• Jo Nijs, Adri Apeldoorn, Hank Hallegraeff, Jacqui Clark, Rob Smeets, Annaleen Malfliet, Enrique L Girbes, Margot De Kooning, and Kelly Ickmans.
• Pain in Motion Research Group; Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium.
• Pain Physician. 2015 May 1;18(3):E333-46.

BackgroundLow back pain (LBP) is a heterogeneous disorder including patients with dominant nociceptive (e.g., myofascial low back pain), neuropathic (e.g., lumbar radiculopathy), and central sensitization pain. In order to select an effective and preferably also efficient treatment in daily clinical practice, LBP patients should be classified clinically as either predominantly nociceptive, neuropathic, or central sensitization pain.ObjectiveTo explain how clinicians can differentiate between nociceptive, neuropathic, and central sensitization pain in patients with LBP.Study DesignNarrative review and expert opinionSettingUniversities, university hospitals and private practicesMethodsRecently, a clinical method for the classification of central sensitization pain versus neuropathic and nociceptive pain was developed. It is based on a body of evidence of original research papers and expert opinion of 18 pain experts from 7 different countries. Here we apply this classification algorithm to the LBP population.ResultsThe first step implies examining the presence of neuropathic low back pain. Next, the differential diagnosis between predominant nociceptive and central sensitization pain is done using a clinical algorithm.LimitationsThe classification criteria are substantiated by several original research findings including a Delphi survey, a study of a large group of LBP patients, and validation studies of the Central Sensitization Inventory. Nevertheless, these criteria require validation in clinical settings.ConclusionThe pain classification system for LBP should be an addition to available classification systems and diagnostic procedures for LBP, as it is focussed on pain mechanisms solely.

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