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Untangling nociceptive, neuropathic and neuroplastic mechanisms underlying the biological domain of back pain

    Julia M Hush

    * Author for correspondence

    Discipline of Physiotherapy, 75 Talavera Road, Macquarie University, North Ryde, NSW 2109, Australia. .

    ,
    Tasha R Stanton

    The Sansom Institute for Health Research, The University of South Australia, School of Health Sciences, City East Campus, GPO Box 2471, Adelaide, SA 5001, Australia

    Neuroscience Research Australia, Sydney, NSW 2031, Australia

    ,
    Philip Siddall

    Department of Pain Management, HammondCare, Greenwich Hospital, Greenwich, NSW 2065, Australia

    Sydney Medical School – Northern, University of Sydney, Sydney, NSW 2007, Australia

    ,
    Anna Marcuzzi

    Discipline of Physiotherapy, 75 Talavera Road, Macquarie University, North Ryde, NSW 2109, Australia

    Università di Pisa (Postgraduate Scholar), Lungarno Pacinotti, 43-56126, Italy

    &
    Nadine Attal

    Inserm U 987 & Centre d‘Evaluation et de Traitement de la Douleur, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France

    Université Versailles Saint Quentin, Versailles F-78035, France

    Published Online:https://doi.org/10.2217/pmt.13.11

    SUMMARY Current clinical practice guidelines advocate a model of diagnostic triage for back pain, underpinned by the biopsychosocial paradigm. However, limitations of this clinical model have become apparent: it can be difficult to classify patients into the diagnostic triage categories; patients with ‘nonspecific back pain‘ are clearly not a homogenous group; and mean effects of treatments based on this approach are small. In this article, it is proposed that the biological domain of the biopsychosocial model needs to be reconceptualized using a neurobiological mechanism-based approach. Recent evidence about nociceptive and neuropathic contributors to back pain is outlined in the context of maladaptive neuroplastic changes of the somatosensory system. Implications for clinical practice and research are discussed.

    Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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