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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 references25

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          The evaluation of neuropathic components in low back pain.

          Ralf Baron, Rainer Freynhagen (2009)
          Chronic low back pain is highly prevalent in Western societies. Large epidemiological studies show that 20% to 35% of patients with back pain suffer from a neuropathic pain component. Presently, chronic lumbar radicular pain is the most common neuropathic pain syndrome. The pathophysiology of back pain is complex and nociceptive, and neuropathic pain-generating mechanisms are thought to be involved, which established the term mixed pain syndrome. Neuropathic pain may be caused by lesions of nociceptive sprouts within the degenerated disc (local neuropathic), mechanical compression of the nerve root (mechanical neuropathic root pain), or by action of inflammatory mediators (inflammatory neuropathic root pain) originating from the degenerative disc even without any mechanical compression. Its diagnosis and management remain an enigma, mainly because there is no gold standard for either. Accuracy of diagnostic tests used to identify the source of back pain and their usefulness in clinical practice, particularly for guiding treatment selection, is unclear. In connection with the specific instance of back pain (one of the single most costly disorders in many industrialized nations), neuropathic pain components are a significant cost factor.
          Article 0 comments Cited 84 times – based on 0 reviews     Review now
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            Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey.

            Ellen Dukes, Gale Harding, Michael Cleary … (2005)
            Persons aged >65 years with pain caused by postherpetic neuralgia (PHN) were recruited via advertisements in 24 US newspapers and were mailed a questionnaire that addressed pain intensity (average, worst, least, current), pain interference (with general activity, mood, relations with other people, sleep, enjoyment of life), and health-related quality of life (using the EuroQoL health measure [EQ-5D] and a global rating scale). Respondents also were asked about their use of medication for shingles pain. A total of 385 persons completed the survey; 61% were >75 years of age. Mean (+/-standard deviation) duration of PHN was 3.3 (+/-4.0) years. Only about one half had taken prescription medication for shingles pain during the prior week; dosages were typically low. Mean average, worst, least, and current pain caused by shingles (0- to 10-point scale) was 4.6 (+/-2.1), 6.0 (+/-2.4), 2.9 (+/-2.3), and 4.0 (+/-2.7), respectively. Mean pain interference with general activity, mood, relations with other people, sleep, and enjoyment of life (0- to 10-point scale) was 3.7 (+/-3.1), 4.3 (+/-2.9), 3.0 (+/-2.8), 3.8 (+/-2.9), and 4.5 (+/-3.1), respectively. The mean EQ-5D health index score was 0.61; respondents rated their overall health as 65.7 (+/-21.1) on a 100-point scale. PHN causes substantial pain, dysfunction, and poor health-related quality of life in older persons, many of whom might be suboptimally treated. Many older persons (age >65 years) with PHN experience longstanding, severe, and debilitating pain and poor health-related quality of life; levels of dissatisfaction with treatment are high. Our study highlights the need for improved management of this disease.
            Article 0 comments Cited 63 times – based on 0 reviews     Review now
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              The neuropathic components of chronic low back pain: a prospective multicenter study using the DN4 Questionnaire.

              Nadine Attal, Didier Bouhassira, Serge Perrot … (2011)
              The present study investigated the neuropathic components of chronic low back pain (LBP) in patients with and without lower limb pain using the DN4 questionnaire and confirmed its psychometric properties. Patients (n = 132) from 11 French multidisciplinary pain or rheumatology centers were classified by a first investigator into 4 groups derived from the Quebec Task Force Classification of Spinal Disorders (QTFSD): group 1 (pain restricted to the lumbar area); group 2 (pain radiating proximally); group 3 (pain radiating below the knee without neurologic signs); and group 4 (pain radiating towards the foot in a dermatomal distribution, with neurological signs, corresponding to typical radiculopathy). A second investigator applied the DN4 questionnaire to the lower limb (groups 2 to 4) and lower back. A comparison of groups 1 and 4 confirmed the psychometric properties of DN4 (sensitivity 80%; specificity 92%, for a cutoff of 4/10, similar to other neuropathic conditions). In the lower limb, the proportion of patients with neuropathic pain (NP) was related to the distality of pain radiation (15, 39, and 80% in groups 2, 3 and 4, respectively; P < .0001). In the lower back, the proportion of patients with NP was higher for patients with typical radicular pain compared with the other groups (P = .006). Thus, typical radiculopathy has similar characteristics as other neuropathic conditions and is confirmed as the commonest neuropathic syndrome in LBP patients. The observation that neuropathic and nociceptive components of LBP vary in the back and lower limb probably accounts for the discrepancies of reported prevalence rates of NP in LBP. As this study was essentially based on a questionnaire, future studies combining standard clinical sensory testing, specific questionnaires, and more objective assessment of the sensory lesion are now required to further investigate the neuropathic component of chronic LBP. This study confirms the psychometric properties of the DN4 questionnaire to assess neuropathic pain in patients with low back pain. Neuropathic mechanisms largely contribute to pain in the lower limb as compared to the back, but neuropathic pain is not restricted to typical radiculopathy. This may have significant implications for the choice of treatment strategy in these patients. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian Spine J
                Journal ID (iso-abbrev): Asian Spine J
                Journal ID (publisher-id): ASJ
                Title: Asian Spine Journal
                Publisher: Korean Society of Spine Surgery
                ISSN (Print): 1976-1902
                ISSN (Electronic): 1976-7846
                Publication date (Print): December 2017
                Publication date (Electronic): 07 December 2017
                Volume: 11
                Issue: 6
                Pages: 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
                DOI: 10.4184/asj.2017.11.6.917
                PMC ID: 5738313
                SO-VID: 8bc0f108-5f80-4762-a90b-2a1e473e6508
                Copyright © Copyright © 2017 by Korean Society of Spine Surgery
                License:

                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.

                History
                Date received : 06 April 2017
                Date revision received : 04 August 2017
                Date accepted : 08 August 2017
                Funding
                Funded by: Pfizer Pharmaceuticals Korea Ltd;
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Orthopedics
                Keywords: chronic low back pain,neuralgia,prevalence,quality of life
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: chronic low back pain, neuralgia, prevalence, quality of life

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