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Contributions of Mood, Pain Catastrophizing, and Cold Hyperalgesia in Acute and Chronic Low Back Pain: A Comparison With Pain-free Controls

Hübscher, Markus PhD*,†; Moloney, Niamh PhD*; Rebbeck, Trudy PhD*; Traeger, Adrian MPhty; Refshauge, Kathryn M. PhD*

doi: 10.1097/AJP.0000000000000045
Original Articles

Objectives: Quantitative sensory testing (QST) has been used to elucidate the peripheral and central mechanisms that underlie changes in pain sensitivity associated with low back pain (LBP). However, it remains unclear to what degree peripheral and central changes contribute to the generation and maintenance of LBP. The aim of this study was to compare thermal pain sensitivity, measured using QST, in participants with acute LBP, chronic LBP, and pain-free controls.

Materials and Methods: Participant groups with acute LBP (N=20), chronic LBP (N=30), and pain-free controls (N=30) were assessed by thermal QST. The unique contributions of pain-related psychological and QST variables to predict membership to the acute and chronic pain groups were also determined.

Results: We found that participants with chronic LBP demonstrated significantly lower cold pain threshold (CPT) in the primary area of pain (low back) as well as in an area anatomically remote from the primary area of pain (forearm) when compared with controls. Participants with acute LBP did not show significantly elevated pain sensitivity. CPT at the remote site was a significant independent predictor of membership to the chronic pain group, after the adjustment for mood and pain catastrophizing. CPT explained 8% of the total variance of 46% related to group membership.

Discussion: We found evidence for localized and generalized cold hyperalgesia in chronic, but not acute LBP. We might speculate that hyperalgesia develops as a consequence of long-lasting LBP, but prospective studies are needed to confirm this assumption.

*Faculty of Health Sciences

Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia

M.H. is supported by a postdoctoral fellowship from the German Academic Exchange Service (DAAD), Bonn, Germany. T.R. is supported by a National Health and Medical Research Council (NHMRC), Canberra, Australian Capital Territory, Australia of Australia Fellowship. The authors declare no conflict of interest.

Reprints: Markus Hübscher, PhD, Faculty of Health Sciences, University of New South Wales, 75 East St, Lidcombe, NSW 2141, Australia (e-mail:

Received July 14, 2013

Received in revised form November 29, 2013

Accepted October 15, 2013

© 2014 by Lippincott Williams & Wilkins