Classifying patients with lumbar spinal stenosis using painDETECT: a cross-sectional study

Abstract

BackgroundThe pathological mechanisms of lumbar spinal stenosis are unclear. Family doctors in the primary care setting may perform medical examinations of patients with lumbar spinal stenosis. Our aim was to use the painDETECT questionnaire to quantify the pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis.MethodsWe enrolled 102 patients (37 men, 65 women) who had been newly diagnosed with lumbar spinal stenosis at 2 facilities. The patients’ conditions were evaluated using the painDETECT questionnaire, Numerical Rating Scale, Roland-Morris Disability Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and 36-Item Short-Form Health Survey. The pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis were classified based on results of the painDETECT questionnaire as nociceptive pain, neuropathic pain, or unclear type of pain (mixed pain). Statistical analyses were performed using the Kruskal–Wallis test. A value of p < 0.05 was considered to indicate statistical significance.ResultsThe mean age of all patients in this study was 70.3 ± 2 years. The male:female distribution was 37:65 (36.3:63.7 %). In all, 72 (70.6 %) patients had chronic pain (duration of ≥3 months), and 30 (29.4 %) had subacute or acute pain (duration of <3 months). The pain was classified as nociceptive in 59 patients (57.9 %), neuropathic in 18 (17.6 %), and unclear in 25 (24.5 %). The neuropathic pain group had a significantly lower quality of life (p < 0.05) than did the other groups.ConclusionsPatients with neuropathic back and/or leg pain caused by lumbar spinal stenosis may have lower physical and/or psychological quality of life than patients with such pain caused by other mechanisms.

Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years

“…These subjects were compared with those with any MSDs (group D). Age, gender, body mass index (BMI), pain, muscle strength, gait ability, balance, and common geriatric syndromes were examined in each group, Severities of LBP, sciatica, and knee joint pain were evaluated using a visual analogue scale (VAS); 0–100 mm), and neuropathic pain (NeP) was defined as ≥13 points on the pain DETECT questionnaire [15, 16]. QOL was evaluated using the physical component summary (PCS) and the mental component summary (MCS) on SF-36 (Japanese v.2.0) [17, 18].…”

Current understanding of the mixed pain concept: a brief narrative review

“…The concept of somatic pain conditions exhibiting a combination of nociceptive and neuropathic components has been reported in the literature for almost 20 years and recently with increasing frequency 10,16,17 . The term "mixed pain"used in reference to a pathophysiological category of painwas first employed by Grond and colleagues in 1999.…”

“…Notably, however, mixed pain has never been formally defined the term "mixed pain" does not appear in the IASP Taxonomy, and it is still missing in textbooks, educational programs, and guidelines of medical associations and health authorities. This lack of a formal definitioncoupled with the vagueness and imprecision inherent in the termhas resulted in "mixed pain" being inadequately used in an extensive array of contexts, including as a description for, among others: pain due to a primary injury and its secondary effects 9 ; pain that transitions from nociceptive pain to neuropathic pain 9 ; pain that yields ambiguous scores on neuropathic pain scoring tools, such as painDETECT 10 ; pain experienced by a non-homogeneous group of study patients 11 ; pain with combined elements of somatic, visceral and neuropathic pain 12 ; pain generated from combined central and peripheral pain mechanisms post-stroke 13 ; or simply pain occurring at multiple sites 14 .…”

Neuropathic Pain and Disability in Patients with Lumbar Spinal Stenosis

“…In our study, 41 patients (51.8%) had NeP according to the DN4 questionnaire, and this was shown to be correlated with increased BMI. In another study of 102 patients, the painDETECT questionnaire was used to show that nociceptive, neuropathic, and unclear pain were present in 57.9%, 17.6%, and 24.5% of patients, respectively (9). Even if the unclear pain is combined with the NeP group, the NeP rate still only reached 42.1%.…”

“…Neurogenic claudication and radicular pain are best described in the literature for patients with LSS (7,8). However, there are few studies on NeP in patients with spinal stenosis (9,10).…”