Preoperative back pain is associated with diverse manifestations of central neuroplasticity

Oliver H.G. Wilder-Smith, Edömer Tassonyi, Lars Arendt-Nielsen

Research output: Contribution to journalArticle

78 Citations (Scopus)


Increased or decreased gain in central nervous system processing after surgery, i.e. neuroplasticity, may play an important role in postoperative pain. Identification of patient subgroups particularly vulnerable to either type of post-surgical neuroplasticity is thus of interest. Preoperative pain has also been suggested to increase vulnerability to post-surgical chronic pain complications due to central facilitation. To study if back pain preoperatively is associated with differences in central sensory processing, we measured transcutaneous electric sensation, pain detection and pain tolerance thresholds at the upper arm, lower back and lower leg in 52 consecutive patients scheduled for back surgery in a blinded, prospective fashion. Patients with no pain had significantly lower pain thresholds than patients with pain in the leg, and significantly higher pain thresholds than those with pain in the back. These results suggest that preoperative pain can induce diverse central neuroplastic changes, i.e. inhibition and facilitation, and that the nature of this neuroplasticity depends on the nature of the pain involved. The presence of facilitation may be the basis of the increased vulnerability described in some studies of patients with significant preoperative pain, whereas the implications of reduced pain sensitivity are less clear. The demonstration of neuroplasticity and its diversity are, however, likely to be of significant clinical relevance.

Original languageEnglish
Pages (from-to)189-194
Number of pages6
Issue number3
Publication statusPublished - Jun 19 2002


  • Descending noxious inhibitory controls
  • Neuroplasticity (facilitation, inhibition)
  • Pain (preoperative, back, chronification, complications)
  • Quantitative sensory testing (sensory thresholds, pain thresholds)

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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