Altered central pain processing assessed by quantitative sensory testing in patients with failed back surgery syndrome

Neurophysiol Clin. 2022 Nov;52(6):427-435. doi: 10.1016/j.neucli.2022.10.005. Epub 2022 Nov 19.


Objective: To investigate the presence of altered central pain processing in patients with failed back surgery syndrome (FBSS) using quantitative sensory testing (QST).

Methods: This study included 34 patients with FBSS, 102 patients post-lumbar surgery without low back pain (LBP), and 102 healthy subjects. All subjects underwent both pressure pain threshold (PPT) and conditioned pain modulation (CPM) in both local and remote pain-free areas, as well as temporal summation (TS) in a remote pain-free area. All patient subjects were assessed using the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), Beck Depression Index (BDI), Numeric rating pain scale (NRS) and Oswestry Disability Index (ODI).

Results: Compared with both control groups, FBSS patients showed a reduction in both PPT and CPM in both tested areas, along with increased TS in a pain-free area (P < 0.05). Furthermore, the patients with FBSS had a significantly higher prevalence of anxiety, depression and pain catastrophizing thoughts than the patient controls (P < 0.05). In the FBSS patients, there was a significant correlation between LBP at rest and both CPM and TS in the pain-free areas, and QST measurements were also associated with the ODI, PCS and BAI (P < 0.05).

Conclusion: These findings support the existence of augmented central pain processing in patients with FBSS, which may be caused by dysfunction of endogenous pain facilitation and inhibition. This central amplification of pain may contribute to both LBP intensity and disability in FBSS patients. Therefore, treatment efforts should take into account functional alterations in the central nervous system of FBSS patients.

Keywords: Central sensitization; Conditioned pain modulation; Failed back surgery syndrome; Quantitative sensory testing; Temporal summation.

MeSH terms

  • Anxiety
  • Failed Back Surgery Syndrome* / complications
  • Failed Back Surgery Syndrome* / diagnosis
  • Healthy Volunteers
  • Humans
  • Neuralgia*
  • Pain Threshold