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

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          Abstract

          Study Design

          A noninterventional, multicenter, cross-sectional study.

          Purpose

          We 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 Literature

          Among patients with CLBP, 20%–55% had NP.

          Methods

          Patients 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.

          Results

          A 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.

          Conclusions

          NP 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.

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          Most cited references 30

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          painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain.

          Nociceptive and neuropathic components both contribute to pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is highly desirable. As low back pain (LBP) patients constitute an important subgroup of chronic pain patients, we addressed the following issues: (i) to establish a simple, validated screening tool to detect neuropathic pain (NeP) components in chronic LBP patients, (ii) to determine the prevalence of neuropathic pain components in LBP in a large-scale survey, and (iii) to determine whether LBP patients with an NeP component suffer from worse, or different, co-morbidities. In co-operation with the German Research Network on Neuropathic Pain we developed and validated the painDETECT questionnaire (PD-Q) in a prospective, multicentre study and subsequently applied it to approximately 8000 LBP patients. The PD-Q is a reliable screening tool with high sensitivity, specificity and positive predictive accuracy; these were 84% in a palm-top computerised version and 85%, 80% and 83%, respectively, in a corresponding pencil-and-paper questionnaire. In an unselected cohort of chronic LBP patients, 37% were found to have predominantly neuropathic pain. Patients with NeP showed higher ratings of pain intensity, with more (and more severe) co-morbidities such as depression, panic/anxiety and sleep disorders. This also affected functionality and use of health-care resources. On the basis of given prevalence of LBP in the general population, we calculated that 14.5% of all female and 11.4% of all male Germans suffer from LBP with a predominant neuropathic pain component. Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients. Since NeP correlates with more intense pain, more severe co-morbidity and poorer quality of life, accurate diagnosis is a milestone in choosing appropriate therapy.
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            Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).

            Few studies have directly compared the clinical features of neuropathic and non-neuropathic pains. For this purpose, the French Neuropathic Pain Group developed a clinician-administered questionnaire named DN4 consisting of both sensory descriptors and signs related to bedside sensory examination. This questionnaire was used in a prospective study of 160 patients presenting with pain associated with a definite neurological or somatic lesion. The most common aetiologies of nervous lesions (n=89) were traumatic nerve injury, post herpetic neuralgia and post stroke pain. Non-neurological lesions (n=71) were represented by osteoarthritis, inflammatory arthropathies and mechanical low back pain. Each patient was seen independently by two experts in order to confirm the diagnosis of neuropathic or non-neuropathic pain. The prevalence of pain descriptors and sensory dysfunctions were systematically compared in the two groups of patients. The analysis of the psychometric properties of the DN4 questionnaire included: face validity, inter-rater reliability, factor analysis and logistic regression to identify the discriminant properties of items or combinations of items for the diagnosis of neuropathic pain. We found that a relatively small number of items are sufficient to discriminate neuropathic pain. The 10-item questionnaire developed in the present study constitutes a new diagnostic instrument, which might be helpful both in clinical research and daily practice.
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              The neuro-immune balance in neuropathic pain: involvement of inflammatory immune cells, immune-like glial cells and cytokines.

              In a large proportion of individuals nervous system damage may lead to a debilitating chronic neuropathic pain. Such pain may now be considered a neuro-immune disorder, since recent data indicate a critical involvement of innate and adaptive immune responses following nerve injury. Activation of immune and immune-like glial cells in the injured nerve, dorsal root ganglia and spinal cord results in the release of both pro- and anti-inflammatory cytokines, as well as algesic and analgesic mediators, the balance of which determines whether pain chronicity is established. This review will critically examine the role of the immune system in modulating chronic pain in animal models of nervous system injury, and highlight the possible therapeutic opportunities to intervene in the development and maintenance of neuropathic pain. Copyright © 2010 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Asian Spine J
                Asian Spine J
                ASJ
                Asian Spine Journal
                Korean Society of Spine Surgery
                1976-1902
                1976-7846
                December 2017
                07 December 2017
                : 11
                : 6
                : 917-927
                Affiliations
                [1 ]Department of Orthopedic Surgery , Inje University Ilsan Paik Hospital, Goyang, Korea.
                [2 ]Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [3 ]Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [4 ]Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
                [5 ]Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea.
                [6 ]Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea.
                [7 ]Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea.
                [8 ]Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
                [9 ]Department of Orthopedic Surgery, Gachon Universtiy Gil Medical Center, Incheon, Korea.
                [10 ]Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
                [11 ]Department of Orthopedic Surgery, Kyung Hee University Hospital, Seoul, Korea.
                [12 ]Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea.
                [13 ]Department of Orthopedic Surgery, Pusan National University Hospital, Busan, Korea.
                [14 ]Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea.
                [15 ]Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
                [16 ]Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea.
                [17 ]Department of Neurosurgery, Kangbuk Samsung Hospital, Seoul, Korea.
                [18 ]Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
                [19 ]Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea.
                [20 ]Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea.
                [21 ]Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea.
                [22 ]Department of Neurosurgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
                [23 ]Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
                [24 ]Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea.
                [25 ]Department of Neurosurgery, Pusan National University Hospital, Busan, Korea.
                [26 ]Department of Neurosurgery, Inje University Sanggye Paik Hospital, Seoul, Korea.
                [27 ]Department of Neurosurgery, Sun Medical Center, Daejeon, Korea.
                [28 ]Outcomes Research/Real World Data, Corporate Affairs & Health and Value, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea.
                [29 ]Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.
                Author notes
                Co-Corresponding author: Chong-Suh Lee. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu Seoul 06351, Korea. Tel: +82-2-3410-3503, FAX: +82-2-3410-0061, csl3503@ 123456skku.edu
                Co-Corresponding author: Keun-Su Kim. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University college of medicine, 211 Eonju-ro, Gangnam-gu, Seoul, Seoul 06273, Korea. Tel: +82-2-2019-4602, FAX: +82-2-3461-9229, SPINEKKS@ 123456yuhs.ac
                Article
                10.4184/asj.2017.11.6.917
                5738313
                Copyright © 2017 by Korean Society of Spine Surgery

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funding
                Funded by: Pfizer Pharmaceuticals Korea Ltd;
                Categories
                Clinical Study

                Orthopedics

                quality of life, prevalence, neuralgia, chronic low back pain

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