Efficacy of sensory discrimination training in chronic low back pain

The aim of our randomized controlled study was to investigate the efficacy of sensory discrimination training (SDT), applied in addition to motor control training (MCT), on cortical reorganization, pain and disability in chronic low back pain (CLBP) with predominant central sensitization (CS). A total of 30 patients diagnosed with CLBP were randomly included in Group I or Group II. MCT was applied to Group I for 30 minutes a day, twice a week, for 10 weeks. Group II was given 10 minutes of SDT in addition to MCT. Cortical reorganization of participants; two-point discrimination (TPD), tactile localization (Point-to-Point Test), proprioception (reposition error) and lumbopelvic motor control were evaluated. Pain intensities of the participants at rest, activity and night were evaluated using the Numerical Pain Rating Scale (NPRS); primary and widespread hyperalgesia levels were evaluated with pain pressure threshold. Participants' CS symptoms (Central Sensitization Scale), catastrophizing (Pain Catastrophizing Scale), disability (Oswestry Low Back Pain Disability Questionnaire-ODI), kinesiophobia (Fear Avoidance Beliefs Questionnaire), quality of life (Short Form 12) and satisfaction (Global Change Scale-GRC) levels were evaluated. All evaluations were repeated three times before treatment, at the 6th week and at the 10th week. As a result of our study, data from a total of 27 patients (Group I: n=15, mean age: 46.50 (27.5) years, body mass index (BMI): 25.38 (0.92) kg/m2; Group II: n=15, mean age: 37.33 (1.60) years, BMI: 25.62 (0.75) kg/m2) were analyzed. At the end of 10 weeks, it was observed that the mean differences between the groups in all parameters were significant in favor of Group II (p=0.001). For TPD, which was the primary outcome, effect sizes were found to be between 0.84 and 2.89 in Group II, while they were between 0.06 and 0.75 in Group I. In addition, a significant difference with a similar effect size (d>0.80) was detected in the NPRS and ODI scores in both groups (p<0.05). At the end of treatment, GRC scores were found to be statistically significantly higher in Group II (p=0.04). The results of our study showed that in chronic low back pain with predominant central sensitization, sensory discrimination training applied in addition to motor control training for 10 weeks provides better treatment results and is also more effective in two-point discrimination and proprioception.