure 2. Subgroups of patients based on their sensory symptoms. To identify relevant subgroups of patients who are characterized by a characteristic symptom constellation a hierarchical cluster analysis w.