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BMC Musculoskeletal Disorders

, 13:136

First Online: 03 August 2012Received: 01 June 2012Accepted: 23 July 2012


BackgroundPain conditions of the musculoskeletal system are very common and have tremendous socioeconomic impact. Despite its high prevalence, musculoskeletal pain remains poorly understood and predominantly non-specifically and insufficiently treated.

The group of chronic musculoskeletal pain patients is supposed to be heterogeneous, due to a multitude of mechanisms involved in chronic pain. Psychological variables, psychophysiological processes, and neuroendocrine alterations are expected to be involved. Thus far, studies on musculoskeletal pain have predominantly focused on the general aspects of pain processing, thus neglecting the heterogeneity of patients with musculoskeletal pain. Consequently, there is a need for studies that comprise a multitude of mechanisms that are potentially involved in the chronicity and spread of pain. This need might foster research and facilitate a better pathophysiological understanding of the condition, thereby promoting the development of specific mechanism-based treatments for chronic pain. Therefore, the objectives of this study are as follows: 1 identify and describe subgroups of patients with musculoskeletal pain with regard to clinical manifestations including mental co-morbidity and 2 investigate whether distinct sensory profiles or 3 distinct plasma levels of pain-related parameters due to different underlying mechanisms can be distinguished in various subgroups of pain patients.

Methods-DesignWe will examine a population-based chronic pain sample n = 100, a clinical tertiary care sample n = 100 and pain-free patients with depression or post-traumatic stress disorder and pain-free healthy controls each n = 30, respectively. The samples will be pain localisation matched by sex and age to the population-based sample. Patients will undergo physical examination and thorough assessments of mental co-morbidity including psychological trauma, perceptual and central sensitisation quantitative sensory testing, descending inhibition conditioned pain modulation, the diffuse noxious inhibitory control-like effect, as well as measurement of the plasma levels of nerve growth factor and endocannabinoids.

DiscussionThe identification of the underlying pathophysiologic mechanisms in different subgroups of chronic musculoskeletal pain patients will contribute to a mechanism-based subgroup classification. This will foster the development of mechanism-based treatments and holds promise to treat patients more sufficient.

KeywordsChronic non-specific musculoskeletal pain Endocannabinoids Mental comorbidity Pain drawing Pain extent Quantitative sensory testing Mechanism-based Subgroup classification Nerve growth factor Trauma Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-136 contains supplementary material, which is available to authorized users.

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Autor: Andreas Gerhardt - Mechthild Hartmann - Jonas Tesarz - Susanne Janke - Sabine Leisner - Günter Seidler - Wolfgang Eich


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