AAPT Diagnostic Criteria for Chronic Low Back Pain

John D Markman; Katarzyna Czerniecka-Foxx; Partap S Khalsa; Salim Michel Hayek; Anthony L Asher; John D Loeser; Roger Chou

doi:10.1016/j.jpain.2020.01.008

AAPT Diagnostic Criteria for Chronic Low Back Pain

J Pain. 2020 Feb 6;S1526-5900(20)30009-2. doi: 10.1016/j.jpain.2020.01.008. Online ahead of print.

Authors

John D Markman¹, Katarzyna Czerniecka-Foxx², Partap S Khalsa³, Salim Michel Hayek⁴, Anthony L Asher⁵, John D Loeser⁶, Roger Chou⁷

Affiliations

¹ Translational Pain Research Program, Department of Neurosurgery, University of Rochester, Rochester, New York. Electronic address: john_markman@urmc.rochester.edu.
² Department of Neurosurgery, University of Rochester, Rochester, New York.
³ National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.
⁴ Division of Pain Medicine, Department of Anesthesiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
⁵ Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Atrium Health, Charlotte, North Carolina.
⁶ Department of Neurological Surgery, University of Washington, Seattle, Washington.
⁷ Department of Medicine, Oregon Health & Science University, Portland, Oregon.

PMID: 32036046
DOI: 10.1016/j.jpain.2020.01.008

Abstract

Chronic low back pain (CLBP) conditions are highly prevalent and constitute the leading cause of disability worldwide. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the US Food and Drug Administration and the American Pain Society (APS), have combined to create the ACTTION-APS Pain Taxonomy (AAPT). The AAPT initiative convened a working group to develop diagnostic criteria for CLBP. The working group identified 3 distinct low back pain conditions which result in a vast public health burden across the lifespan. This article focuses on: 1) the axial predominant syndrome of chronic musculoskeletal low back pain, 2) the lateralized, distally-radiating syndrome of chronic lumbosacral radicular pain 3) and neurogenic claudication associated with lumbar spinal stenosis. This classification of CLBP is organized according to the AAPT multidimensional framework, specifically 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. PERSPECTIVE: An evidence-based classification of CLBP conditions was constructed for the AAPT initiative. This multidimensional diagnostic framework includes: 1) core diagnostic criteria; 2) common features; 3) medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Keywords: Chronic low back pain; diagnostic criteria; lumbar spinal stenosis; neurogenic claudication; radicular back pain; sciatica.