Laser heat hyperalgesia is not a feature of non-specific chronic low back pain

• Published in: European journal of pain 2014-11, Vol.18 (10), p.1501-1508
• Main Authors: Franz, M., Ritter, A., Puta, C., Nötzel, D., Miltner, W.H.R., Weiss, T.
• Format: Article
• Language: English
• Subjects: Adult; Case-Control Studies; Chronic Pain - complications; Chronic Pain - physiopathology; Electroencephalography; Female; Hot Temperature; Humans; Hyperalgesia - etiology; Hyperalgesia - physiopathology; Lasers, Solid-State; Low Back Pain - complications; Low Back Pain - physiopathology; Male; Middle Aged; Pain Measurement; Pain Threshold - physiology
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1002/ejp.535

Background Based upon studies using mechanical pin‐prick, pressure, electrical or heat stimuli applied to painful and/or pain‐free parts of the body, chronic low back pain (CLBP) has been shown to be associated with generalized and enhanced pain sensitivity and altered brain responses to noxious stimuli. To date, no study examined the processing of noxious laser heat pulses, which are known to selectively excite thermal nociceptors located in the superficial skin layers, in CLBP. Methods We studied laser heat pain thresholds (LHPTs) and nociceptive laser‐evoked brain electrical potentials (LEPs) following skin stimulation of the pain‐affected back and the pain‐free abdomen using noxious laser heat stimulation in 16 CLBP patients and 16 age‐ and gender‐matched healthy controls (HCs). Results We observed no statistically significant differences in LHPTs between CLBP patients and HCs, neither on the back nor on the abdomen. Furthermore, we found no evidence for altered brain responses between CLBP patients and HCs in response to stimulation of the back and abdomen in single‐trial latencies and amplitudes of LEP components (N2, P2). Conclusion The results are in contrast to previous studies showing hypersensitivity to different experimental noxious stimuli (e.g., contact heat). We argue that these discrepancies may be due to low spatial and temporal summation within the central nervous system following laser heat stimulation. Our results indicate important methodological differences between laser heat and thermode stimulation that should be taken into account when interpreting results, such as from thermal quantitative sensory testing.