Assessment of the neuropathic component in a chronic low back pain syndrome

Zoran Vukojević; Aleksandra Dominović Kovačević; Stojan Perić; Ivo Božović; Sanja Grgić; Ivana Basta; Dragana Lavrnić

doi:10.2298/VSP181002069V

Zoran Vukojević University Clinical Center of the Republic of Srpska, Clinic of Neurology, Banja Luka, Republic of Srpska
Aleksandra Dominović Kovačević University Clinical Center of the Republic of Srpska, Clinic of Neurology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Stojan Perić Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia
Ivo Božović Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia
Sanja Grgić University Clinical Center of the Republic of Srpska, Clinic of Neurology, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
Ivana Basta Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia
Dragana Lavrnić Clinical Center of Serbia, Neurology Clinic, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP181002069V

Keywords: anxiety;, back pain;, depression;, neuralgia;, quality of life

Abstract

Background/Aim. Chronic low back pain syndrome (CLBPS) is the most common cause of functional disability and loss of working ability in developed countries. Some research shows that neuropathic pain (NP) is present in almost 50% of patients with CLPBS. The aim of this study was to determine the characteristics of NP and its impact on quality of life (QoL) in patients with CLBPS. Methods. Patients were tested using three questionnaires for NP: Pain Detect Questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4 questions. Thirty-two patients diagnosed with NP based on current clinical criteria and with positive results for NP on all three NP questionnaires formed an experimental group. A control group consisted of 32 patients with CLBPS who did not fulfill clinical criteria for NP and were negative for NP on all three questionnaires. Hamilton depression and anxiety rating scales (Ham-D and Ham-A, respectively) and Short Form (SF)-36 questionnaire were also applied. Results. According to magnetic resonance imaging (MRI), disc herniation was typically detected in the experimental group, while degenerative changes were commonly found in the control group. Patients from the experimental group had significantly greater intensity of pain, pain radiation in the legs, and the pain was usually presented as episodes of sudden attacks with mild pain between them. The most distinctive features of NP were allodynia, electric shock sensation, and hypoesthesia to prick. Patients from the experimental group also had significantly higher depression and anxiety scores, as well as worse QoL compared to the control group, especially in mental domains. Predictors of worse QoL in the patients with CLBPS were a higher level of anxiety and depression. Conclusion. The presence of allodynia, electric shock-like sensations, and hypoesthesia to prick in patients with CLBPS suggest NP. CLBPS patients with NP had worse scores in mental domains of QoL compared to CLPBS patients without NP.

References

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15(Suppl 2): S192–300.

Freburger J, Holmes G, Agans R, Jackman A, Darter J, Wallace A, et al. The rising prevalence of chronic low back pain. Arch In-tern Med 2009; 169(3): 251‒8.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380(9859): 2163–96.

Baron R, Binder A, Attal N, Casale R, Dickenson AH, Treede RD. Neuropathic low back pain in clinical practice. Eur J Pain 2016; 20(6): 861–73.

Freynhagen R, Baron R. The evaluation of neuropathic compo-nents in low back pain. Curr Pain Headache Rep 2009; 13(3): 185–90.

Schmidt CO, Schweikert B, Wenig CM, Schmidt U, Gockel U, Freynhagen R, et al. Modelling the prevalence and cost of back pain with neuropathic components in the general population. Eur J Pain 2009; 13(10): 1030–5.

Haanpää M, Attal N, Backonja M, Baron R, Bennet M, Bouhassira D, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011; 152(1): 14‒27.

Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic compo-nents in patients with back pain. Curr Med Res Opin 2006; 22(10): 1911–20.

Bennet MI. The LANSS pain scale: the Leeds assessment af neuropathic symptoms and signs. Pain 2001; 92(1‒2): 147‒57.

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114(1‒2): 29–36.

Kimura J. Electrodiagnosis in Diseases of nerve and muscle: Principles and Practice. Oxford: Oxford University Press; 2001.

Hamilton M. Development of a rating scale for primary depres-sive illness. Br J Soc Clin Psychol 1967; 6(4): 278‒96.

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–5.

SF-36 Health Survey (Original version). Language Recalls. Available from: http://www.qualitymetric.com [accessed 2010April 04].

Mehra M, Hill K, Nicholl D, Schadrack J. The burden of chronic low back pain with and without a neuropathic component: a healthcare resource use and cost analysis. J Med Econ 2012; 15(2): 245‒52.

Adamson J, Hunt K, Azareth I. The influence of socio-demographic characteristics on consultation for back pain- a review of the literature. Fam Pract 2011; 28(2): 163–71.

Attal N, Perrot S, Fermanian J, Bouhassira D. The neuropathic components of chronic low back pain: A prospective multi-center study using the DN4 questionnaire. J Pain 2011; 12(10): 1080–7.

Smart KM, Blake C, Staines A, Doody C. Self-reported pain se-verity, quality of life, disability, anxiety and depression in pa-tients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (+/-leg) pain. Man Ther 2012; 17(2): 119‒25.

Beith ID, Kemp A, Kenyon J, Prout M, Chestnut TJ. Identifying neuropathic back and leg pain: A cross-sectional study. Pain 2011; 152(7): 1511‒6.

Hamdan A, Luna JD, Del Pozo E, Galvez R. Diagnostic accura-cy of two questionnaires for the detection of neuropathic pain in the Spanish population. Eur J Pain 2014; 18(1): 101‒9.

Unal-Cevik I, Sarioglu-Ay S, Deniz Evcik D. Comparison of the DN4 and LANSS Questionnaires in the Assessment of Neu-ropathic Pain: Validity and Reliability of the Turkish Version of DN4. J Pain 2010; 11(11): 1129‒35.

Bisaga W, Dorazil M, Dobrogowski J, Wordliczek J. A comparison of the usefulness of selected neuropathic pain scales in pa-tients with chronic pain syndromes: a short communication. Adv Pall Med 2010; 9(4): 117‒21.

Guclu O, Ozaner A, Senomarci O, Konkan R. The Relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain. Turk Neurosurg 2012, 22(6): 724‒31.

Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMS Musculoskelet Disord 2007; 8:1-6.

Bentsen S. Quality of life in chronic back pain patients treated with instrumented fusion. J Clin Nurs 2008; 17(15): 2061‒9.

Suarez-Almazor ME, Kendall C, Johnson JA, Skeith K, Vincent D. Use of health status measures in patients with low back pain in clinical settings. Comparison of specific, generic and prefer-ence-based instruments. Rheumatology (Oxford) 2000; 39(7): 783‒90.

Scholich S, Hallner D, Wittenberg R, Hasenbring M, Rusu A. The relationship betwween pain, disability, quality of life and cog-nitive-behavioural factors in chronic back pain. Disab Rehabil 2012; 34(23): 1993‒2000.

Morlion B. Chronic low back pain: pharmacological, interven-tional and surgical strategies. Nat Rev Neurol 2013; 9: 462–73.

Koleck M, Mazaux JM, Rascle N, Bruchon-Schweitzer M. Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospecitve study. E J Pain 2006; 10(1): 1‒11.

Lamé IE, Peters ML, Vlaeyen JW, Kleef M, Patijn J. Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. Eur J Pain 2005; 9(1): 15–24.

Hasenbring MI, Hallner D, Rusu AC. Fear-avoidance- and en-durancerelated responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ). Eur J Pain 2009; 13(6): 620–8.

Kovacs FM, Abraira V, Zamora J, Fernandez C. Spanish Back Pain Research Network. The transition from acute to sub-acute and chronic low back pain: a study based on determi-nants of quality of life and prediction of chronic disability. Spine (Phila Pa 1976) 2005; 30(15): 1786‒92.