Physiotherapy theory and practice · 2026
The relationship between central sensitization, body awareness, pain, and muscle endurance in patients with chronic nonspecific low back pain.
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Güneş Musa, İmanur Seher, Aydoğan Elif, Turan Bedirhan, Apaydın Aydin Sinan
Аннотация
BACKGROUND: Central sensitization (CS), which alters how the central nervous system processes pain stimuli, leading to increased sensitivity, is a significant component of chronic pain and can also affect patients with low back pain. Beyond increased pain, this condition can also impact body awareness and muscle endurance. However, the relationship between CS severity and clinical outcomes in chronic nonspecific low back pain (CNLBP) remains unclear.
OBJECTIVE: To compare pain severity, pressure pain threshold (PPT), disability, muscle endurance, and body and low back awareness across CS-related symptoms severity in patients with CNLBP, and to examine the relationships between these variables.
METHODS: This study included 103 patients CNLBP referred from the neurosurgery clinic. Patients were divided into two groups according to Central Sensitization Inventory (CSI) scores: high CSI and low CSI. Pain severity (Visual Analog Scale (VAS)), PPT, disability (Oswestry Disability Index (ODI)), muscle endurance, body (Body Awareness Questionnaire (BAQ)), and low back awareness (Fremantle Back Awareness Questionnaire (FreBAQ)) were evaluated.
RESULTS: According to CSI, 43.7% of the patients had high CSI. Patients in the high CSI group had statistically significantly higher VAS, ODI, and FreBaQ scores compared to the low CSI group (p < .05), while PPT, muscle endurance, and BAQ values were lower (p < .05). Lower muscle endurance (Odds ratio (OR)=0.963, p = .041) and BAQ (OR = 0.970, p = .017) scores, and higher FreBaQ (OR = 1.122, p = .006) scores were associated with a significant increase in the probability of high CSI (p < .001).
CONCLUSION: Patients with high CSI in CNLBP experience increased pain and disability, decreased PPT and muscle endurance, and worsening body and low back awareness. Furthermore, impaired muscle endurance and awareness are associated with an increased likelihood of a high CSI. Therefore, to effectively manage CNLBP, CS-related symptoms should be identified early, and their relationships with psychosocial factors affecting patients' pain experience should be assessed. ClinicalTrials number: NCT06958263.
OBJECTIVE: To compare pain severity, pressure pain threshold (PPT), disability, muscle endurance, and body and low back awareness across CS-related symptoms severity in patients with CNLBP, and to examine the relationships between these variables.
METHODS: This study included 103 patients CNLBP referred from the neurosurgery clinic. Patients were divided into two groups according to Central Sensitization Inventory (CSI) scores: high CSI and low CSI. Pain severity (Visual Analog Scale (VAS)), PPT, disability (Oswestry Disability Index (ODI)), muscle endurance, body (Body Awareness Questionnaire (BAQ)), and low back awareness (Fremantle Back Awareness Questionnaire (FreBAQ)) were evaluated.
RESULTS: According to CSI, 43.7% of the patients had high CSI. Patients in the high CSI group had statistically significantly higher VAS, ODI, and FreBaQ scores compared to the low CSI group (p < .05), while PPT, muscle endurance, and BAQ values were lower (p < .05). Lower muscle endurance (Odds ratio (OR)=0.963, p = .041) and BAQ (OR = 0.970, p = .017) scores, and higher FreBaQ (OR = 1.122, p = .006) scores were associated with a significant increase in the probability of high CSI (p < .001).
CONCLUSION: Patients with high CSI in CNLBP experience increased pain and disability, decreased PPT and muscle endurance, and worsening body and low back awareness. Furthermore, impaired muscle endurance and awareness are associated with an increased likelihood of a high CSI. Therefore, to effectively manage CNLBP, CS-related symptoms should be identified early, and their relationships with psychosocial factors affecting patients' pain experience should be assessed. ClinicalTrials number: NCT06958263.