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Validity of a Paradigm for Low Back Pain Symptom Development During Prolonged Standing

Sorensen, Christopher J. MS*; Johnson, Molly B. MAmSAT, PhD; Callaghan, Jack P. PhD; George, Steven Z. PT, PhD§; Van Dillen, Linda R. PT, PhD*

The Clinical Journal of Pain: July 2015 - Volume 31 - Issue 7 - p 652–659
doi: 10.1097/AJP.0000000000000148
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Objectives: Examine the validity of an induced pain paradigm in which people stand while performing simulated light work tasks (standing paradigm).

Materials and Methods: Initially, people with low back pain (LBP) reported the quality and location of their typical symptoms on a body pain diagram. Then, people with LBP and back-healthy people stood for 2 hours and reported the intensity, quality, and location of symptoms at baseline and every 15 minutes. Quality and location of typical symptoms of people with LBP were compared with their symptoms during standing. Back-healthy people were separated into pain developers (PDs) and nonpain developers. Symptom quality and location were compared between people with LBP and PDs.

Results: There were no differences in the quality and location of typical symptoms and symptoms during standing in people with LBP (P>0.05). Three symptom descriptors were used by >30% of people with LBP to describe typical symptoms. Only 2 people with LBP used these descriptors to describe typical symptoms but not during standing. There were no differences in the quality and location of symptoms reported in standing between people with LBP and PDs (P>0.05). Four symptom descriptors were used by >30% of participants with LBP during standing. There were no symptoms reported by PDs that were not reported by people with LBP.

Discussion: This study provides evidence that symptoms experienced during the standing paradigm are similar to symptoms experienced by people with LBP and, thus, provides support for the validity of the paradigm.

*Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO

Integrated Motion Studio, Austin, TX

Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada

§Department of Physical Therapy, Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.clinicalpain.com.

C.J.S. was supported by the Washington University Institute of Clinical and Translational Sciences, St. Louis, MO; Grants UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH), Bethesda, MD. L.R.V.D. was receiving a Grant (R01 HD047709-04) from the NIH. The remaining authors declare no conflict of interest.

Reprints: Linda R. Van Dillen, PT, PhD, Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Blvd., Campus Box 8502, Saint Louis, MO 63108 (e-mail: vandillenl@wustl.edu).

Received December 9, 2013

Received in revised form August 9, 2014

Accepted August 9, 2014

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