Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain

Abstract

Study DesignA noninterventional, multicenter, cross-sectional study.PurposeWe investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP).Overview of LiteratureAmong patients with CLBP, 20%–55% had NP.MethodsPatients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4<4) groups.ResultsA total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p<0.01), in patients who had pain based on radiological and neurological findings (59.0%; p<0.01), and in patients who had severe pain (49.0%; p<0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p<0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p<0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p<0.01) and higher QBPDS (β=7.0; p<0.01) scores than those without NP.ConclusionsNP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.

Does the presence of neuropathic pain affect the outcomes of the interlaminar epidural steroid injection for cervical disc herniation?

“…[ 27 ] The relatively poor treatment outcomes among the NP predominant patients compared with those with nociceptive pain can be attributed to the structural alteration of the synapses in the cornu of the spinal cord, interneurons, and glial cells which are involved in the development and chronicity of NP, and glial activation-induced central sensitization. [ 28 ] In other respects, the fact that the initial pain scores in patients with NP were higher than those with nociceptive pain may be the reason for the difference between the 2 groups during follow-ups. On the other hand, the ratio of patients with MCIC were similar between groups at any time points which suggests that ILESI is effective in both nociceptive and neuropathic components of pain and the NP symptoms and signs before the intervention do not adversely affect the treatment outcomes.…”

Comparison of treatment outcomes in lumbar central stenosis patients treated with epidural steroid injections: interlaminarversusbilateral transforaminal approach

“…The better results in all post-treatment follow-up parameters in the ILESI group, compared to the TFESI group, might be related to the higher rate of the neuropathic component in the TFESI group. The possible negative effects of the neuropathic component on therapeutic responses might be a result of the structural changes in the synapses of the spinal conus, interneurons, and glial cells, and central sensitization mechanisms related to the glial activation [24].…”

Effectiveness of Pregabalin Treatment for Neuropathic Pain in Patients with Spine Diseases: A Pooled Analysis of Two Multicenter Observational Studies in Japan

“…6 NeP is common among patients with chronic pain associated with spine diseases, with a reported prevalence as high as 53.3%. 5 Involvement of NeP further increases the burden of chronic pain in patients, including pain intensity, 7–9 quality of life (QOL), 8–11 and sleep interference, 9 , 10 and interference with daily activities, 10 when compared to chronic pain without an NeP component. Considering the indirect effect of pain on QOL (T Taguchi, personal unpublished data), 12 , 13 pain relief with pharmacological treatment is a cornerstone for NeP management to reduce the multifaceted burdens.…”