Table 3 Definitions and Evidence-Based Criteria for Conditions Arising From Nociceptive Signaling

Diagnosis Diagnostic Criteria/Tools Evidence Base

Nociceptive pain
Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors •Clear proportionate mechanical/anatomical nature to symptoms•Pain in proportion to trauma/pathology•Pain in area of injury/dysfunction with/without referral•Resolving consistent with expected tissue healing time•Usually intermittent and sharp with movement/mechanical provocation•Pain in association with other symptoms of inflammation (eg, swelling, redness) Expert consensus-based IASP criteria ¹⁴ ^, ⁵⁷

Discogenic pain
Pain from nociceptive signaling within the intervertebral disc •Centralization phenomenon Diagnostic utility studies using an objective standard diagnosis ¹⁵

Myofascial pain
Pain from nociceptive signaling within muscle, tendon, and/or fascial tissues of the low back region •Tenderness within a muscle with or without referred pain•Reproduction of familiar pain with palpation or use No standard criteria exist: Recommendation based on definitions consistent with IASP terminology ¹⁴

Sacroiliac joint pain
Pain from nociceptive signaling within and surrounding a sacroiliac joint(s) 3 or more positive provocation tests reproducing familiar pain:•Distraction•Compression•Thigh thrust•Gaenslen’s left or right•Sacral thrust or Patrick’s test Diagnostic utility studies using an objective standard diagnosis ¹⁵ ^, ²²

Zygapophyseal (facet) joint pain
Pain from nociceptive signaling within and surrounding a facet joint(s) ⁶⁰ 3 or more:•Age over 50 y•Onset paraspinal•Pain relieved with walking•Pain relieved with sitting•Positive extension-rotation test Diagnostic utility study using an objective standard diagnosis ⁶⁹

Nociceptive vs neuropathic pain •DN4•PainDETECT questionnaire•LANSS Pain Scale•Neuropathic Pain Questionnaire•ID Pain questionnaire•PROMIS PQ-Neuro Experimentally derived instruments based on expert consensus criteria demonstrating reliability, acceptable psychometric properties, and face validity ³¹ ^, ³² ^, ^34-36 ^, ⁴¹ ^, ⁴² ^, ⁴⁷ ^, ⁵¹ ^, ⁷⁰

DN4 = Douleur Neruopathique 4;
IASP = International Association for the Study of Pain;
LANSS = Leeds Assessment of Neuropathic Symptoms and Signs;
PROMIS PQ-Neuro = Patient-Reported Outcome Measurement Information System Neuropathic Pain Quality Scale.

Diagnosis	Diagnostic Criteria/Tools	Evidence Base
Nociceptive pain Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors	•Clear proportionate mechanical/anatomical nature to symptoms•Pain in proportion to trauma/pathology•Pain in area of injury/dysfunction with/without referral•Resolving consistent with expected tissue healing time•Usually intermittent and sharp with movement/mechanical provocation•Pain in association with other symptoms of inflammation (eg, swelling, redness)	Expert consensus-based IASP criteria ¹⁴ ^, ⁵⁷
Discogenic pain Pain from nociceptive signaling within the intervertebral disc	•Centralization phenomenon	Diagnostic utility studies using an objective standard diagnosis ¹⁵
Myofascial pain Pain from nociceptive signaling within muscle, tendon, and/or fascial tissues of the low back region	•Tenderness within a muscle with or without referred pain•Reproduction of familiar pain with palpation or use	No standard criteria exist: Recommendation based on definitions consistent with IASP terminology ¹⁴
Sacroiliac joint pain Pain from nociceptive signaling within and surrounding a sacroiliac joint(s)	3 or more positive provocation tests reproducing familiar pain:•Distraction•Compression•Thigh thrust•Gaenslen’s left or right•Sacral thrust or Patrick’s test	Diagnostic utility studies using an objective standard diagnosis ¹⁵ ^, ²²
Zygapophyseal (facet) joint pain Pain from nociceptive signaling within and surrounding a facet joint(s) ⁶⁰	3 or more:•Age over 50 y•Onset paraspinal•Pain relieved with walking•Pain relieved with sitting•Positive extension-rotation test	Diagnostic utility study using an objective standard diagnosis ⁶⁹
Nociceptive vs neuropathic pain	•DN4•PainDETECT questionnaire•LANSS Pain Scale•Neuropathic Pain Questionnaire•ID Pain questionnaire•PROMIS PQ-Neuro	Experimentally derived instruments based on expert consensus criteria demonstrating reliability, acceptable psychometric properties, and face validity ³¹ ^, ³² ^, ^34-36 ^, ⁴¹ ^, ⁴² ^, ⁴⁷ ^, ⁵¹ ^, ⁷⁰