Gender Influences Radicular Pain Perception in Patients with Lumbar Disc Herniation

Tschugg, Anja; Löscher, Wolfgang N.; Hartmann, Sébastian; Neururer, Sabrina; Wildauer, Matthias; Thomé, Claudius

doi:10.1089/jwh.2014.5108

Cited by 31 publications

(20 citation statements)

References 26 publications

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“…The largest effect size was found for heat and pressure pain [11,22]. Women were more sensitive than men for many QST parameters, consistent with prior studies [22,23].…”

Section: Discussionsupporting

confidence: 87%

“…Although a huge number of studies measuring the outcome after surgical treatment have been published, there appears to have been little interest in gender aspects [5][6][7]. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders [4,[8][9][10][11][12]. Besides a variety of mechanisms that have been proposed to account for these sex-related differences, pain seems to be also influenced by differences in hypothalamic-pituitary-adenocortical responses [13].…”

Section: Introductionmentioning

confidence: 99%

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Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing

et al. 2016

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Background Quantitative sensory testing (QST) gained popularity to evaluate the time course of recovery in sensory dysfunction and the results of different treatment options. Concerning sex differences in lumbar spine surgery, female gender seems to play a major role as a negative prognostic factor in different spinal disorders. For this purpose, we hypothesised that there are also comparable differences in pain patterns in men and women after lumbar sequestrectomy using QST. Methods We applied the QST protocol of the German Research Network on Neuropathic Pain in 53 patients (21 women and 32 men) with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: BeckDepression-Inventory, Oswestry Disability Index, Core Outcome Measure Index, painDETECT-Questionnaire and EQ-5D thermometer. Results Our analyses showed lower heat thresholds in females preoperatively, that adjusted to that of males 1 week postoperatively. Pressure pain thresholds were lower in women as well, but differed between genders throughout the study. Vibration perception deficits resolve earlier in female than in male patients. Both, women and men, had an excellent overall improvement, postoperatively. Conclusion Our results clearly revealed pre-and postoperative differences in pain perception between genders. These differences have to be taken into account in the evaluation of outcome between genders. Therefore, QST seems to be a good method to evaluate the time course of recovery after surgery.

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“…The largest effect size was found for heat and pressure pain [11,22]. Women were more sensitive than men for many QST parameters, consistent with prior studies [22,23].…”

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing

et al. 2016

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“…Overall, the improvement of pain and sensory function after lumbar spine surgery may be associated with various factors, such as the severity of preoperative leg pain [16] or gender [17]. Pain perception thresholds, for example, seem to be lower in women than in men [17].…”

Section: Discussionmentioning

confidence: 99%

“…Pain perception thresholds, for example, seem to be lower in women than in men [17]. The outcome after surgery may also be influenced by the surgical technique itself.…”

Section: Discussionmentioning

confidence: 99%

Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing

et al. 2016

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Background Previous studies have investigated sensory recovery in patients with lumbar disc herniation using rather subjective methods. There have been no reports on changes of sensory function in patients suffering from a preoperative sensory deficit using quantitative sensory testing (QST). The aims of this prospective study were (1) to assess the recovery of preoperative sensory dysfunction after lumbar sequestrectomy and (2) to quantify the strength of relationship between a sensory deficit and the patient's quality of life. Methods We applied the QST protocol of the German Research Network on Neuropathic Pain (DFNS) in fiftytwo patients with a single lumbar disc herniation confirmed on MRI treated by lumbar sequestrectomy. Further evaluation included a detailed medical history, a physical examination, numeric rating scale for leg, EQ-5D questionnaire, and thermometer.Results Disc surgery resulted in a significant reduction of leg pain and a significant gain of quality of life. Thermal, mechanical, and vibration perception thresholds showed an obvious side-to-side difference preoperatively (p \ 0.005). An early recovery of mechanical and vibration perception thresholds was detected, whereas cold perception needed more than 6 months to recover (p \ 0.05). Quality of life was independent from perception thresholds, but correlated significantly with pain reduction. Conclusion Our data clearly show that there is a subjective and quantifiable improvement in sensory dysfunction postoperatively. The current data suggest that a sensory dysfunction does not influence a patient's quality of life.

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“…In the past decades, quantitative sensory testing (QST) gained popularity as a diagnostic tool to quantify pain and assess sensory function, especially to document a treatment’s effectiveness [9, 10, 16, 19–21]. QST is a psychophysiological test of different sensory modalities that permits a differential assessment of preserved sensation and also of subclinical deficits [4].…”

Section: Introductionmentioning

confidence: 99%

The value of quantitative sensory testing in spine research

et al. 2016

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The improvement of pain and functionality is the major goal of a surgical intervention. Thus, the purpose of the present prospective study was to evaluate whether subjective sensory deficits in patients with lumbar radiculopathy caused by a lumbar disc herniation are related to clinical status, using several outcome scores and the quantitative sensory testing (QST) pre- and 12 months postoperatively. We applied the QST in 52 patients with a single lumbar disc herniation treated by lumbar sequestrectomy pre- and 12 months postoperatively. Further evaluation included numeric rating scale (NRS) for leg, EuroQoL-5D (EQ-5D), Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI) and PaindDetect questionnaire (PD-Q). Patients were then categorized into two groups based on their subjective recovery of sensory function. The patients’ self-assessment and QST were correlated with each other for the pre- and postoperative visit after 12 months. The two groups showed postoperative differences in mechanical and vibration detection threshold as well as in the postoperative PD-Q (p < 0.005). Multidimensional scores did not consistently match the QST parameters in patients with a lumbar disc herniation. Commonly used clinical scores in spine research show low or no correlation with QST. Nevertheless, mechanical thresholds seem to play an important role to detect and follow up a sensory deficit investigated by QST.

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Gender Influences Radicular Pain Perception in Patients with Lumbar Disc Herniation

Abstract: Our results clearly indicate that sex differences in pain perception not only exist in healthy subjects, but also in patients with lumbar disc herniation. Therefore, it is essential to provide different treatment modalities to women and men.

Cited by 31 publications

References 26 publications

Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing

Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing

Improvement of sensory function after sequestrectomy for lumbar disc herniation: a prospective clinical study using quantitative sensory testing

The value of quantitative sensory testing in spine research

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