Publications by authors named "Liam Holm"

2 Publications

  • Page 1 of 1

Posterior to anterior spinal stiffness measured in a sample of 127 secondary care low back pain patients.

Clin Biomech (Bristol, Avon) 2021 Jul 10;87:105408. Epub 2021 Jun 10.

Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Spine Center of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark.

Background: The sensation of spinal stiffness is a commonly reported symptom among back pain patients, with the clinical assessment of spinal stiffness usually being part of the decision-making process when deciding on providing manual treatment of low back pain. While any relationship between spinal stiffness and low back pain is likely to be multifactorial, prior exploration of this relationship has been overly simplistic (e.g., univariate regression analyses). The purpose of this study was to address this gap by taking a broader approach to compare instrumented measures of spinal stiffness to demographic characteristics, pain phenotypes, psychometrics, and spine-related disability in a sample of secondary care low back pain patients using multivariate regression analysis.

Methods: Instrumented spinal stiffness measures from 127 patients in secondary care were used to calculate terminal and global spinal stiffness scores. A best subset analysis was used to find the subsets of 14 independent variables that most accurately predicted stiffness based on the evaluation of the adjusted R-square, Akaike Information Criteria, and the Bayesian Information Criteria.

Findings: In the resulting multivariate models, sex (p < 0.001) and age (p < 0.001) were the primary determinants of terminal stiffness, while global stiffness was primarily determined by age (p = 0.003) and disability (p = 0.024).

Interpretation: Instrumented measures of spinal stiffness are multifactorial in nature, and future research into this area should make use of multivariate analyses.
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July 2021

The inhibitory effect of conditioned pain modulation on temporal summation in low-back pain patients.

Scand J Pain 2021 May 26. Epub 2021 May 26.

Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark.

Objectives: The literature on conditioned pain modulation (CPM) is inconclusive in relation to low-back pain and it is unclear how CPM affects temporal summation as a proxy of central pain integration. The aim of this study was to examine whether the CPM effect would be different on pain induced by temporal summation than single stimuli in a group of low back pain patients.

Methods: A total of 149 low-back pain patients were included. CPM was examined using single, repeated and temporal summation (repeated-single difference) of mechanical pressure pain as test stimuli at an individualized, fixed supra-pain-threshold force, before and after 2 min of cold pressor test (0-2 degrees Celsius). Participants were categorized as CPM responders or non-responders according to three different criteria: (any pain inhibition), (pain inhibition of more than 10VAS) and (pain inhibition or facilitation of less than 10VAS). Clinical data on back pain was collected for correlation and descriptive purposes.

Results: Significant modulation was observed for all three test stimuli. Effects sizes were comparable in relative terms, but repeated pressure pain modulation was greater in absolute terms. No correlations to clinical data were observed, for any measure.

Conclusions: The current data suggests that repeated pressure pain may be better suited as the CPM test stimuli, than single pressure pain and temporal summation of pressure pain, as the CPM effect in absolute terms was greater. Employing temporal summation as the test stimulus in a CPM paradigm may be more sensitive than a single test stimulus.
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May 2021